Trachoma Control Program - Articles by Carter Center Experts

May 13, 2021
The Population-based Prevalence of Trachomatous Scarring in a Trachoma Hyperendemic Setting: Results from 152 Impact Surveys in Amhara, Ethiopia
Published by BMC Ophthalmology.
Authors: Tigist Astale, Caleb D. Ebert, Andrew W. Nute, Mulat Zerihun, Demelash Gessese, Berhanu Melak, Eshetu Sata, Zebene Ayele, Gedefaw Ayenew, E. Kelly Callahan, Mahteme Haile, Taye Zeru, Zerihun Tadesse, and Scott D. Nash
Description: Trachomatous scarring (TS) results from repeated infection with the bacterium Chlamydia trachomatis. Pronounced scarring is an underlying cause of trachomatous trichiasis (TT) that can lead to blindness. Since the condition is irreversible, TS in adults has been considered a marker of past exposure to trachoma infection. The aim of this report was to estimate the population-based prevalence of TS within Amhara, Ethiopia, a region with a historically high burden of trachoma.

Dec. 14, 2020
Effect Of Repeated Epilation For Minor Trachomatous Trichiasis On Lash Burden, Phenotype, And Surgical Acceptance: A Cohort Study
Published by PLOS Neglected Tropical Diseases.
Authors: Esmael Habtamu, Tariku Wondie, Wubshet Gobezie, Zerihun Tadesse, Bizuayehu Gashaw, Abebaw Gebeyehu, Chrissy H. Roberts, E. Kelly Callahan, David Macleod, and Matthew J. Burton
Description: WHO endorsed the use of epilation as an alternative treatment to surgery for the management of both minor unoperated TT (UTT) and postoperative TT (PTT). However, some trachoma control programmes hesitated to implement epilation citing concerns that it would hamper TT surgical acceptance and result in larger numbers of and stiffer trichiatic eyelashes than the original TT lashes. We investigated the burden and phenotypes of post-epilation trichiatic eyelashes, and willingness to accept surgical management separately in unoperated and postoperative TT cases. 

April 20, 2020
Piloting a Trachomatous Trichiasis Patient Case-Searching Approach in Two Localities of Sudan
Published by Royal Society of Tropical Medicine and Hygiene.
Authors: Angelia M. Sanders, Maha Adam, Nabil Aziz, E. Kelly Callahan, Belgesa E. Elshafie.
Description: Surveys conducted in Sudan have shown that thousands of Sudanese people suffer from trachomatous trichiasis (TT), the advanced stage of the disease warranting sight-saving surgery. We piloted a systematic case-finding approach to identify people with TT. The piloted approach had a 75.2% success rate. It is an effective method that should be expanded to other areas that are known to be endemic for trachoma.

Nov. 1, 2019
Posterior Lamellar Versus Bilamellar Tarsal Rotation Surgery for Trachomatous Trichiasis: Long-Term Outcomes from a Randomised Controlled Trial
Published by The Lancet.
Authors: Esmael Habtamu, Tariku Wondie, Zerihun Tadesse, Bezawit Atinafu, Bizuayehu Gashaw, Abebaw Gebeyehu, E. Kelly Callahan, David Macleod, Matthew J. Burton.
Description: We re-examined the participants of a clinical trial four years after enrolment to identify which of the two most commonly used eyelid surgery procedures to treat the blinding stage of trachoma, trachomatous trichiasis (TT), the Posterior Lamellar Tarsal Rotation (PLTR) and Bilamellar Tarsal Rotation (BLTR), gives better results in the long-term.

Oct. 7, 2019
Pre-operative Trichiatic Eyelash Pattern Predicts Post-Operative Trachomatous Trichiasis
Published by PLOS Neglected Tropical Diseases.
Authors: Emily W. Gower, Beatriz Munoz, Saul Rajak, Esmael Habtamu, Sheila K. West, Shannath L. Merbs, Jennifer C. Harding, Wondu Alemayehu, E. Kelly Callahan, Paul M. Emerson, Teshome Gebre, Matthew J. Burton.
Description: This manuscript reports results of an analysis of four clinical trials that were conducted to evaluate best practices for trichiasis surgery. The analysis showed that regardless of type of surgery performed or the skill level of the surgeon who conducted the surgery, similar patterns emerge. The majority of people have good surgery outcomes. Individuals who had eyelashes touching their eye only centrally before surgery were less likely to develop poor outcomes than those who had eyelashes touching at the edges of their eyelids. The findings highlight the importance of making the surgical incision the entire length of the eyelid and paying special attention to how well the edges of the eyelid are rotated at the end of surgery.

April 15, 2018
Oral Doxycycline for the Prevention of Postoperative Trachomatous Trichiasis in Ethiopia: a Randomised, Double-Blind, Placebo-Controlled Trial
Published by The Lancet.
Authors: Esmael Habtamu, Tariku Wondie, Sintayehu Aweke, Zerihun Tadesse, Mulat Zerihun, Bizuayehu Gashaw, Chrissy H Roberts, Amir Bedri Kello, David C W Mabey, Saul N Rajak, E. Kelly Callahan, David Macleod, Helen A Weiss, Matthew J Burton.
Description: Blinding trachoma, trachomatous trichiasis, continues to be a major threat, post-surgical intervention. We investigated if oral doxycycline could reduce this risk among post-operative groups but found individuals receiving the drug did not have improved outcomes. Continued research and training efforts are necessary.

Aug. 22, 2017
Impact of Trichiasis Surgery on Daily Living: A Longitudinal Study in Ethiopia
Published by Wellcome Open Research.
Authors: Esmael Habtamu, Tariku Wondie, Sintayehu Aweke, Zerihun Tadesse, Mulat Zerihun, Berhanu Melak, Bizuayehu Gashaw, E. Kelly Callahan, Paul E. Emerson, Robin L. Bailey, David C.W. Mabey, Saul N. Rajak, Hannah Kuper, Sarah Polack, David Macleod, Helen A. Weiss, Matthew J. Burton.
Description: Among individuals with TT, we assessed the impact surgery has on productive and leisure activity participation. Independent of vision gains, surgery improved functional capabilities and decreased need for assistance to perform daily activities.

April 21, 2017
Predictors of Trachomatous Trichiasis Surgery Outcome
Published by Ophthalmology.
Authors: Esmael Habtamu, Tariku Wondie, Sintayehu Aweke, Zerihun Tadesse, Mulat Zerihun, Bizuayehu Gashaw, Guadie S. Wondimagegn, Hiwot D. Mengistie, Saul N. Rajak, E. Kelly Callahan, Helen A. Weiss, Matthew J. Burton.
Description: Nested within a larger randomized controlled trial of patients with TT undergoing surgery, we examined factors that may be associated with the three most common adverse surgery outcomes. Carrying important implications, our data indicate irregular incisions, asymmetric suture, and peripheral lash location are strong predictors for poor surgical outcomes.

March 13, 2017
Trachomatous Scar Ranking: A Novel Outcome for Trachoma Studies
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Angela Baldwin, Alexander M. Ryner, Zerihun Tadesse, Ayalew Shiferaw, E. Kelly Callahan, Dionna M. Fry, Zhaoxia Zhou, Thomas M. Lietman, Jeremy D. Keenan.
Description: The use of conjunctival photography permits an alternate method for assessing TS. In this report, we test a novel ranking system for assessing TS from conjunctival photographs that could be useful for comparative trachoma studies.

April 14, 2016
Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia
Published by PLOS Neglected Tropical Diseases.
Authors: Esmael Habtamu, Tariku Wondie, Sintayehu Aweke, Zerihun Tadesse, Mulat Zerihun, Aderajew Mohammed, Zebideru Zewudie, Kelly Callahan, Paul M. Emerson, Robin L. Bailey, David C. W. Mabey, Saul N. Rajak, Hannah Kuper, Sarah Polack, Helen A. Weiss, Matthew J. Burton.
Description: Trichiasis surgery may lead to improvements in Quality of Life; however, QoL outcomes seldom have been assessed long-term. This study provides crucial longitudinal data irrefutably linking surgery with improvements in overall health/well-being – in addition to the intervention’s well-documented success in reducing risk for blindness.

Jan. 13, 2016
Posterior Lamellar Versus Bilamellar Tarsal Rotation Surgery for Trachomatous Trichiasis in Ethiopia: A Randomised Controlled Trial
Published by The Lancet Global Health.
Authors: Esmael Habtamu, Tariku Wondie, Sintayehu Aweke, Zerihun Tadesse, Mulat Zerihun, Zebideru Zewudie, Amir Bedri Kello, Chrissy H Roberts, Paul M Emerson, Robin L Bailey, David CW Mabey, Saul N Rajak, Kelly Callahan, Helen A Weiss, Matthew J Burton.
Description: Eyelid surgery is done to correct trachomatous trichiasis to prevent blindness. However, recurrent trichiasis is frequent. Two procedures are recommended by WHO and are in routine practice: bilamellar tarsal rotation (BLTR) and posterior lamellar tarsal rotation (PLTR). This study was done to identify which procedure gives the better results.

Nov. 23, 2015
The Impact of Trachomatous Trichiasis on Quality of Life: A Case Control Study
Published by PLOS Neglected Tropical Diseases.
Authors: Esmael Habtamu, Tariku Wondie, Sintayehu Aweke, Zerihun Tadesse, Mulat Zerihun, Zebideru Zewudie, Wondimu Gebeyehu, Kelly Callahan, Paul M. Emerson, Hannah Kuper, Robin L. Bailey, David C. W. Mabey, Saul N. Rajak, Sarah Polack, Helen A. Weiss, Matthew J. Burton.
Description: Trachomatous trichiasis is thought to have a profound effect on quality of life, however, there is little research in this area. We measured vision and health-related quality of life in a case-control study in Amhara Region, Ethiopia.

