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Prevalence and Associations of Active Trachoma Among Rural Preschool Children in Wadla District, Northern Ethiopia

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Prevalence and Associations of Active Trachoma Among Rural Preschool Children in Wadla District, Northern Ethiopia Prevalence and associations of active trachoma among rural preschool children in Wadla district, northern Ethiopia Mesn Wudu Kassaw ( [email protected] ) Woldia University https://orcid.org/0000-0002-6327-7723 Ayele Mamo Abebe Debre Birhan Health Science College Kirubel Dagnaw Tegegne Wollo University Mikiyas Amare Getu Woldia University Woldemichael Tadesse Bihonegn Samara university Research article Keywords: Active Trachoma, Factors, Environmental Components, Villages, Water Supply. Posted Date: February 17th, 2020 DOI: https://doi.org/10.21203/rs.2.14562/v3 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published on August 26th, 2020. See the published version at https://doi.org/10.1186/s12886-020-01585-9. Page 1/20 Abstract BackgroundTrachoma is a neglected eye problem and an important cause of preventable corneal blindness. In endemic areas, initial infection can occur in early childhood, and following recurrent episodes of infection, it progresses to scarring and blindness. In past decades, trachoma disappeared from developed countries through enhancements of hygiene and sanitation but the disease is still a problem in developing countries. In Ethiopia, data indicate that Amhara is the region with the highest prevalence of active trachome. The aim of this study was to asse{Birlie, 2016 #48}ss prevalence and association of active trachoma among rural preschool children in Wadla district, north Wollo zone, Amhara. Methods: A total of 596 children aged 1–5 years living in 30 of Wadla’s 150 rural villages were screened for signs of active trachoma using a cluster sampling technique. Following pre-testing of the survey instrument in a different district, questions about socio-demographic status were asked of heads of households by health informatics professionals. Integrated eye care workers, previously trained to undertake trachoma screening over one month, performed eye examination. Logistic regression was used to look for associations of active trachoma. Results: The prevalence of active trachoma among rural pre-school age children in Wadla district was 22%. Low economic status (adjusted odds ratio [AOR] 3.8 (95% CI 1.3–11.4), being 37– 48 months old (4.2;1.5–12.0), living in a house with thatched roof (4.4;1.4–13.6), presence of ies in the home (4.6;2.1– 9.9), once-weekly face-washing frequency (8.6;2.5–29.3), having a face that had not been washed for longer than a week (10.6;2.9–37.7), and not using soap when washing hands (4.5;1.8–11.3) were associated with active trachoma Conclusion: The prevalence of active trachoma among rural pre-school children was high and it is still a major public health problem in Wadla. Thus, the woreda health oce should create awareness for Wadla woreda communities. Introduction Trachoma is a neglected eye problem and an important cause of preventable corneal blindness (1, 2). It categorize in to activet rachoma and cicatricial trachoma (2-4). In endemic areas, initial infection with ocular strains of Chlamydia trachomatis often occurs in early childhood with multiple infections, and the disease may progresses to scarring, trachomatous trichiasis and blindness (5, 6,7). Trachoma is usually a disease of poverty and poor hygiene (8). The infection is primarily found in children (5), with late stage disease more frequently seen in adult women than adult men, probably because of that women’s greater time spent in proximity to children. Preschool children hold the main pool of ocular C. trachomatis infection (9, 10). Although trachoma affects entire families and communities (11), active trachoma is more prevalent in children. In hyper endemic areas, active trachoma can be an extremely common Page 2/20 problem in preschool children, with a prevalence estimates of 60-90%, particularly in areas with extreme poverty, poor water supply, and poor access to sanitation (12). Ocular C. trachomatisis believed to be transmitted through hand-to-hand contact, sharing of towels, fomites, pillows, and eye-seeking ies (13). Globally, in 2019, an estimated 2.5 million people worldwide had trachomatous trichiasis, needing surgery (S) to prevent ongoing visual impairment. Some 142 million people lived in districts in which the prevalence of active trachoma met WHO-dened criteria for intervention with antibiotics (A) and interventions to promote facial cleanliness (F) and improve the environment (E), in order to prevent future trichiasis. Ethiopia is the most affected country: more than half of the 142 million people needing the A, F and E components of the “SAFE strategy” in 2019 lived here (14). With in Ethiopia, Amhara has the highest trachoma burden (15). Because prevalence and associations of active trachoma vary from setting to setting, and studying these things should help to tailor local control approaches, we