News & Publications

Trachoma Control Program - Articles By Carter Center Experts

 

19 October 2009
Trachoma and women: latrines in Ethiopia and surgery in Southern Sudan (PDF)
This case study by Paul Emerson and Lisa Rotondo was published in the June 2009 edition of Community Eye Health Journal 22(70): 24-25.
Trachoma is an infectious disease of the eye caused by the bacterium Chlamydia trachomatis. Bacteria can spread via an infected person's hands or clothing and may be carried by flies that have come into contact with discharge from the eyes or nose of an infected person.

 

1 September 2009
Effect of Mass Distribution of Azithromycin for Trachoma Control on Overall Mortality in Ethiopian Children
Published Sept. 2, 2009 in the Journal of the American Medical Association.
Travis C. Porco, PhD, MPH; Teshome Gebre, MBA; Berhan Ayele, MSc; Jenafir House, MPH; Jeremy Keenan, MD; Zhaoxia Zhou, BS; Kevin Cyrus Hong, BS; Nicole Stoller, MPH; Kathryn J. Ray, MA; Paul Emerson, PhD; Bruce D. Gaynor, MD; Thomas M. Lietman, MD. JAMA. 2009;302(9):962-968. Note: Subscription is required for full text version. 
Read the press release: Efforts to Control Blinding Trachoma Reduce Child Mortality in Ethiopia, JAMA Study Finds >>

 

1 July 2009
Atlas of Pediatrics in the Tropics: Trachoma Chapter (PDF)
Published in the June 2009 edition of  "American Academy of Pediatrics' Atlas of Pediatrics in the Tropics and Resource-limited Settings."
Edited by: Jonathan M. Spector, MD, MPH, FAAP and Timothy E. Gibson, MD, FAAP. Paul Emerson, Ph.D., director of the Carter Center's Trachoma Control Program, contributor.
The trachoma chapter is part of the AAP's take-along guide to more than 80 pediatric tropical diseases and conditions. © AAP. Reprinted with permission. ISBN 13: 978-1-58110-303-8. American Academy of Pediatrics.

 

7 April 2009
Mass Antibiotic Treatment Alone Does Not Eliminate Ocular Chlamydial Infection (PDF)
This article was published March 2009 in the PLoS Journal of Neglected Tropical Diseases and is reprinted with permission.
Emerson PM, Ngondi J (2009) Mass Antibiotic Treatment Alone Does Not Eliminate Ocular Chlamydial Infection. PLoS Negl Trop Dis 3(3): e394. doi:10.1371/journal.pntd.0000394.
There has been considerable debate as to whether mass treatment with antibiotics alone can eliminate trachoma. There is little doubt that the mass distribution of azithromycin for trachoma control is the most effective way of rapidly reducing ocular infection with C. trachomatis, and that mass distribution will probably have many population level collateral benefits beyond trachoma control. However, unless accompanied by effective facial cleanliness and environmental improvements, mass treatment alone will not result in eliminating trachoma in the most affected areas.

 

6 April 2009
Assessment of Herd Protection Against Trachoma due to Repeated Mass Antibiotic Distributions: A Cluster-Randomised Trial
This article was published in the March 28, 2009 edition of The Lancet. Online signup is required to read the full article.
The Lancet, Volume 373, Issue 9669, Pages 1111 - 1118, 28 March 2009.  Jenafir I House MPH, Berhan Ayele BSc, Travis C Porco PhD, Zhaoxia Zhou BA, Kevin C Hong BA , Teshome Gebre MSc, Kathryn J Ray MS, Jeremy D Keenan MD, Nicole E Stoller MPH, Prof John P Whitcher MD, Bruce D Gaynor MD, Paul M Emerson PhD, Thomas M Lietman MD.
Single-dose azithromycin is used to treat the bacterial strains of Chlamydia that cause trachoma, the leading infectious cause of blindness. A new study shows for the first time that treating children among communities in Ethiopia can lead to significant reductions of infection in older children and adults. Eliminating infection by targeting treatment to less than one third of the population could provide a realistic long-term strategy for trachoma programmes.