May 13, 2015
Pathogenesis of Progressive Scarring Trachoma in Ethiopia and Tanzania and its Implications for Disease Control: Two Cohort Studies
Published by PLOS Neglected Tropical Diseases.
Authors: Matthew J. Burton, Saul N. Rajak, Victor H. Hu, Athumani Ramadhani, Esmael Habtamu, Patrick Massae, Zerihun Tadesse, Kelly Callahan, Paul M. Emerson, Peng T. Khaw, David Jeffries, David C. W. Mabey, Robin L. Bailey, Helen A. Weiss, Martin J. Holland.
Description: Trachoma causes blindness through a conjunctival scarring process initiated by ocular Chlamydia trachomatis infection; however, the rates, drivers, and pathophysiological determinants are poorly understood. We investigated progressive scarring and its relationship to conjunctival infection, inflammation, and transcript levels of cytokines and fibrogenic factors.

March 13, 2015
Epilation for Minor Trachomatous Trichiasis: Four-Year Results of a Randomised Controlled Trial
Published by PLOS Neglected Tropical Diseases.
Authors: Esmael Habtamu, Saul N. Rajak, Zerihun Tadesse, Tariku Wondie, Mulat Zerihun, Birhan Guadie, Teshome Gebre, Amir Bedri Kello, Kelly Callahan, David C. W. Mabey, Peng T. Khaw, Clare E. Gilbert, Helen A. Weiss, Paul M. Emerson, Matthew J. Burton.
Description: Trachomatous trichiasis (TT) needs to be managed to reduce the risk of vision loss. The long-term impact of epilation (a common traditional practice of repeated plucking of lashes touching the eye) in preventing visual impairment and corneal opacity from TT is unknown. We conducted a randomized controlled trial of epilation versus surgery for the management of minor TT (fewer than six lashes touching the eye) in Ethiopia. Here we report the four-year outcome and the effect on vision and corneal opacity.

Aug. 14, 2014
'A Living Death': A Qualitative Assessment of Quality of Life Among Women with Trichiasis in Rural Niger
Published by International Health.
Authors: Stephanie L. Palmer, Kate Winskell, Amy E. Patterson, Kadri Boubacar, Fatahou Ibrahim, Ibrahim Namata, Tahirou Oungoila, Mohamed Salissou Kané, Adamou Sabo Hassan, Aryc W. Mosher, Donald R. Hopkins, Paul M. Emerson.
Description: Prior to blindness, trachoma is thought to profoundly affect women's abilities to lead normal lives, but supporting evidence is lacking. To better understand the effects of trichiasis, we asked women to define quality of life, how trichiasis affects this idea, and their perceptions of eyelid surgery.

Aug. 22, 2013
The Outcome of Trachomatous Trichiasis Surgery in Ethiopia: Risk Factors for Recurrence
Published by PLOS Neglected Tropical Diseases.
Authors: Saul N. Rajak, Esmael Habtamu, Helen A. Weiss, Amir B. Kello, Bayeh Abera, Mulat Zerihun, Teshome Gebre, Clare E. Gilbert, Peng T. Khaw, Paul M. Emerson, Matthew J. Burton.
Description: Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practiced TT procedures in endemic settings.

Aug. 28, 2012
Why Do People Not Attend for Treatment for Trachomatous Trichiasis in Ethiopia? A Study of Barriers to Surgery
Published by PLOS Neglected Tropical Diseases.
Authors: Saul N. Rajak, Esmael Habtamu, Helen A. Weiss, Amir Bedri, Mulat Zerihun, Teshome Gebre, Clare E. Gilbert, Paul M. Emerson, Matthew J. Burton.
Description: Trachomatous trichiasis (TT) surgery is provided free or subsidized in most trachoma endemic settings. However, only 18–66% of TT patients attend for surgery. This study analyses barriers to attendance among TT patients in Ethiopia, the country with the highest prevalence of TT in the world.

Dec. 13, 2011
Surgery Versus Epilation for the Treatment of Minor Trichiasis in Ethiopia: A Randomised Controlled Noninferiority Trial
Published by PLOS Medicine.
Authors: Saul N. Rajak, Esmael Habtamu, Helen A. Weiss, Amir Bedri Kello, Teshome Gebre, Asrat Genet, Robin L. Bailey, David C. W. Mabey, Peng T. Khaw, Clare E. Gilbert, Paul M. Emerson, Matthew J.Burton.
Description: Trachomatous trichiasis can cause corneal damage and visual impairment. The World Health Organization recommends surgery for all cases. However, in many regions surgical provision is inadequate and patients frequently decline. Self-epilation is common and was associated with comparable outcomes to surgery in nonrandomized studies for minor trichiasis (<six lashes touching eye). This trial investigated whether epilation is noninferior to surgery for managing minor trichiasis.

Dec. 13, 2011
Absorbable Versus Silk Sutures for Surgical Treatment of Trachomatous Trichiasis in Ethiopia: A Randomized Controlled Trial
Published by PLOS Medicine.
Authors: Saul N. Rajak, Esmael Habtamu, Helen A. Weiss, Amir Bedri Kello, Teshome Gebre, Asrat Genet, Robin L. Bailey, David C. W. Mabey, Peng T. Khaw, Clare E. Gilbert, Paul M. Emerson, Matthew J.Burton.
Description: Trachoma causes blindness through an anatomical abnormality called trichiasis (lashes touching the eye). Trichiasis can recur after corrective surgery. We tested the hypothesis that using absorbable sutures instead of silk sutures might reduce the risk of recurrent disease among patients with major trichiasis in a randomized trial.

Oct. 11, 2010
Conjunctival Transcriptome in Scarring Trachoma
Published by Infection and Immunity.
Authors: Matthew J. Burton, Saul N. Rajak, Julien Bauer, Helen A. Weiss, Sonda B. Tolbert, Alice Shoo, Esmail Habtamu, Alphaxard Manjurano, Paul M. Emerson, David C. W. Mabey, Martin J. Holland, Robin L. Bailey.
Description: Trachoma is a poorly understood immunofibrogenic disease process, initiated by Chlamydia trachomatis. Differences in conjunctival gene expression profiles between Ethiopians with trachomatous trichiasis (with [TTI] or without [TT] inflammation) and controls (C) were investigated to identify relevant host responses.

April 10, 2009
The Excess Burden of Trachomatous Trichiasis in Women: A Systematic Review and Meta-Analysis
Published by Transactions of the Royal Society of Tropical Medicine and Hygiene.
Authors: Elizabeth A. Cromwell, Paul Courtright, Jonathan D. King, Lisa A. Rotondo, Jeremiah Ngondi, Paul M. Emerson.
Description: 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 utilizing 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.

Sept. 30, 2008
Risk Factors for Trachomatous Trichiasis in Children: Cross-Sectional Household Surveys in Southern Sudan
Published by Transactions of the Royal Society of Tropical Medicine and Hygiene.
Authors: Jeremiah Ngondi, Mark H. Reacher, Fiona E. Matthews, Carol Brayne, Gideon Gatpan, Steven Becknell, Lucia Kur, Jonathan King, Kelly Callahan, Paul M. Emerson.
Description: 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. We aimed to investigate risk factors for TT in children in Southern Sudan. 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.

Oct. 25, 2021
Population-based Prevalence of Ocular Chlamydia trachomatis Infection Among Infants in the Trachoma Endemic Amhara Region, Ethiopia
Published by The American Journal of Tropical Medicine and Hygiene.
Authors: Scott D. Nash, Ambahun Chernet, Tigist Astale, Eshetu Sata, Mulat Zerihun, Andrew W. Nute, Kimberly A. Jensen, Demelash Gessese, Zebene Ayele, Berhanu Melak, Mahteme Haile, Taye Zeru, Zerihun Tadesse, and E. Kelly Callahan
Description: Trachoma, caused by Chlamydia trachomatis, is the leading infectious cause of blindness. A key trachoma intervention is the mass distribution of azithromycin, which has been shown to be effective against C. trachomatis and to convey a mortality benefit in some settings, particularly among the youngest children. Despite azithromycin’s effectiveness, some countries are experiencing persistent trachoma (continually above elimination threshold) after >10 years of community-wide treatment. Under current guidelines infants ages <6 months do not receive azithromycin as part of trachoma control, and thus may both miss out on a potential mortality benefit and serve as a potential infection reservoir within districts experiencing persistent trachoma. The aim of this study was to determine the C. trachomatis infection prevalence and infectious load among infants ages 1-12 months in districts experiencing persistent levels of trachoma in Amhara, Ethiopia.

April 17, 2020
Frequency of Mass Azithromycin Distribution for Ocular Chlamydia in a Trachoma Endemic Region of Ethiopia: A Cluster Randomized Trial
Published by American Journal of Ophthalmology.
Authors: Thomas M. Lietman, Berhan Ayele, Teshome Gebre, Mulat Zerihun, Zerihun Tadesse, Paul M. Emerson, Scott D. Nash, Travis C. Porco, Jeremy D. Keenan, Catherine E. Oldenburg.
Description: Annual mass azithromycin distribution significantly reduces the prevalence of ocular Chlamydia trachomatis, the causative organism of trachoma. However, in some areas a decade or more of treatment has not controlled infection. Here, we compared multiple treatment arms from a community-randomized trial to evaluate whether increasing frequency of azithromycin distribution decreases prevalence in the short term.