undertook investigations in Wadla district, North Wollo zone, Amhara after 5 successive years of antibiotic mass drug administration to re-estimate prevalence of active trachoma and examine its local associations. Methods Study design, period and setting A community based cross-sectional study design was used. Fieldwork was undertaken from March 11, 2017 to April 26, 2107. The estimated population of Wadla district was 128,170 with 64,574 males and 63,596 females. There were 28,414 households in this district with an average of 4.51 persons per house. The district had 1 general hospital, 7 health centers, and 20 health posts. Population The sampling frame was children aged 1–5 years and their mothers in 150 rural villages of Wadla district. The study units were rural households that had preschool-age children. Sample size determination We estimated the required sample size using the single population proportion formula.We assumed, based on previous surveys, an observed prevalence of active trachoma (12.1%) (16), which we wished to estimate with 95% condence within ±5%. We used a design effect of 1.5, and allowed for 10% non- response rate. Then, the sample calculated as follow See formula 1 in the supplementary les. Where Z is the 95% CI, d is marigion of error, p is the observed prevalence of active trachoma, and q is the observed trachoma free prevalence, and n is the required sample size. n = (1.96)2 (0.121 × 0.879), Page 3/20 (0.05)2 n = 3.8416 ×0.106359 = 163.435 ≈ 163 (0.0025) After multiplying by the design effect of 1.5 and incorporating a 10% non-response rate, we estimated that (163 ×1.5), 244.5+24.45=268.9 ≈ 269 children needed to be framed in selected households. Sampling technique and procedure A multistage cluster sampling technique was applied. Wadla district had 20 Kebeles (sub-districts) with 247 villages. Twelve of the kebeles were rural, whereas eight of the kebeles were urban. This meant that 150 of the 247 villages were rural.We used simple random sampling to select 30 villages. There were 967 households in the selected 30 villages, but only 499 of those households had preschool children. Those 499 households were visited. Heads of households were interviewed for socio-demographic and economic information, plus housing and environmental conditions, and all children aged between 1 and 5 years who had been resident in the district for at least six months were invited to be examined. Graders used the WHO simplied trachoma grading scheme to grade signs of trachoma (17) (Figure1). Denitions Clean face: A child free of eye discharges, nose discharges and ies on the face at the time of examination Preschool: Children aged greater than and equal to 1 year and less than or equal to ve years Village: A grouping of homes that contained at least 30 households that organized as one peasant association Active trachoma: Preschool children who had at least one of the two signs of active trachoma in the WHO simplied trachoma grading scheme (TF or TI) in eye (4, 18, 19). Trachomatous inammation follicular (TF): Five or more follicles each having a diameter of at least 0.5mm in the central part of the upper tarsal conjunctiva(4, 18, 19). Trachomatous inammation—intense (TI): a pronounced inammatory thickening of the upper tarsal conjunctiva that obscures more than half of the normal deep tarsal blood vessels (4, 18, 19). Trachomatous scarring (TS): easily visible scarring in the upper tarsal conjunctiva (4, 18, 19) Trachomatous trichiasis (TT): at least one eyelash rubs on the eyeball, or evidence of removal of inturned eyelashes in the two weeks before examination (4, 18, 19). Page 4/20 Corneal opacity (CO): easily visible corneal opacity over the pupil (2, 6, 20) Exclusion and Inclusion Criteria All children in the appropriate age range who had lived in the district for at least 6 months, who were resident in selected villages and available at the time of the study were invited to be included. Children who were seriously ill or for whom informed consent for participationwas withheld by parents or guardians were excluded Data collection tools and procedures Face to face interviews, observation using a checklist, and clinical eye examination were used. Socio- demographic status, environmental, and housing conditions were collected by experienced health informatics professionals using structured interview questions, which were prepared following a literature review (21, 22). All questionaries on socio-demographic status, housing, and environmental condition, observation checklist, and eye examination tools were pretested, and validated before data collection in Kosomender, Meket district, a district bordering Wadla to the north. A household wealth index was developed using composite indicators for rural residents’assets: livestock ownership, size of agricultural land and quantity of crop production. Two integrated eye care workers performed eye examination: Those integrated eye care workers are ophthalmic nurses, who had been trained for one month for the purpose of national trachoma survey by the Carter Center-Ethiopia.
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