Prevalence of Trachoma in the Far North Region of Cameroon: Results of a Survey in 27 Health Districts

Abstract

Background

Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010–11.

Methodology

A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma.

Principal Findings

48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1–9 years, the overall prevalence of trachomatous inflammation–follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0–11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of ≥10%. The overall TT prevalence was 1.0% (95% CI: 0.9–1.1%). There were estimated 17193 (95% CI: 12576–25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03–0.07%) and visual impairment was 0.09% (95% CI: 0.07–0.13%).

Conclusions/Significance

The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind.

Author Summary

Trachoma is the leading infectious cause of blindness in the world, which is caused by repeated eye infections with the bacterium Chlamydia trachomatis. The global objective of trachoma control is to eliminate trachoma as a blinding disease worldwide by Year 2020, using the World Health Organization-endorsed SAFE strategy (Surgery to correct trichiasis, Antibiotics to treat infection, Facial cleanliness and Environmental improvement to interrupt transmission). In order to implement the control program, the knowledge of the disease distribution and prevalence in each district is essential. Disease mapping surveys were conducted in 27 health districts in the Far North region in Cameroon. Thirteen health districts have a prevalence of trachomatous inflammation–follicular ≥10% in children aged 1–9 years and qualify for district-level mass antibiotic treatment as well as intensive implementation of other components of SAFE. There are estimated to be 17193 trichiasis cases in the region, which need surgical operations to prevent from being blinded. The survey provided a foundation for the national program to plan and implement the SAFE strategy in the region.