 

17 March 2009
What Will Happen If We Do Nothing To Control Trachoma: Health Expectancies for Blinding Trachoma in Southern Sudan (PDF)
This article was published in the March 2009 issue of PLoS Journal of Neglected Tropical Diseases and is reprinted with permission. 
PLoS Negl Trop Dis 3(3): e396. doi:10.1371/journal.pntd.0000396. Jeremiah M. Ngondi, Fiona E. Matthews, Mark H. Reacher, Jonathan King, Carol Brayne, Hebe Gouda, Paul M. Emerson. Uncontrolled trachoma is a leading cause of blindness. Current global trachoma burden summary measures are presented as disability adjusted life years but have limitations due to inconsistent methods and inadequate population based data on trachomatous low vision and blindness. We aimed to describe more completely the burden of blinding trachoma in Southern Sudan using health expectancies.

 

1 March 2009
The Excess Burden of Trachomatous Trichiasis in Women: A Systematic Review and Meta-analysis (PDF)
This article was published in the March 2009 edition of Transactions of the Royal Society of Tropical Medicine and Hygiene and reprinted with permission.
Elizabeth A. Cromwell, Paul Courtright, Jonathan D. King, Lisa A. Rotondo, Jeremiah Ngondi, Paul M. Emerson. doi:10.1016/j.trstmh.2009.03.012. It is widely accepted that women carry an increased burden of trachomatous trichiasis compared with men, but there is no systematic review of the available prevalence surveys in the peer-reviewed literature. A literature search was conducted to identify population-based trachoma prevalence surveys utilising the WHO simplified grading system that included data for trichiasis. There were statistically significant differences in odds of trichiasis by gender in 17 of 24 studies, all of which showed increased odds of trichiasis in women compared with men. These data confirm the perception that women have a greater burden of trichiasis, and this burden persists across all populations studied. Women must be specifically and deliberately targeted for trichiasis surgery if the aim of eliminating blindness from trachoma is to be achieved.

 

12 February 2009
Achieving Trachoma Control in Ghana after Implementing the SAFE Strategy (PDF)
This article was published in the February 2009 edition of Transactions of the Royal Society of Tropical Medicine and Hygiene and is reprinted with permission.
Daniel Yayemain, Jonathan D. King, Oscar Debrah, Paul M. Emerson, Agatha Aboe, Felix Ahorsu, Seth Wanye, Manfred Owusu Ansah, John O. Gyapong, Maria Hagan. doi:10.1016/j.trstmh.2009.02.007. The Ghana Health Service plans to eliminate blinding trachoma by 2010 and has implemented the SAFE strategy since 2001. The programme impact was assessed in all endemic districts. Active trachoma is no longer a public health problem in Ghana after successful implementation of the SAFE strategy. The programme should maintain health education, advocate for improved water and sanitation and focus on providing surgery. Surveillance activities are needed to ensure sustained control.

 

24 November 2008
Evaluation of Three Years of the SAFE Strategy for Trachoma Control in Five Districts of Ethiopia Hyperendemic for Trachoma (PDF)
This article was published in the November edition of Transactions of the Royal Society of Tropical Medicine and Hygiene and is reprinted with permission.
Jeremiah Ngondi, Teshome Gebre, Estifanos B. Shargie, Liknaw Adamu, Yeshewamebrat Ejigsemahu, Tesfaye Teferi, Mulat Zerihun, Berhan Ayele, Vicky Cevallos, Jonathan King, Paul M. Emerson. doi:10.1016/j.trstmh.2008.11.023 Trachoma surveys were conducted at baseline in five districts of Amhara National Regional State, Ethiopia (7478 participants in 1096 households) and at 3-year evaluation (5762 participants in 1117 households). Uptake of SAFE was assessed with programme monitoring data and interviews, and children (1—6 years) were swabbed for detection of ocular Chlamydia.

