Trachoma among children in community surveys from four African countries and implications of using school surveys for evaluating prevalence

Int Health. 2013 Dec;5(4):280-7. doi: 10.1093/inthealth/iht027. Epub 2013 Oct 30.

Abstract

Background: School surveys provide a convenient platform to obtain large child cohorts from multiple communities and are widely used as a proxy to determine community prevalence of neglected tropical diseases. The purpose of this study was to compare trachoma prevalence between preschool- and school-aged children and children who attend and do not attend school.

Methods: We analysed data from community-based trachoma surveys conducted from 2008-2011 in Ethiopia, Mali, Niger and Nigeria. The surveys utilised a cross-sectional, randomised cluster design. Individual-level data on school attendance was collected.

Results: Overall, 75 864 children aged 1-15 years from 2100 communities were included in the analysis. The prevalence of trachomatous inflammation follicular (TF) among these children in surveyed districts was 19.1% (95% CI 17.9-20.2%) in Ethiopia, 6.2% (95% CI 5.4-6.9%) in Niger, 4.6% (95% CI 4.2-4.9%) in Mali and 4.2% (95% CI 3.5-4.9%) in Nigeria. Controlling for age, sex and clustering, the OR of TF for school-attendees compared to non-attendees was 0.64 (95% CI 0.56-0.73) in Ethiopia, 0.67 (95% CI 0.56-0.80) in Mali, 1.03 (95% CI 0.81-1.16) in Niger and 1.06, (95% CI 0.65-1.73) in Nigeria.

Conclusion: Estimating the prevalence of trachoma through examination of only school-going children risks underestimating the true prevalence.

Keywords: Neglected tropical diseases; School attendance; Sub-Sahara Africa; Surveys; Trachoma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Africa / epidemiology
  • Child
  • Child, Preschool
  • Cluster Analysis
  • Cross-Sectional Studies
  • Ethiopia / epidemiology
  • Female
  • Health Surveys / methods*
  • Health Surveys / statistics & numerical data*
  • Humans
  • Infant
  • Male
  • Mali / epidemiology
  • Neglected Diseases / epidemiology*
  • Niger / epidemiology
  • Nigeria / epidemiology
  • Prevalence
  • Students / statistics & numerical data*
  • Trachoma / epidemiology*