June 6, 2019
Longer-Term Assessment of Azithromycin for Reducing Childhood Mortality in Africa
Published by New England Journal of Medicine.
Authors: Jeremy D. Keenan, Ahmed M. Arzika, Ramatou Maliki, Nameywa Boubacar, Sanoussi Elh Adamou, Maria Moussa Ali, Catherine Cook, Elodie Lebas, Ying Lin, Kathryn J. Ray, Kieran S. O’Brien, Thuy Doan, Catherine E. Oldenburg, E. Kelly Callahan, Paul M. Emerson, Travis C. Porco, Thomas M. Lietman.
Description: The MORDOR I trial (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) showed that in Niger, mass administration of azithromycin twice a year for 2 years resulted in 18% lower post neonatal childhood mortality than administration of placebo. Whether this benefit could increase with each administration or wane owing to antibiotic resistance was unknown. We found no evidence that the effect of mass administration of azithromycin on childhood mortality in Niger waned in the third year of treatment.

June 5, 2019
Linear Growth in Preschool Children Treated with Mass Azithromycin Distributions for Trachoma: A Cluster-Randomized Trial
Published by PLOS Neglected Tropical Diseases.
Authors: Jeremy D. Keenan, Sintayehu Gebresillasie, Nicole E. Stoller, Berhan A. Haile, Zerihun Tadesse, Sun Y. Cotter, Kathryn J. Ray, Kristen Aiemjoy, Travis C. Porco, E. Kelly Callahan, Paul M. Emerson, Thomas M. Lietman.
Description: Mass azithromycin distributions have been shown to reduce mortality among pre-school children in sub-Saharan Africa. It is unclear what mediates this mortality reduction, but one possibility is that antibiotics function as growth promoters for young children. In this study, we report the height and weight of children enrolled in a trial in Ethiopia in which communities were randomized either to twice annual mass azithromycin distributions for blinding trachoma or to no treatments.

Jan. 23, 2019
Population Coverage and Factors Associated with Participation Following a Mass Drug Administration of Azithromycin for Trachoma Elimination in Amhara, Ethiopia
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Caleb D. Ebert, Tigist Astale, Eshetu Sata, Mulat Zerihun, Andrew W. Nute, Aisha E. P. Stewart, Demelash Gessese, Gedefaw Ayenew, Zebene Ayele, Berhanu Melak, Melsew Chanyalew, Bizuayehu Gashaw, Zerihun Tadesse, E. Kelly Callahan, Samuel M. Jenness, Scott D. Nash.
Description: Mass drug administration (MDA) with azithromycin is a core component of the WHO-recommended strategy to eliminate trachoma as a public health problem, but low participation rates in MDA campaigns may undermine the effectiveness of this intervention. We explored factors associated with individual MDA participation at the individual, head of household and household levels in Amhara, Ethiopia.

Jan. 21, 2019
Self-Reported Side Effects following Mass Administration of Azithromycin to Eliminate Trachoma in Amhara, Ethiopia: Results from a Region-Wide Population-Based Survey
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Tigist Astale, Eshetu Sata, Mulat Zerihun, Andrew W. Nute, Aisha E. P. Stewart, Melsew Chanyalew, Berhanu Melak, Zebene Ayele, Demelash Gessese, Gedefaw Ayenew, Bizuayehu Gashaw, Zerihun Tadesse, E. Kelly Callahan, Scott D. Nash.
Description: After a round of mass drug administration in Amhara, Ethiopia, we conducted surveys to investigating type and prevalence of any side effects potentially associated with the azithromycin drug.

Sept. 28, 2018
Trachoma Prevalence Remains Below Threshold in Five Districts After Stopping Mass Drug Administration: Results of Five Surveillance Surveys Within a Hyperendemic Setting in Amhara, Ethiopia
Published by Transactions of the Royal Society of Tropical Medicine and Hygiene.
Authors: Scott D Nash, Aisha E. P. Stewart, Tigist Astale, Eshetu Sata, Mulat Zerihun, Demelash Gessese, Berhanu Melak, Gedefaw Ayenew, Zebene Ayele, Belay Bayissasse, Melsew Chanyalew, Zerihun Tadesse, E. Kelly Callahan.
Description: In five hyperendemic districts in Amhara, Ethiopia, trachoma prevalence was successfully reduced to rates that no longer warranted annual MDA. To determine if low prevalence levels are sustainable following MDA cessation, we assessed if prevalence rates reflected low or rebounded levels of trachoma two years after the intervention ended.

Aug. 14, 2018
Mass Azithromycin Distribution for Hyperendemic Trachoma Following a Cluster-Randomized Trial: A Continuation Study of Randomly Reassigned Subclusters (TANA II)
Published by PLOS Medicine.
Authors: Jeremy D. Keenan, Zerihun Tadesse, Sintayehu Gebresillasie, Ayalew Shiferaw, Mulat Zerihun, Paul M. Emerson, Kelly Callahan, Sun Y. Cotter, Nicole E. Stoller, Travis C. Porco, Catherine E. Oldenburg, Thomas M. Lietman.
Description: The World Health Organization recommends annual mass azithromycin administration in communities with at least 10% prevalence of trachomatous inflammation–follicular (TF) in children, with further treatment depending on reassessment after 3–5 years. However, the effect of stopping mass azithromycin distribution after multiple rounds of treatment is not well understood. Here, we report the results of a cluster-randomized trial where communities that had received 4 years of treatments were then randomized to continuation or discontinuation of treatment.

April 26, 2018
Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa
Published by New England Journal of Medicine.
Authors: J.D. Keenan, R.L. Bailey, S.K. West, A.M. Arzika, J. Hart, J. Weaver, K. Kalua, Z. Mrango, K.J. Ray, C. Cook, E. Lebas, K.S. O’Brien, P.M. Emerson, T.C. Porco, T.M. Lietman.
Description: Based on The Carter Center TANA study, it was hypothesized that mass distribution of a broad-spectrum antibiotic agent to preschool children would reduce mortality in areas of sub-Saharan Africa that are currently far from meeting the Sustainable Development Goals of the United Nations.

Feb. 16, 2018
Population-Based Coverage Survey Results Following the Mass Drug Administration of Azithromycin for the Treatment of Trachoma in Amhara, Ethiopia
Published by PLOS Neglected Tropical Diseases.
Authors: Tigist Astale, Eshetu Sata, Mulat Zerihun, Andrew W. Nute, Aisha E. P. Stewart, Demelash Gessese, Gedefaw Ayenew, Berhanu Melak, Melsew Chanyalew, Zerihun Tadesse, E. Kelly Callahan, Scott D. Nash.
Description: Three weeks after conducting mass drug administration in Amara, we estimated zonal coverage through self-report assessments. Comparing our administration records to self-reports helped us understand why more people than we expected did not receive trachoma drugs. This insight will benefit the direction of future programs emphasizing accessibility and information campaigns.

Jan. 10, 2013
Monitoring of Mass Distribution Interventions for Trachoma in Plateau State, Nigeria
Published by PLOS Neglected Tropical Diseases.
Authors: Elizabeth A. Cromwell, Jonathan D. King, Scott McPherson, Falam N. Jip, Amy E. Patterson, Aryc W. Mosher, Darin S. Evans, Paul M. Emerson.
Description: Mass drug administration (MDA) with antibiotics is a key component of the SAFE strategy for trachoma control. Guidelines recommend that where MDA is warranted the whole population be targeted with 80% considered the minimum acceptable coverage. In other countries, MDA is usually conducted by salaried Ministry of Health personnel. In Plateau State, Nigeria, the existing network of volunteer Community Directed Distributors (CDD) was used for the first trachoma MDA. We conducted a population-based cluster random survey (CRS) of MDA participation to determine the true coverage and compared this to coverage reported from CDD registers.

Dec. 21, 2011
Comparison of Annual Versus Twice-Yearly Mass Azithromycin Treatment for Hyperendemic Trachoma in Ethiopia: A Cluster-Randomised Trial
Published by The Lancet.
Authors: Teshome Gebre, Berhan Ayele, Mulat Zerihun, Asrat Genet, Nicole E Stoller, Zhaoxia Zhou, Jenafir I House, Sun N Yu, Kathryn J Ray, Paul M Emerson, Jeremy D Keenan, Travis C Porco, Thomas M Lietman, Bruce D Gaynor.
Description: In trachoma control programs, azithromycin is distributed to treat the strains of chlamydia that cause ocular disease. We aimed to compare the effect of annual versus twice-yearly distribution of azithromycin on infection with these strains.

July 6, 2010
Where Do We Go from Here? Prevalence of Trachoma Three Years after Stopping Mass Distribution of Antibiotics in the Regions of Kayes and Koulikoro, Mali
Published by PLOS Neglected Tropical Diseases.
Authors: Sanoussi Bamani, Jonathan D. King, Mamadou Dembele, Famolo Coulibaly, Dieudonne Sankara, Yaya Kamissoko, Jim Ting, Lisa A. Rotondo, Paul M. Emerson.
Description: A national survey in 1997 demonstrated that trachoma was endemic in Mali. Interventions to control trachoma including mass drug administration (MDA) with azithromycin were launched in the regions of Kayes and Koulikoro in 2003. MDA was discontinued after three annual rounds in 2006, and an impact survey was conducted. We resurveyed all districts in Kayes and Koulikoro in 2009 to reassess trachoma prevalence and determine intervention objectives for the future. In this paper we present findings from both the 2006 and 2009 surveys.