 

1 September 2008
The Burden of Trachoma in Ayod County of Southern Sudan (PDF)
Published Sept. 2008 in the PLoS Journal of Neglected Tropical Diseases.
Jonathan D. King, Jeremiah Ngondi, Gideon Gatpan, Steve Becknell, Paul M. Emerson
Citation: King JD, Ngondi J, Gatpan G, Lopidia B, Becknell S, et al. (2008) The Burden of Trachoma in Ayod County of Southern Sudan. PLoS Negl Trop Dis 2(9): e299. doi:10.1371/journal.pntd.0000299.
Read the press release: Sept. 24, 2008 - A Clearer Picture of Trachoma in Southern Sudan: Bacterial Eye Disease Devastates Ayod County >>

 

22 August 2008
Risk Factors for Trachomatous Trichiasis in Children: Cross-Sectional Household Surveys in Southern Sudan (PDF)
This article was published in the August edition of Transactions of the Royal Society of Tropical Medicine and Hygiene and is reprinted with permission.
Transactions of the Royal Society of Tropical Medicine and Hygiene (2009) 103, 305—314. Jeremiah Ngondi, Mark H. Reacher, Fiona E. Matthews, Carol Brayne, Gideon Gatpan, Steven Becknell, Lucia Kur, Jonathan King, Kelly Callahan, Paul M. Emerson. We have previously documented blinding trachoma to be a serious public health problem in Southern Sudan, with an unusually high prevalence of trachomatous trichiasis (TT) among children. While the associations of TT in children with TI in siblings and TT in adult relatives merit further investigation, there is an urgent need for trachoma prevention interventions and trichiasis surgery services that are tailored to cater for young children in Southern Sudan.

 

1 June 2008
Dracunculiasis, Onchocerciasis, Schistosomiasis, and Trachoma (PDF)
Annals of the New York Academy of Sciences, 1136: 45-52 (2008), Issue - Reducing the Impact of Poverty on Health and Human Development: Scientific Approaches,
Donald R. Hopkins, Frank O. Richards, Jr, Ernesto Ruiz-Tiben, Paul Emerson, P. Craig Withers, Jr. Published Online: 25 Jul 2008. The definitive version is available at www.wileyinterscience.com.

 

19 February 2008
Risk Factors for Active Trachoma in Children and Trichiasis in Adults: A Household survey in Amhara Regional State, Ethiopia (PDF)
Transactions of the Royal Society of Tropical Medicine and Hygiene (2008) 102, 432—438. © 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. Jeremiah Ngondia, Teshome Gebre, Estifanos B. Shargie, Patricia M. Graves, Yeshewamebrat Ejigsemahu, Tesfaye Teferi, Asrat Genet, Aryc W. Mosher, Tekola Endeshawc, Mulat Zerihun, Ayenew Messele, Frank O. Richards Jr., Paul M. Emerson.

 

22 October 2007
The Cochrane Library and Trachoma: An Overview of Reviews (PDF)
Evidence-Based Child Health: A Cochrane Review Journal; 2: 943–964, DOI: 10.1002/ebch.172. © 2007 John Wiley & Sons, Ltd. Elizabeth Sumamo, Paul Emerson, Krystal Harvey, and Matthew Burton. Objective: To summarize Cochrane reviews that assess the effect of SAFE strategy (surgery, antibiotics, face washing and environmental change) for trachoma in developing countries.

28 August 2007
BMC Ophthalmology (PDF)
BMC Ophthalmology; 7:12 doi:10.1186/1471-2415-7-12. © 2007 Ngondi et al; licensee BioMed Central Ltd. We investigated vision status associated with trachomatous trichiasis (TT) and explored age-sex patterns of low vision and blindness associated with trichiasis in Mankien district of southern Sudan where trachoma prevention and trichiasis surgery were absent.

1 July 2007
Prevalence of Risk Factors and Severity of Active Trachoma in Southern Sudan: An Ordinal Analysis (PDF)
Am. J. Trop. Med. Hyg., 77(1), 2007, pp. 126–132. Copyright © 2007 by The American Society of Tropical Medicine and Hygiene. Jeremiah Ngondi, Fiona Matthews, Mark Reacher, Alice Onsarigo, Ibrahim Matende, Samson Baba, Carol Brayne, James Zingeser, and Paul Emerson. We aimed to investigate prevalence of potential risk factors, and associations between risk factors and active trachoma in southern Sudan. Surveys were undertaken in ten sites and children aged 1–9 years examined for trachoma. Risk factors were assessed through interviews and observations. Using ordinal logistic regression, associations between severity of active trachoma and risk factors were explored.

