埃塞俄比亚县级以下沙眼流行情况：确定何时停止大规模阿奇霉素分发。
Prevalence of trachoma at sub-district level in ethiopia: determining when to stop mass azithromycin distribution.
机构信息
The Carter Center, Atlanta, Georgia, United States of America; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
The Carter Center, Addis Ababa, Ethiopia.
出版信息
PLoS Negl Trop Dis. 2014 Mar 13;8(3):e2732. doi: 10.1371/journal.pntd.0002732. eCollection 2014 Mar.
BACKGROUND
To eliminate blinding trachoma, the World Health Organization emphasizes implementing the SAFE strategy, which includes annual mass drug administration (MDA) with azithromycin to the whole population of endemic districts. Prevalence surveys to assess impact at the district level are recommended after at least 3 years of intervention. The decision to stop MDA is based on a prevalence of trachomatous inflammation follicular (TF) among children aged 1-9 years below 5% at the sub-district level, as determined by an additional round of surveys limited within districts where TF prevalence is below 10%. We conducted impact surveys powered to estimate prevalence simultaneously at the sub-district and district in two zones of Amhara, Ethiopia to determine whether MDA could be stopped.
METHODOLOGY
Seventy-two separate population-based, sub-district surveys were conducted in 25 districts. In each survey all residents from 10 randomly selected clusters were screened for clinical signs of trachoma. Data were weighted according to selection probabilities and adjusted for correlation due to clustering.
PRINCIPAL FINDINGS
Overall, 89,735 residents were registered from 21,327 households of whom 72,452 people (80.7%) were examined. The prevalence of TF in children aged 1-9 years was below 5% in six sub-districts and two districts. Sub-district level prevalence of TF in children aged 1-9 years ranged from 0.9-76.9% and district-level from 0.9-67.0%. In only one district was the prevalence of trichiasis below 0.1%.
CONCLUSIONS/SIGNIFICANCE: The experience from these zones in Ethiopia demonstrates that impact assessments designed to give a prevalence estimate of TF at sub-district level are possible, although the scale of the work was challenging. Given the assessed district-level prevalence of TF, sub-district-level surveys would have been warranted in only five districts. Interpretation was not as simple as stopping MDA in sub-districts below 5% given programmatic challenges of exempting sub-districts from a highly regarded program and the proximity of hyper-endemic sub-districts.
背景
为消除盲目性沙眼，世界卫生组织强调实施 SAFE 策略，其中包括对流行地区的全体人群进行阿奇霉素年度大规模药物治疗 (MDA)。建议在干预至少 3 年后进行区级影响调查，以评估效果。停止 MDA 的决定是基于在亚区一级，年龄在 1-9 岁的儿童中沙眼滤泡性炎症 (TF)的患病率低于 5%，这是通过在 TF 患病率低于 10%的地区进行的额外一轮调查确定的。我们在埃塞俄比亚阿姆哈拉地区的两个区进行了影响调查，目的是在亚区和区一级同时估计患病率，以确定是否可以停止 MDA。
方法
在 25 个区进行了 72 项独立的基于人群的亚区调查。在每次调查中，所有来自 10 个随机选择的集群的居民都接受了沙眼临床体征的筛查。根据选择概率对数据进行加权，并根据聚类的相关性进行调整。
主要发现
总体而言，从 21327 户家庭登记了 89735 名居民，其中 72452 人（80.7%）接受了检查。1-9 岁儿童的 TF 患病率在六个亚区和两个区低于 5%。1-9 岁儿童的亚区 TF 患病率范围为 0.9-76.9%，区一级为 0.9-67.0%。只有一个区的倒睫患病率低于 0.1%。
结论/意义：来自埃塞俄比亚这些区的经验表明，尽管工作规模具有挑战性，但设计用于提供亚区 TF 患病率估计的影响评估是可行的。鉴于评估的区 TF 患病率，只有五个区需要进行亚区调查。鉴于免除一个备受推崇的项目的亚区所面临的计划挑战以及高度流行的亚区的接近程度，在低于 5%的亚区停止 MDA 的做法并不简单。
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