Sept. 2, 2009
Effect of Mass Distribution of Azithromycin for Trachoma Control on Overall Mortality in Ethiopian Children
Published by Journal of the American Medical Association.
Authors: Travis C. Porco, Teshome Gebre, Berhan Ayele, Jenafir House, Jeremy Keenan, Zhaoxia Zhou, Kevin Cyrus Hong, Nicole Stoller, Kathryn J. Ray, Paul Emerson, Bruce D. Gaynor, Thomas M. Lietman.
Description: Mass oral azithromycin distribution to affected communities is a cornerstone of the World Health Organization's trachoma elimination program. Antibiotics are provided to target the ocular strains of chlamydia that cause trachoma but may also be efficacious against respiratory disease, diarrhea, and malaria—frequent causes of childhood mortality in trachoma-endemic areas.

March 31, 2009
Mass Antibiotic Treatment Alone Does Not Eliminate Ocular Chlamydial Infection
Published by PLOS Neglected Tropical Diseases.
Authors: Paul M. Emerson, Jeremiah Ngondi.
Description: 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 of 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.

March 28, 2009
Assessment of Herd Protection Against Trachoma Due to Repeated Mass Antibiotic Distributions: A Cluster-Randomised Trial
Published by The Lancet.
Authors: Jenafir I House, Berhan Ayele, Travis C Porco, Zhaoxia Zhou, Kevin C Hong, Teshome Gebre, Kathryn J Ray, Jeremy D Keenan, Nicole E Stoller, John P Whitcher, Bruce D Gaynor, Paul M Emerson, Thomas M Lietman.
Description: 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 programs.

Dec. 18, 2021
Water, Sanitation, and Hygiene for Control of Trachoma in Ethiopia (WUHA): a Two-Arm, Parallel-Group, Cluster-Randomised Trial
Published by Lancet Global Health.
Authors: Solomon Aragie, Dionna M Wittberg, Wondyifraw Tadesse, Adane Dagnew, Dagnachew Hailu, Ambahun Chernet, Jason S Melo, Kristen Aiemjoy, Mahteme Haile, Taye Zeru, Zerihun Tadesse, Sarah Gwyn, Diana L Martin, Benjamin F Arnold, Matthew C Freeman, Scott D Nash, E Kelly Callahan, Travis C Porco, Thomas M Lietman, and Jeremy D Keenan.
Description: WHO promotes the SAFE strategy for the elimination of trachoma as a public health programme, which promotes (S) surgery for trichiasis, (A) antibiotics to clear the ocular strains of chlamydia that cause trachoma, (F) facial cleanliness to prevent transmission of secretions, and (E) environmental improvements to provide water for washing and sanitation facilities. However, little evidence is available from randomised trials to support the efficacy of interventions targeting the F and E components of the strategy. We aimed to determine whether an integrated water, sanitation, and hygiene (WASH) intervention prevents the transmission of trachoma.

Nov. 29, 2021
Evaluation of Facial Cleanliness and Environmental Improvement Activities: Lessons Learned from Malawi, Tanzania, and Uganda
Published by PLOS Neglected Tropical Diseases.
Authors: Angelia Sanders, Ruth Dixon, Logan Stuck, Michaela Kelly, Geordie Woods, Edridah M. Muheki, Gilbert Baayenda, Michael Masika, Holystone Kafanikhale, Upendo Mwingira, and Leah Wohlgemuth.
Description: Trachoma control programs promote facial cleanliness, use of latrines, and emphasizes the importance of access to water as means to reduce trachoma transmission. To address these areas, various country ministries and supporting non-governmental organizations (NGOs) support the implementation of tailored behavior change programs. The process and results of evaluating these types of programs in Malawi, Tanzania, and Uganda are described here. The goal of this manuscript is to provide trachoma program managers and supporting NGOs with insights, recommendations, and data collection tools that could be used to support their efforts to conduct monitoring and evaluation of their current or future trachoma prevention activities.

Nov. 1, 2021
Changing Hygiene Behaviours: A Cluster-Randomized Trial, Ethiopia
Published by Bulletin of the World Health Organization.
Authors: Solomon Aragie, Wondyifraw Tadesse, Adane Dagnew, Dagnachew Hailu, Melese Dubie, Dionna M. Wittberg, Jason S. Melo, Mahteme Haile, Taye Zeru, Matthew C. Freeman, Scott D. Nash, E. Kelly Callahan, Zerihun Tadesse, Benjamin F. Arnold, Travis C. Porco, Thomas M. Lietman, and Jeremy D. Keenan.
Description: A cluster-randomized trial was conducted in rural Ethiopia from November 2015 to March 2019 to determine whether a water, sanitation, and hygiene intervention could change behaviours thought to be important for trachoma control. All intervention clusters received a primary-school hygiene curriculum, community water point, household wash station, household soap, and home visits from hygiene promotion workers. The community-and school-based intervention was associated with improved hygiene access and behaviours, although changes in behaviour were slow and required several years of the intervention.

Feb. 1, 2021
Community Hand-Dug Wells for Trachoma: A Cluster-Randomized Trial
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Solomon Aragie, Sintayehu Gebresillasie, Ambahun Chernet, Ayalew Shiferaw, Zerihun Tadesse, Mulat Zerihun, Nicole E. Varnado, Sun Y. Cotter, Dionna M. Wittberg, Zhaoxia Zhou, E. Kelly Callahan, Scott D. Nash, Kristen Aiemjoy, and Jeremy D. Keenan.
Description: The WHO recommends improving access to water as part of a comprehensive strategy for elimination of trachoma as a public health problem; however, this recommendation is not based on evidence from randomized trials. In a region of Ethiopia with hyperendemic trachoma, seven communities were randomized to a hand-dug well (HDW) and seven communities to no intervention to determine the impact of HDWs on the community prevalence of ocular chlamydia infection.

Nov. 14, 2019
Associations Between Water, Sanitation and Hygiene (WASH) and Trachoma Clustering at Aggregate Spatial Scales, Amhara, Ethiopia
Published by Parasites & Vectors.
Authors: Forest M. Altherr, Andrew W. Nute, Mulat Zerihun, Eshetu Sata, Aisha E. P. Stewart, Demelash Gessese, Berhanu Melak, Tigist Astale, Gedefaw Ayenew, E. Kelly Callahan, Melsew Chanyalew, Bizuayehu Gashaw, Lance A. Waller, Zerihun Tadesse, Scott D. Nash.
Description: Trachoma is the leading infectious cause of blindness globally. The WHO has recommended the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements) strategy to eliminate trachoma as a public health problem. The F and E arms of the strategy will likely be important for sustained disease reductions, yet more evidence is needed detailing relationships between hygiene, sanitation, and trachoma in areas with differing endemicity. This study addressed whether the regional differences in water, sanitation, and hygiene (WASH) variables were associated with the spatial distribution of trachomatous inflammation-follicular (TF) among children aged 1 to 9 years in the Amhara National Regional State of Ethiopia.

Jan. 26, 2017
Active Trachoma and Community Use of Sanitation, Ethiopia
Published by Bulletin of the World Health Organization.
Authors: William E Oswald, Aisha EP Stewart, Michael R Kramer, Tekola Endeshaw, Mulat Zerihun, Berhanu Melak, Eshetu Sata, Demelash Gessese, Tesfaye Teferi, Zerihun Tadesse, Birhan Guadie, Jonathan D King, Paul M Emerson, Elizabeth K Callahan, Dana Flanders, Christine L Moe, Thomas F Clasen.
Description: Improvements in community sanitation are associated with reduced potential for infection transmission. Latrine access is recorded to measure improvements and is a primary indicator used to estimate trachoma prevalence within a community. However, both high levels of latrine access and consistent use of latrines are required to effectively control transmission. We hypothesized communities with higher usage of sanitation facilities would be associated with a lower prevalence of active trachoma.

Nov. 14, 2016
Is Using a Latrine “a Strange Thing To Do”? A Mixed-Methods Study of Sanitation Preference and Behaviors in Rural Ethiopia
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Kristen Aiemjoy, Nicole E. Stoller, Sintayehu Gebresillasie, Ayalew Shiferaw, Zerihun Tadesse, Tegene Sewent, Bezuayehu Ayele, Melsew Chanyalew, Solomon Aragie, Kelly Callahan, Aisha Stewart, Paul M. Emerson, Thomas M. Lietman, Jeremy D. Keenan, Catherine E. Oldenburg.
Description: Latrines are the most basic form of improved sanitation and are a common public health intervention. Understanding motivations for building and using latrines can help develop effective, sustainable latrine promotion programs. We conducted a mixed-methods study of latrine use in the Amhara region of Ethiopia.

Oct. 27, 2016
'If an Eye Is Washed Properly, It Means It Would See Clearly': A Mixed Methods Study of Face Washing Knowledge, Attitudes, and Behaviors in Rural Ethiopia
Published by PLOS Neglected Tropical Diseases.
Authors: Kristen Aiemjoy, Nicole E. Stoller, Sintayehu Gebresillasie, Ayalew Shiferaw, Zerihun Tadesse, Tegene Sewnet, Bezuayehu Ayele, Melsew Chanyalew, Kelly Callahan, Aisha Stewart, Paul M. Emerson, Thomas M. Lietman, Jeremy D. Keenan, Catherine E. Oldenburg.
Description: In Ethiopia, we asked participants about their knowledge, attitude, and behaviors related to facial washing and fly control strategies. To improve facial cleanliness, interventions only addressing knowledge may not be enough. We assess key barriers to address and the importance of habits.