1 June 2007
Characteristics of Latrine Promotion Participants and Non-participants; Inspection of Latrines; and Perceptions of Household Latrines in Northern Ghana (PDF)
Tropical Medicine and International Health; volume 12, no 6, pp 772–782, doi:10.1111/j.1365-3156.2007.01848.x. © 2007 Blackwell Publishing Ltd. Ann F. Rodgers, Lydia A. Ajono, John O. Gyapong, Maria Hagan, and Paul M. Emerson. objectives To examine characteristics of household heads in two districts of Northern Ghana who had or had not participated in latrine promotion programmes; to inspect latrines; and to explore perceptions of latrine ownership. 

1 December 2006
Blinding Trachoma in Postconflict Southern Sudan (PDF)
PLOS Medicine; Volume 3, Issue 12, e478.© 2006 Ngondi et al.  Trachoma is a leading cause of preventable blindness. Reports from eye surgery camps and anecdotal data indicated that blinding trachoma is a serious cause of visual impairment in Mankien payam (district) of southern Sudan. We conducted this study to estimate the prevalence of trachoma, estimate targets for interventions, and establish a baseline for monitoring and evaluation.

1 December 2006
Prevalence and Causes of Blindness and Low Vision in Southern Sudan (PDF)
PLOS Medicine; Volume 3, Issue 12, e477. Copyright: © 2006 Ngondi et al. Blindness and low vision are thought to be common in southern Sudan. However, the magnitude and geographical distribution are largely unknown. We aimed to estimate the prevalence of blindness and low vision, identify the main causes of blindness and low vision, and estimate targets for blindness prevention programs in Mankien payam (district), southern Sudan.

1 September 2006
Follow-up of a Low Cost Latrine Promotion Programme in One District of Amhara, Ethiopia: Characteristics of Early Adopters and Non-adopters (PDF)
Tropical Medicine and International Health; volume 11 no 9 pp 1406–1415, doi:10.1111/j.1365-3156.2006.01689.x. © 2006 Blackwell Publishing Ltd. Rosalynn O'Loughlin, Gashu Fentie, Brendan Flannery, and Paul M. Emerson. objectives: To verify reported construction of 22 385 household latrines in 2004, after community mobilization, as part of a trachoma control programme in one district of Amhara, Ethiopia, and to explore characteristics of early latrine adopters and non-adopters. 

 

11 Aug 2006
Trachoma Control: The Lancet Features Groundbreaking SAFE Strategy Study, Article
Effect of three years of SAFE (surgery, antibiotics, facial cleanliness, and environmental change) strategy for trachoma control in southern Sudan: a cross-sectional study.

 

1 Aug 2006
The SAFE Strategy for Trachoma Control: Using Operational Research for Policy, Planning, and Implementation
The following was published in the Bulletin of the World Health Organization, August 2006, Volume 84, Issue 8. By Paul M. Emerson, Matthew Burton, Anthony W. Solomon, Robin Bailey, and David Mabey.
Read the press release: Oct. 27, 2006 - Trachoma Study in Sudan Shows SAFE Strategy Works >>

 

1 December 2005
The Epidemiology of Trachoma in Eastern Equatoria and Upper Nile States, Southern Sudan (PDF)
Bulletin of the World Health Organization 2005;83:904-912. Jeremiah Ngondi, Alice Onsarigo, Liknaw Adamu, Ibrahim Matende, Samson Baba, Mark Reacher, Paul Emerson, and James Zingeser. Objective: Limited surveys and anecdotal data indicate that trachoma is endemic in the states of Eastern Equatoria and Upper Nile in southern Sudan. However, its magnitude and geographical distribution are largely unknown. We conducted surveys to ascertain the prevalence and geographical distribution of trachoma, and to identify targets for control interventions.

 

2 Feb 2005
Sight for Sore Eyes: Natural History Magazine Features Trachoma Essay (PDF)
Reprint (with permission) from Natural History magazine, 12/04-1/05. Written by Dr. James A. Zingeser, former technical director, Carter Center Trachoma Control Program.