Prevalence of Ocular Chlamydia trachomatis Infection in Amhara Region, Ethiopia, after 8 Years of Trachoma Control Interventions

• Type of Material: Article
• Authors: Scott Nash, Emory University; Ambahun Chernet, Trachoma Control Program, The Carter Center, Ethiopia; Paul Weiss, Emory University; Andrew W Nute, Trachoma Control Program, The Carter Center, Atlanta; Mulat Zerihun, Trachoma Control Program, The Carter Center, Ethiopia; Eshetu Sata, Trachoma Control Program, The Carter Center, Ethiopia; Demelash Gessese, Trachoma Control Program, The Carter Center, Ethiopia; Kimberly A Jensen, Trachoma Control Program, The Carter Center, Atlanta; Zebene Ayele, Trachoma Control Program, The Carter Center, Ethiopia; Berhanu Melak, Trachoma Control Program, The Carter Center, Ethiopia; Taye Zeru, Amhara Public Health Institute, Bahir, Dar, Ethiopia; Abdulkerim Mengistu, Amhara Regional Health Bureau, Bahir Dar, Ethiopia; Adisu Abebe, Amhara Regional Health Bureau, Bahir Dar, Ethiopia; Fikre Seife, Ministry of Health, Addis Ababa, Ethiopia; Zerihun Tadesse, Trachoma Control Program, The Carter Center, Ethiopia; Elizabeth Callahan, Emory University
• Language: English
• Date: 2023-02-01
• Publisher: American Society of Tropical Medicine and Hygiene
• Publication Version: Final Published Version
• Copyright Statement: © The author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4269/ajtmh.22-0535
• Title of Journal or Parent Work: AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE
• Volume: 108
• Issue: 2
• Start Page: 261
• End Page: 267
• Grant/Funding Information: We received no external funding for this work. This was a routine monitoring activity in a trachoma program technically and financially assisted by The Carter Center in collaboration with the Amhara Regional Health Bureau and carried out by program personnel.
• Keywords: Trachoma Control Interventions; Ethiopia
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Although trachoma mass drug administration (MDA) programs target ocular Chlamydia trachomatis, the global trachoma control program does not monitor infection as a measure of impact but instead relies on monitoring clinical indicators. This study aimed to monitor the prevalence of ocular C. trachomatis among a population-based sample of children ages 1–5 years throughout Amhara, Ethiopia, a region that has received approximately 8 years of annual MDA as part of trachoma control. Between 2014 and 2021, trachoma impact surveys and surveillance surveys were conducted in all 156 districts of Amhara using a multistage cluster randomized methodology. Certified graders assessed individuals ages ≥ 1 year for trachomatous inflammation-follicular (TF), and a random subset of children ages 1–5 years also provided a conjunctival swab. Polymerase chain reaction was used to test for C. trachomatis. A total of 28,410 conjunctival swabs were collected from children ages 1–5 years across Amhara. The regional C. trachomatis infection prevalence was 4.7% (95% uncertainty interval: 4.3–5.1%). Infection was detected in all 10 zones of the region and ranged from 0.2% in Awi Zone to 11.9% in Waghemra Zone. Infection was detected in 17 (26%) districts with a TF prevalence < 10% and in 7 (21%) districts with a TF prevalence < 5%. Through programmatic monitoring of C. trachomatis infection, this study demonstrated that considerable infection remained throughout Amhara despite approximately 8 years of trachoma interventions and that enhanced interventions such as more frequent than annual MDA will be needed if elimination thresholds are to be reached.