July 18, 2016
Prediction of Low Community Sanitation Coverage Using Environmental and Sociodemographic Factors in Amhara Region, Ethiopia
Published by American Journal of Tropical Medicine and Hygiene.
Authors: William E.Oswald, Aisha E.P. Stewart, W. Dana Flanders, Michael R. Kramer, Tekola Endeshaw, Mulat Zerihun, Birhanu Melaku, Eshetu Sata, Demelash Gessesse, Tesfaye Teferi, Zerihun Tadesse, Birhan Guadie, Jonathan D. King, Paul M. Emerson, Elizabeth K. Callahan, Christine L. Moe, Thomas F. Clasen.
Description: This study developed and validated a model for predicting the probability that communities in Amhara Region, Ethiopia, have low sanitation coverage, based on environmental and sociodemographic conditions. Community sanitation coverage was measured between 2011 and 2014 through trachoma control program evaluation surveys.

Oct. 30, 2013
Trachoma Among Children in Community Surveys from Four African Countries and Implications of Using School Surveys for Evaluating Prevalence
Published by International Health.
Authors: Jonathan D King, Peter Odermatt, Jürg Utzinger, Jeremiah Ngondi, Sanoussi Bamani, Yaya Kamissoko, Kadri Boubicar, Adamou Sabo Hassan, Benjamin C Nwobi, Nimzing Jip, Asrat Amnie, Tesfaye Teferi, Aryc W Mosher, Aisha E P Stewart, Elizabeth A Cromwell, Paul M Emerson.
Description: 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. We analyzed data from community-based trachoma surveys conducted from 2008–2011 in Ethiopia, Mali, Niger, and Nigeria.

Sept. 26, 2013
Integration of Water, Sanitation, and Hygiene for the Prevention and Control of Neglected Tropical Diseases: A Rationale for Inter-Sectoral Collaboration
Published by PLOS Neglected Tropical Diseases.
Authors: Matthew C. Freeman, Stephanie Ogden, Julie Jacobson, Daniel Abbott, David G. Addiss, Asrat G. Amnie, Colin Beckwith, Sandy Cairncross, Rafael Callejas, Jack M. Colford, Jr., Paul M. Emerson, Alan Fenwick, Rebecca Fishman, Kerry Gallo, Jack Grimes, Gagik Karapetyan, Brooks Keene, Patrick J. Lammie, Chad MacArthur, Peter Lochery, Helen Petach, Jennifer Platt, Sarina Prabasi, Jan Willem Rosenboom, Sharon Roy, Darren Saywell, Lisa Schechtman, Anupama Tantri, Yael Velleman, Jürg Utzinger.
Description: Improvements of water, sanitation, and hygiene (WASH) infrastructure and appropriate health-seeking behavior are necessary for achieving sustained control, elimination, or eradication of many neglected tropical diseases (NTDs). We discuss strategic opportunities and ways forward for enhanced collaboration between the WASH and the NTD sectors.

Sept. 3, 2013
The Association Between Latrine Use and Trachoma: A Secondary Cohort Analysis from a Randomized Clinical Trial
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Meron Haile, Zerihun Tadesse, Sintayehu Gebreselassie, Berhan Ayele, Teshome Gebre, Sun N. Yu, Nicole E. Stoller, Bruce D. Gaynor, Travis C. Porco, Paul M. Emerson, Thomas M. Lietman, Jeremy D. Keenan.
Description: Latrine use has been promoted as a component of an integrated strategy for trachoma control. As part of a randomized trial in Ethiopia, 12 communities received a mass azithromycin distribution followed by a latrine promotion intervention. A random sample of children ages 0–9 years in each community was monitored longitudinally for ocular chlamydia. After latrine construction ended, those communities with a higher proportion of households using latrines were more likely to experience a reduction in the prevalence of ocular chlamydia.

June 21, 2013
Children as Agents of Change in Trachoma Control
Published by Community Eye Health Journal.
Authors: Lisa Dickman, Berhanu Melek.
Description: In Ethiopia, the country with the heaviest known burden of trachoma cases in the world, health educators promote the SAFE strategy in a range of different settings. Schools are an ideal place to target children, who are most susceptible to trachoma infection. In 2005, the Carter Center began health education in 700 schools in the Amhara National Regional State. Teacher training was scaled up in 2008 and 2009, following the expansion of the program to cover the entire region. In total, 7,822 primary schools now have ongoing health education.

Aug. 28, 2012
How Communities Can Control Trachoma Without a Big Budget
Published by Community Eye Health Journal.
Authors: Stephanie Ogden, Paul Emerson.
Description: Trachoma is an eye infection that affects an estimated 325 million people in Africa, Asia, and the Americas, and is the world's leading cause of preventable blindness. Infection occurs most readily in children, causing itching, redness, irritation in the eyes and eyelids, and infected ocular discharge. Repeated infections in childhood lead to the formation of scar tissue which culminates in the inversion of the eyelids and eyelashes in adulthood, and ultimately, blindness.

June 20, 2012
SAFE Strategy for Blinding Trachoma Addresses Sanitation, the Other Half of MDG7
Published by The Lancet.
Authors: Paul Emerson, Martin Kollmann, Chad MacArthur, Simon Bush, Danny Haddad.
Description: The trachoma community has long been concerned that the approach to NTDs has focused on drug distribution, and not a comprehensive control package that treats these diseases as the public health problems they are. For example, improvement of water, sanitation, and hygiene is an integral part of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvements) for the elimination of blinding trachoma.

Sept. 1, 2011
Latrine Promotion for Trachoma: Assessment of Mortality from a Cluster-Randomized Trial in Ethiopia
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Teshome Gebre, Berhan Ayele, Mulat Zerihun, Jenafir I. House, Nicole E. Stoller, Zhaoxia Zhou, Kathryn J. Ray, Bruce D. Gaynor, Travis C. Porco, Paul M. Emerson, Thomas M. Lietman, Jeremy D. Keenan.
Description: Trachoma control strategies, including latrine construction and antibiotic distribution, are directed at reducing ocular chlamydia, but may have additional benefits. In a cluster-randomized clinical trial, 24 sub-kebeles (administrative geographic units) in Ethiopia were offered a single mass azithromycin treatment, and half were randomized to receive an intensive latrine promotion.

June 11, 2009
Trachoma and Women: Latrines in Ethiopia and Surgery in Southern Sudan
Published by Community Eye Health Journal.
Authors: Paul M Emerson, Lisa Rotondo.
Description: Ethiopia and Southern Sudan are two locations with an exceedingly high burden of trachoma. Projects focusing on environmental improvement (in Ethiopia) and increasing access to surgery (in Southern Sudan) have made significant progress towards reducing the impact of the disease on women.

June 5, 2007
Characteristics of Latrine Promotion Participants and Non-Participants; Inspection of Latrines; and Perceptions of Household Latrines in Northern Ghana
Published by Tropical Medicine and International Health.
Authors: Ann F. Rodgers, Lydia A. Ajono, John O. Gyapong, Maria Hagan, Paul M. Emerson.
Description: This paper set out to examine characteristics of household heads in two districts of Northern Ghana who had or had not participated in latrine promotion programs; to inspect latrines; and to explore perceptions of latrine ownership.

Aug. 8, 2006
Follow-Up of a Low Cost Latrine Promotion Programme in One District of Amhara, Ethiopia: Characteristics of Early Adopters and Non-Adopters
Published by Tropical Medicine and International Health.
Authors: Rosalyn O'Loughlin, Gashu Fentie, Brendan Flannery, Paul M. Emerson.
Description: To verify reported construction of 22,385 household latrines in 2004, after community mobilization, as part of a trachoma control program in one district of Amhara, Ethiopia, and to explore characteristics of early latrine adopters and non-adopters.

Aug. 21, 2021
Trachoma Prevalence in Four Localities of Darfur Region, Sudan, Following One Round of Antibiotic Mass Drug Administration
Published by Ophthalmic Epidemiology.
Authors: Balgesa E. Elshafie, Mazin Salih Abdalla Elsanosi, Atif El Amin, Robert Butcher, Rebecca Willis, Ana Bakhtiari, Cristina Jimenez, Michael Dejene, Anthony W. Solomon, Emma M. Harding-Esch, and Kamal H. Binnawi
Description: The prevalence of trachomatous inflammation – follicular (TF) in 1–9-year-olds and of trachomatous trichiasis (TT) in ≥15-year-olds in four endemic evaluation units (EUs) of Darfur region, Sudan, was measured more than a year after the required single round of antibiotic mass drug administration (MDA). Surveys were conducted using highly standardized, World Health Organization-recommended methodologies. Individuals age ≥1 year, resident in selected households, were chosen for the survey using a two-stage cluster sampling process. Consenting adults and children were examined for the signs TF and TT by graders trained to international standards. Prevalence of disease in key indicator groups was calculated and weighted to the underlying population structure. The aim of the survey series presented in this manuscript was to measure the prevalence of TF and TT in four localities of the Darfur region, namely Dar El Salam, Kalmindo, El Salam, and Belail. In these localities, the prevalence of TT was 0.0–0.6% and of TF was 5.0–9.9% during baseline mapping in 2014–5 and they duly received a single round of MDA between February and May 2017. The Trachoma Impact Survey (TIS) data generated in this exercise will enable the Sudan National Trachoma Program to review progress towards elimination in these localities and determine whether further interventions may be needed there in the future.

