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      Prevalence of Trachoma in Kogi State, Nigeria: Results of four Local Government Area-Level Surveys from the Global Trachoma Mapping Project

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          ABSTRACT

          Purpose : To determine the prevalence of trachoma in four Local Government Areas (LGAs) of Kogi State, Nigeria.

          Methods : In June 2014, we conducted population-based, cross-sectional surveys according to Global Trachoma Mapping Project (GTMP) protocols in selected LGAs of Kogi State. In each LGA, 25 clusters were selected with probability proportional to size. In each of these clusters, 25 households were enrolled for the survey. All residents of selected households aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation–follicular (TF) and trichiasis using the simplified trachoma grading scheme. Data on sources of household water and types of sanitation facilities were collected through questioning and direct observation.

          Results : The age-adjusted TF prevalence in 1–9-year-olds ranged from 0.4% (95% CI 0.1–0.8%) in Bassa to 1.0% (95% CI 0.3–1.9%) in Omala. Across all four LGAs, only one case of trichiasis was found; this individual was in Omala, giving that LGA a trichiasis prevalence in individuals aged ≥15 years of 0.02% (95% CI 0.00–0.07%). Between 77 and 88% of households had access to water for hygiene purposes, while only 10–30% had access to improved sanitation facilities.

          Conclusion : Trachoma is not a public health problem in any of the 4 LGAs surveyed. There is, however, the need to increase access to adequate water and sanitation services to contribute to the health and social and economic well-being of these communities.

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          Most cited references26

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          A simple system for the assessment of trachoma and its complications.

          A simple grading system for trachoma, based on the presence or absence of five selected "key" signs, has been developed. The method was tested in the field and showed good observer agreement, the most critical point being the identification of severe cases of the disease. It is expected that the system will facilitate the assessment of trachoma and its complications by non-specialist health personnel working at the community level.
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            The Global Trachoma Mapping Project: Methodology of a 34-Country Population-Based Study

            ABSTRACT Purpose: To complete the baseline trachoma map worldwide by conducting population-based surveys in an estimated 1238 suspected endemic districts of 34 countries. Methods: A series of national and sub-national projects owned, managed and staffed by ministries of health, conduct house-to-house cluster random sample surveys in evaluation units, which generally correspond to “health district” size: populations of 100,000–250,000 people. In each evaluation unit, we invite all residents aged 1 year and older from h households in each of c clusters to be examined for clinical signs of trachoma, where h is the number of households that can be seen by 1 team in 1 day, and the product h × c is calculated to facilitate recruitment of 1019 children aged 1–9 years. In addition to individual-level demographic and clinical data, household-level water, sanitation and hygiene data are entered into the purpose-built LINKS application on Android smartphones, transmitted to the Cloud, and cleaned, analyzed and ministry-of-health-approved via a secure web-based portal. The main outcome measures are the evaluation unit-level prevalence of follicular trachoma in children aged 1–9 years, prevalence of trachomatous trichiasis in adults aged 15 + years, percentage of households using safe methods for disposal of human feces, and percentage of households with proximate access to water for personal hygiene purposes. Results: In the first year of fieldwork, 347 field teams commenced work in 21 projects in 7 countries. Conclusion: With an approach that is innovative in design and scale, we aim to complete baseline mapping of trachoma throughout the world in 2015.
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              Polymorphisms in Chlamydia trachomatis tryptophan synthase genes differentiate between genital and ocular isolates.

              We previously reported that laboratory reference strains of Chlamydia trachomatis differing in infection organotropism correlated with inactivating mutations in the pathogen's tryptophan synthase (trpBA) genes. Here, we have applied functional genomics to extend this work and find that the paradigm established for reference serovars also applies to clinical isolates - specifically, all ocular trachoma isolates tested have inactivating mutations in the synthase, whereas all genital isolates encode a functional enzyme. Moreover, functional enzyme activity was directly correlated to IFN-gamma resistance through an indole rescue mechanism. Hence, a strong selective pressure exists for genital strains to maintain a functional synthase capable of using indole for tryptophan biosynthesis. The fact that ocular serovars (serovar B) isolated from the genital tract were found to possess a functional synthase provided further persuasive evidence of this association. These results argue that there is an important host-parasite relationship between chlamydial genital strains and the human host that determines organotropism of infection and the pathophysiology of disease. We speculate that this relationship involves the production of indole by components of the vaginal microbial flora, allowing chlamydiae to escape IFN-gamma-mediated eradication and thus establish persistent infection.
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                Author and article information

                Contributors
                On behalf of : for the Global Trachoma Mapping Project
                Journal
                Ophthalmic Epidemiol
                Ophthalmic Epidemiol
                IOPE
                iope20
                Ophthalmic Epidemiology
                Taylor & Francis
                0928-6586
                1744-5086
                2018
                31 December 2018
                : 25
                : Suppl 1 , 2017 Global Trachoma Mapping Project
                : 33-40
                Affiliations
                [a ]Department of Ophthalmology, Federal Medical Centre , Makurdi, Nigeria
                [b ]Department of Ophthalmology, University of Jos , Jos, Nigeria
                [c ]Sightsavers , Kaduna, Nigeria
                [d ]Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town , Cape Town, South Africa
                [e ]Department of Control of Neglected Tropical Diseases, World Health Organization , Geneva, Switzerland
                [f ]Department of Public Health, the Environment and Social Determinants of Health, World Health Organization , Geneva, Switzerland
                [g ]International Trachoma Initiative, Task Force for Global Health , Decatur, GA, USA
                [h ]Ophthalmology Unit, Surgery Department, Usmanu Danfodiyo University , Sokoto, Nigeria
                [i ]National Eye Centre , Kaduna, Nigeria
                [j ]Federal Ministry of Health , Abuja, Nigeria
                [k ]Ministry of Health , Lokoja, Kogi State, Nigeria
                [l ]Clinical Research Department, London School of Hygiene & Tropical Medicine , London, United Kingdom
                [m ]London Centre for Neglected Tropical Disease Research , London, United Kingdom
                Author notes
                CONTACT Joel Alada Joel.alada@ 123456gmail.com Federal Medical Centre , Makurdi, PMB 12245, Benue State, Nigeria
                [*]

                See Appendix.

                Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/IOPE.

                Article
                1409359
                10.1080/09286586.2017.1409359
                6444201
                30806551
                98fcdb27-0992-40ec-b276-9fdff17c6181
                © 2018 World Health Organization. Published with license by Taylor & Francis

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. In any use of this article, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.

                History
                : 14 August 2017
                : 30 October 2017
                : 19 November 2017
                Page count
                Figures: 2, Tables: 5, References: 42, Pages: 8
                Funding
                Funded by: United Kingdom‘s Department for International Development
                Award ID: DFID; ARIES: 203145
                Categories
                Article

                Ophthalmology & Optometry
                blindness,global trachoma mapping project,sanitation,trachoma,trichiasis,water supply

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