March 1, 2021
Targeted Antibiotics for Trachoma: A Cluster-Randomized Trial
Published by Clinical Infectious Diseases.
Authors: Jason S. Melo, Solomon Aragie, Ambahun Chernet, Zerihun Tadesse, Adane Dagnew, Dagnachew Hailu, Mahteme Haile, Tàye Zeru, Dionna M. Wittberg, Scott D. Nash, E. Kelly Callahan, Benjamin F. Arnold, Travis C. Porco, Thomas M. Lietman, and Jeremy D. Keenan.
Description: We conducted a cluster-randomized trial to assess the effectiveness of a targeted antibiotic strategy for trachoma. The study was set in Ethiopia, which continues to have persistently high trachoma despite years of repeated mass azithromycin distributions. Cluster-randomization was important because we were interested both in the direct and indirect effects of community-wide antibiotic distributions. We hypothesized that antibiotic treatments targeted to infected preschool children would be superior to absence of treatment in terms of reducing ocular chlamydia and noninferior to community-wide antibiotics.

Jan. 18, 2021
Twelve-Year Longitudinal Trends in Trachoma Prevalence among Children Aged 1-9 years in Amhara, Ethiopia, 2007-2019
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Eshetu Sata, Andrew W. Nute, Tigist Astale, Demelash Gessese, Zebene Ayele, Mulat Zerihun, Ambahun Chernet, Berhanu Melak, Kimberly A. Jensen, Mahteme Haile, Taye Zeru, Melkamu Beyen, Adisu Abebe Dawed, Fikre Seife, Zerihun Tadesse, E. Kelly Callahan, Jeremiah Ngondi, and Scott D Nash.
Description: Trachoma control in the Amhara region of Ethiopia, where all districts were once endemic, began in 2001 and attained full scale-up of the Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE) strategy by 2010. Since scaling up, the program has distributed approximately 14 million doses of antibiotic per year, implemented village- and school-based health education, and promoted latrine construction. This report aims to provide an update on the prevalence of trachoma among children ages 1–9 years as of the most recent impact or surveillance survey in all 160 districts of Amhara.

Oct. 9, 2020
Genomics of Ocular Chlamydia Trachomatis After 5 Years of SAFE Interventions for Trachoma in Amhara, Ethiopia
Published by Journal of Infectious Diseases.
Authors: Harry Pickering, Ambahun Chernet, Eshetu Sata, Mulat Zerihun, Charlotte A. Williams, Judith Breuer, Andrew W. Nute, Mahteme Haile, Taye Zeru, Zerihun Tadesse, Robin L. Bailey, E. Kelly Callahan, Martin J. Holland, Scott D. Nash.
Description: Trachoma is a blinding disease caused by Chlamydia trachomatis (Ct). The Trachoma Control Program in Amhara has conducted multiple studies to better understand the epidemiology of trachoma in communities that have received approximately 5 years of annual MDA, yet still have significant levels of Ct infection and disease. This study sequenced 99 ocular Ct samples from Amhara to identify antimicrobial resistance alleles and investigate the role of genomic variation in the continued transmission of Ct. We further explored the relationship between Ct genomic variation, ocular Ct infection prevalence, and trachomatous disease prevalence at the village and district levels.

Sept. 2, 2020
Seroprevalence of Antibodies Against Chlamydia Trachomatis and Enteropathogens and Distance to the Nearest Water Source Among Young Children in the Amhara Region of Ethiopia
Published by PLOS Neglected Tropical Diseases.
Authors: Kristen Aiemjoy, Solomon Aragie, Dionna M. Wittberg, Zerihun Tadesse, E. Kelly Callahan, Sarah Gwyn, Diana Martin, Jeremy D. Keenan, Benjamin F. Arnold.
Description: Trachoma, an infection of the eye caused by the bacteria Chlamydia trachomatis, and many diarrhea-causing infections are associated with access to water for washing hands and faces. Measuring these different pathogens in a population is challenging and rarely are multiple infections measured at the same time. Here, we used an integrated approach to simultaneously measure antibody responses to C. trachomatis, Giardia intestinalis, Cryptosporidium parvum, Entamoeba histolytica, Salmonella enterica, Campylobacter jejuni, enterotoxigenic Escherichia coli (ETEC) and Vibrio cholerae among young children residing in rural Ethiopia..

May 18, 2020
Ocular Chlamydia trachomatis Infection and Infectious Load Among Pre-School Aged Children Within Trachoma Hyperendemic Districts Receiving the SAFE Strategy, Amhara Region, Ethiopia
Published by PLOS Neglected Tropical Diseases.
Authors: Scott D. Nash, Ambahun Chernet, Jeanne Moncada, Aisha E. P. Stewart, Tigist Astale, Eshetu Sata, Mulat Zerihun, Demelash Gessese, Berhanu Melak, Gedefaw Ayenew, Zebene Ayele, Melsew Chanyalew, Thomas M. Lietman, E. Kelly Callahan, Julius Schachter, Zerihun Tadesse.
Description: After approximately 5 years of SAFE interventions for trachoma, hyperendemic districts remained in Amhara, Ethiopia. This study’s aim was to characterize the epidemiology of Chlamydia trachomatis (Ct) infection and load among pre-school aged children living under the SAFE strategy.

Oct. 7, 2019
Progress Toward Elimination of Trachoma as a Public Health Problem in Seven Localities in the Republic of Sudan: Results from Population-Based Surveys
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Angelia M. Sanders, Zeinab Abdalla, Belgesa E. Elshafie, Mazin Elsanosi, Andrew W. Nute, Nabil Aziz, E. Kelly Callahan, Scott D. Nash.
Description: After it was determined Sudan was endemic for trachoma, multiple years of SAFE interventions were implemented. We measured the prevalence of trachoma and estimated water, sanitation, and hygiene indicators on a population level. We are excited to report with continued commitment, the Sudan Trachoma Control program is on target to eliminate Trachoma as a public health problem by 2020.

Sept. 23, 2019
Progress to Eliminate Trachoma as a Public Health Problem in Amhara National Regional State, Ethiopia: Results of 152 Population-Based Surveys
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Aisha E. P. Stewart, Mulat Zerihun, Demelash Gessese, Berhanu Melak, Eshetu Sata, Andrew W. Nute, Tigist Astale, Tekola Endeshaw, Tesfaye Teferi, Zerihun Tadesse, Elizabeth Kelly Callahan, Melsew Chanyalew, Birhan Gaudie, Paul M. Emerson, Jonathan D. King, Scott D. Nash.
Description: Amhara, Ethiopia, was the most trachoma-endemic region in the country in 2006. This study sought to evaluate the uptake and effectiveness of WHO SAFE strategies. Throughout Amhara, we conducted population-based trachoma impact surveys for five years and found elimination targets were widely unmet. We recommend increasing the number of years SAFE interventions are implemented to help ensure progress in this hyperendemic region.

June 13, 2019
Prevalence of Trachoma Within Refugee Camps Serving South Sudanese Refugees in White Nile State, Sudan: Results from Population-Based Surveys
Published by PLOS Neglected Tropical Diseases.
Authors: Angelia M. Sanders, Zeinab Abdalla, Belgesa E. Elshafie, Andrew W. Nute, Elizabeth F. Long, Nabil Aziz, Paul Weiss, E. Kelly Callahan, Scott D. Nash.
Description: The world is witnessing mass displacement of populations which could impact global efforts to eliminate neglected tropical diseases such as trachoma. On the African continent, South Sudan has experienced high levels of population displacement. Population based baseline trachoma surveys were conducted among refugee camps in two Sudanese localities hosting South Sudanese refugee populations to determine whether the SAFE strategy was warranted.

Dec. 20, 2018
Achieving the Endgame: Integrated NTD Case Searches
Published by PLOS Neglected Tropical Diseases.
Authors: Lucas Buyon, Randall Slaven, Paul M. Emerson, Jonathan King, Oscar Debrah, Agatha Aboe, Ernesto Ruiz-Tiben, E. Kelly Callahan.
Description: Finding the very last cases of Guinea Worm Disease and Trachoma is an important, yet difficult, task in reaching the public health goals set for these NTDs. To promote identification of cases, we piloted an integrated method of house-to-house case searches with a point-of care-referral approach.

May 5, 2018
Ocular Chlamydia Trachomatis Infection Under the Surgery, Antibiotics, Facial Cleanliness, and Environmental Improvement Strategy in Amhara, Ethiopia, 2011-2015
Published by Clinical Infectious Diseases.
Authors: Scott D. Nash, Aisha E. P. Stewart, Mulat Zerihun, Eshetu Sata, Demelash Gessese, Berhanu Melak, Tekola Endeshaw, Melsew Chanyalew, Ambahun Chernet, Belay Bayissasse, Jeanne Moncada, Thomas M. Lietman, Paul M. Emerson, Jonathan D. King, Zerihun Tadesse, and E. Kelly Callahan.
Description: This study aimed to understand the effect of SAFE interventions on ocular chlamydia in Amhara, Ethiopia, by describing the infection prevalence in a population-based sample of children aged 1-5 years. Trachoma surveys were conducted in all districts of Amhara, from 2011 to 2015 following approximately 5 years of SAFE.

June 14, 2017
Burden of Trachoma in Five Counties of Eastern Equatoria State, South Sudan: Results from Population-Based Surveys
Published by PLOS Neglected Tropical Diseases.
Authors: Angelia M. Sanders, Aisha E. P. Stewart, Samuel Makoy, Joy J. Chebet, Peter Magok, Aja Kuol, Carla Blauvelt, Richard Lako, John Rumunu, E. Kelly Callahan, Scott D. Nash.
Description: In order to decrease the prevalence of trachoma within the country, the Republic of South Sudan has implemented components of the SAFE strategy in various counties since 2001. Five counties in Eastern Equatoria state were surveyed in order to monitor progress of programmatic interventions and determine if additional rounds of Mass Drug Administration with azithromycin were needed.

Nov. 23, 2015
Trachoma and Relative Poverty: A Case-Control Study
Published by PLOS Neglected Tropical Diseases.
Authors: Esmael Habtamu, Tariku Wondie, Sintayehu Aweke, Zerihun Tadesse, Mulat Zerihun, Zebideru Zewdie, Kelly Callahan, Paul M. Emerson, Hannah Kuper, Robin L. Bailey, David C. W. Mabey, Saul N. Rajak, Sarah Polack, Helen A. Weiss, Matthew J. Burton.
Description: Trachoma is widely considered a disease of poverty. Although there are many epidemiological studies linking trachoma to factors normally associated with poverty, formal quantitative data linking trachoma to household economic poverty within endemic communities is very limited.

Sept. 18, 2014
Trachoma Control as a Vehicle Toward International Development and Achievement of the Millennium Development Goals
Published by PLOS Neglected Tropical Diseases.
Authors: Kelly Callahan, Yasmin P. Ogale, Stephanie L. Palmer, Paul M. Emerson, Donald R. Hopkins, P. Craig Withers Jr., Jeremiah M. Ngondi.
Description: Interventions to prevent trachoma, the leading infectious cause of blindness in the world, may also assist in the achievement of the eight United Nations Millennium Development Goals. This article cites anecdotal evidence gathered by leaders in the field to make a correlation between trachoma prevention and efforts to reduce poverty and improve development.

Nov. 25, 2013
Trachoma Prevalence in Niger: Results of 31 District Level Surveys
Published by Transactions of the Royal Society of Tropical Medicine and Hygiene.
Authors: Elizabeth A. Cromwell, Abdou Amza, Boubacar Kadri, Nassirou Beidou, Jonathan D. King, Dieudonne Sankara, Aryc W. Mosher, Sabo Hassan, Salissou Kane, Paul M. Emerson.
Description: Thirty-one districts in eastern and western Niger were surveyed for trachoma prevalence from May 2009 to March 2012 as part of routine program impact evaluations. A total of 14,211 households was surveyed; 58,617 individuals were evaluated for clinical signs of trachoma, of whom 27,087 were children aged 1–9 years.

June 6, 2013
Intestinal Parasite Prevalence in an Area of Ethiopia after Implementing the SAFE Strategy, Enhanced Outreach Services, and Health Extension Program
Published by PLOS Neglected Tropical Diseases.
Authors: Jonathan D. King, Tekola Endeshaw, Elisabeth Escher, Genetu Alemtaye, Sileabatt Melaku, Woyneshet Gelaye, Abebe Worku, Mitku Adugna, Berhanu Melak, Tesfaye Teferi, Mulat Zerihun, Demelash Gesese, Zerihun Tadesse, Aryc W. Mosher, Peter Odermatt, Jürg Utzinger, Hanspeter Marti, Jeremiah Ngondi, Donald R. Hopkins, Paul M. Emerson.
Description: The SAFE strategy aims to reduce transmission of Chlamydia trachomatis through antibiotics, improved hygiene, and sanitation. We integrated assessment of intestinal parasites into large-scale trachoma impact surveys to determine whether documented environmental improvements promoted by a trachoma program had collateral impact on intestinal parasites.

March 6, 2012
The Burden of Trachoma in South Sudan: Assessing the Health Losses from a Condition of Graded Severity
Published by PLOS Neglected Tropical Diseases.
Authors: Hebe Gouda, John Powles, Jan Barendregt, Paul Emerson, Jeremiah Ngondi.
Description: Trachoma is a disease that can lead to visual impairment and ultimately blindness. Previous estimates of health losses from trachoma using the Global Burden of Disease methodology have not, however, included the stage prior to visual impairment. We estimated the burden of all stages of trachoma in South Sudan and assessed the uncertainty associated with the severity and duration of stages of trachoma prior to full blindness.

May 31, 2011
The Prevalence of Blinding Trachoma in Northern States of Sudan
Published by PLOS Neglected Tropical Diseases.
Authors: Awad Hassan, Jeremiah M. Ngondi, Jonathan D. King, Balgesa E. Elshafie, Ghada Al Ginaid, Mazin Elsanousi, Zeinab Abdalla, Nabil Aziz, Dieudonne Sankara, Victoria Simms, Elizabeth A. Cromwell, Paul M. Emerson, Kamal H. Binnawi.
Description: Despite historical evidence of blinding trachoma, there have been no widespread contemporary surveys of trachoma prevalence in the northern states of Sudan. We aimed to conduct district-level surveys in this vast region in order to map the extent of the problem and estimate the need for trachoma control interventions to eliminate blinding trachoma.

Jan. 11, 2010
Evaluation of the Prevalence of Trachoma 12 Years After Baseline Surveys in Kidal Region, Mali
Published by Tropical Medicine & International Health.
Authors: S. Bamani, M. Dembele, D. Sankara, F. Coulibaly, Y. Kamissoko, J. Ting, L. A. Rotondo, P. M. Emerson, J. D. King.
Description: After prevalence surveys in all eight regions, Mali started a national program to control trachoma in 1998. In the sparsely populated desert region of Kidal, where active trachoma prevalence was 46.2 percent in children under 10, no interventions beyond routine eye-care services were implemented. We estimated the prevalence of trachoma in Kidal, 12 years after baseline mapping surveys, to determine whether interventions to control trachoma were warranted.

Nov. 1, 2009
Integrating NTD Mapping Protocols: Can Surveys for Trachoma and Urinary Schistosomiasis Be Done Simultaneously?
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Jonathan D. King, Abel Eigege, Frank Richards Jr, Nimzing Jip, John Umaru, Michael Deming, Emmanuel Miri, Deborah McFarland, Paul M. Emerson.
Description: We determined whether the school-based "disease mapping" methodology used to assess urinary schistosomiasis (SCH) is useful for determining trachoma interventions and whether the district-based approach recommended for trachoma is useful for SCH control programs.

March 17, 2009
What Will Happen If We Do Nothing to Control Trachoma: Health Expectancies for Blinding Trachoma in Southern Sudan
Published by PLOS Neglected Tropical Diseases.
Authors: Jeremiah M. Ngondi, Fiona E. Matthews, Mark H. Reacher, Jonathan King, Carol Brayne, Hebe Gouda, Paul M. Emerson.
Description: 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.

March 14, 2009
Achieving Trachoma Control in Ghana after Implementing the SAFE Strategy
Published by Transactions of the Royal Society of Tropical Medicine and Hygiene.
Authors: Daniel Yayemain, Jonathan D. King, Oscar Debrah, Paul M. Emerson, Agatha Aboe, Felix Ahorsu, Seth Wanye, Manfred Owusu Ansah, John O. Gyapong, Maria Hagan.
Description: The Ghana Health Service plans to eliminate blinding trachoma by 2010 and has implemented the SAFE strategy since 2001. The program 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 program should maintain health education, advocate for improved water and sanitation and focus on providing surgery. Surveillance activities are needed to ensure sustained control.

Jan. 28, 2009
Evaluation of Three Years of the SAFE Strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) for Trachoma Control in Five Districts of Ethiopia Hyperendemic for Trachoma
Published by Transactions of the Royal Society of Tropical Medicine and Hygiene.
Authors: Jeremiah Ngondi, Teshome Gebre, Estifanos B. Shargie, Liknaw Adamu, Yeshewamebrat Ejigsemahu, Tesfaye Teferi, Mulat Zerihun, Berhan Ayele, Vicky Cevallos, Jonathan King, Paul M. Emerson.
Description: 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 program monitoring data and interviews, and children (1-6 years) were swabbed for detection of ocular Chlamydia.

Sept. 24, 2008
The Burden of Trachoma in Ayod County of Southern Sudan
Published by PLOS Neglected Tropical Diseases.
Authors: Jonathan D. King, Jeremiah Ngondi, Gideon Gatpan, Ben Lopidia, Steve Becknell, Paul M. Emerson.
Description: Blindness due to trachoma is avoidable through Surgery, Antibiotics, Facial hygiene, and Environmental improvements (SAFE). Recent surveys have shown trachoma to be a serious cause of blindness in Southern Sudan. We conducted this survey in Ayod County of Jonglei State to estimate the need for intervention activities to eliminate blinding trachoma. Read the press release: Sept. 23, 2008 - A Clearer Picture of Trachoma in Southern Sudan: Bacterial Eye Disease Devastates Ayod County.

April 3, 2008
Risk Factors for Active Trachoma in Children and Trichiasis in Adults: A Household Survey in Amhara Regional State, Ethiopia
Published by Transactions of the Royal Society of Tropical Medicine and Hygiene.
Authors: 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.
Description: Identification of risk factors is essential for planning and implementing effective trachoma control programmes. We aimed to investigate risk factors for active trachoma and trichiasis in Amhara Regional State, Ethiopia.

Oct. 22, 2007
Dracunculiasis, Onchocerciasis, Schistosomiasis, and Trachoma
Published by Annals of the New York Academy of Sciences, Issue - Reducing the Impact of Poverty on Health and Human Development: Scientific.
Authors: Donald R. Hopkins, Frank O. Richards Jr., Ernesto Ruiz-Tiben, Paul Emerson, P. Craig Withers Jr.
Description: The four diseases discussed in this chapter (dracunculiasis, onchocerciasis, schistosomiasis, and trachoma) are among the officially designated "Neglected Tropical Diseases," and each is also both the result of and a contributor to the poverty of many rural populations. To various degrees, they all have adverse effects on health, agricultural productivity, and education. The Carter Center decided to work on these health problems because of their adverse effect on the lives of poor people and the opportunity to help implement effective interventions.

Oct. 22, 2007
The Cochrane Library and Trachoma: An Overview of Reviews
Published by Evidence-Based Child Health: A Cochrane Review Journal.
Authors: Elizabeth Sumamo, Paul Emerson, Krystal Harvey, Matthew Burton.
Description: To summarize Cochrane reviews that assess the effect of SAFE strategy (surgery, antibiotics, face washing, and environmental change) for trachoma in developing countries.

Aug. 28, 2007
The Epidemiology of Low Vision and Blindness Associated with Trichiasis in Southern Sudan
Published by BMC Ophthalmology.
Authors: Jeremiah Ngondi, Mark Reacher, Fiona Matthews, Francis Ole-Sempele, Alice Onsarigo, Ibrahim Matende, Samson Baba, Carol Brayne, Paul Emerson.
Description: 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.

July 11, 2007
Prevalence of Risk Factors and Severity of Active Trachoma in Southern Sudan: An Ordinal Analysis
Published by The American Society of Tropical Medicine and Hygiene.
Authors: Jeremiah Ngondi, Fiona Matthews, Mark Reacher, Alice Onsarigo, Ibrahim Matende, Samson Baba, Carol Brayne, James Zingeser, Paul Emerson.
Description: 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.

Dec. 19, 2006
Blinding Trachoma in Postconflict Southern Sudan
Published by PLOS Medicine.
Authors: Jeremiah Ngondi, Francis Ole-Sempele, Alice Onsarigo, Ibrahim Matende, Samson Baba, Mark Reacher, Fiona Matthews, Carol Brayne, Paul Emerson.
Description: 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.

Dec. 19, 2006
Prevalence and Causes of Blindness and Low Vision in Southern Sudan
Published by PLOS Medicine.
Authors: Jeremiah Ngondi, Francis Ole-Sempele, Alice Onsarigo, Ibrahim Matende, Samson Baba, Mark Reacher, Fiona Matthews, Carol Brayne, Paul M. Emerson.
Description: 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.

Aug. 19, 2006
The SAFE Strategy for Trachoma Control: Using Operational Research for Policy, Planning, and Implementation
Published by Bulletin of the World Health Organization.
Authors: Paul M Emerson, Matthew Burton, Anthony W Solomon, Robin Bailey, David Mabey.
Description: Trachoma is a neglected disease and also the world's leading infectious cause of blindness. It causes misery, dependency and is a barrier to development.

Aug. 12, 2006
Effect of 3 Years of Safe (Surgery, Antibiotics, Facial Cleanliness, and Environmental Change) Strategy for Trachoma Control in Southern Sudan: A Cross-Sectional Study
Published by The Lancet.
Authors: Jeremiah Ngondi, Alice Onsarigo, Fiona Matthews, Mark Reacher, Carol Brayne, Samson Baba, Anthony W Solomon, James Zingeser, Paul M Emerson.
Description: A trachoma control programme was started in southern Sudan in 2001. We did a 3-year evaluation to quantify uptake of SAFE (surgery, antibiotics, facial cleanliness, and environmental change) interventions, and to assess the prevalence of active trachoma and unclean faces.

Dec. 1, 2005
The Epidemiology of Trachoma in Eastern Equatoria and Upper Nile States, Southern Sudan
Published by Bulletin of the World Health Organization.
Authors: Jeremiah Ngondi, Alice Onsarigo, Liknaw Adamu, Ibrahim Matende, Samson Baba, Mark Reacher, Paul Emerson, James Zingeser.
Description: 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.

Feb. 2, 2005
Sight for Sore Eyes
Published by Natural History Magazine – Extra Feature.
Author: James A. Zingeser.
Description: Trachoma is an infection caused by certain strains of the bacterium Chlamydia trachomatis. The symptoms first appear as conjunctivitis, an inflammation of the conjunctiva, the layer of tissue that lines the inside of the eyelids and extends over the adjacent edges of the eyeball up to the margins of the cornea.

March 11, 2022
Predicting Future Community-level Ocular Chlamydia Trachomatis Infection Prevalence Using Serological, Clinical,  Molecular, and Geospatial Data
Published by PLOS Neglected Tropical Diseases.
Authors: Christine Tedijanto, Solomon Aragie, Zerihun Tadesse, Mahteme Haile, Taye Zeru, Scott D. Nash, Dionna M. Wittberg, Sarah Gwyn, Diana L. Martin, Hugh J.W. Sturrock, Thomas M. Lietman, Jeremy D. Keenan, and Benjamin F. Arnold
Description: Trachoma, one of the leading infectious causes of blindness globally, is targeted for elimination as a public health problem by 2030. District-level estimates of active trachoma among children 1–9 years old are currently used to guide control programs and assess elimination. However, active trachoma, based on diagnosis of clinical signs, is a subjective indicator. Serological markers present an objective, scalable alternative that could be measured in integrated platforms. In a hyperendemic region, community-level seroprevalence aligned more closely with concurrent infection prevalence than active trachoma. The correlation between seroprevalence and infection prevalence was stronger among 0–5-year-olds compared to 6–9-year-olds and was consistent over a three-year period of increasing transmission. Serosurveillance among children 0–5 years old may be a promising monitoring strategy to identify communities with the highest burdens of ocular chlamydial infection.

Dec. 26, 2021
Optimizing Cluster Survey Designs for Estimating Trachomatous Inflammation-follicular Within Trachoma Control Programs
Published by International Journal of Infectious Diseases
Authors: Julia W. Gallini, Eshetu Sata, Mulat Zerihun, Berhanu Melak, Mahteme Haile, Taye Zeru, Demelash Gessese, Zebene Ayele, Zerihun Tadesse, E. Kelly Callahan, Scott D. Nash, and Paul S. Weiss.
Description: The World Health Organization recommends mass drug administration (MDA) with azithromycin to eliminate trachoma as a public health problem. MDA decisions are based on prevalence estimates from two-stage cluster surveys. Work remains to mathematically evaluate current trachoma survey designs. We aimed to characterize the effects of the number of units sampled on the precision and cost of trachomatous inflammation-follicular (TF) estimates.

Aug. 16, 2021
The Performance of Immunoassays to Measure Antibodies to the Chlamydia trachomatis Antigen Pgp3 in Different Epidemiological Settings for Trachoma
Published by The American Journal of Tropical Medicine and Hygiene.
Authors: Sarah Gwyn, Andrew W. Nute, Eshetu Sata, Zerihun Tadesse, Ambahun Chernet, Mahteme Haile, Taye Zeru, Danaya Bethea, Christian Laurent, E. Kelly Callahan, Scott D. Nash, and Diana Martin
Description: Programs to eliminate trachoma as a public health problem use prevalence of the clinical sign trachomatous inflammation—follicular (TF) in 1- to 9-year-olds in endemic districts to make decisions to begin or end mass drug administration with azithromycin. TF is used as a proxy for transmission of ocular Chlamydia trachomatis infection. Long-term monitoring of previously endemic districts for recrudescence of ocular C. trachomatis infection would benefit from a simple blood test that could be integrated with other public health programs. In this study, we evaluated multiple tests to measure antibodies against the C. trachomatis antigen Pgp3—a multiplex bead assay (MBA), an ELISA, and two versions of a lateral flow assay (LFA)—in four districts of the Amhara region of Ethiopia with varying levels of TF.

July 12, 2021
Precision of Serologic Testing from Dried Blood Spots Using a Multiplex Bead Assay
Published by The American Journal of Tropical Medicine and Hygiene.
Authors: Sarah Gwyn, Solomon Aragie, Dionna M. Wittberg, Jason S. Melo, Adane Dagnew, Dagnachew Hailu, Zerihun Tadesse, Mahteme Haile, Taye Zeru, Scott D. Nash, Benjamin F. Arnold, Diana L. Martin, and Jeremy D. Keenan.
Description: Serologic testing of dried blood spots (DBS) is increasingly used in resource-limited settings for surveillance of neglected tropical diseases. DBS are relatively easy and inexpensive to collect, store, and transport, making them an attractive biospecimen. Seroprevalence studies can provide information about ongoing transmission of infection through estimation of seroconversion rates among young children. Testing is most commonly done with either a multiplex bead assay (MBA) or an enzyme-linked immunosorbent assay (ELISA). The MBA is particularly efficient because it allows simultaneous serological testing of exposure to a variety of pathogens from a single specimen. It also provides robust data by measuring the signal for bound antibody antigen on multiple beads for each antigen. Despite the promise of MBA platforms, little has been published regarding the precision of these testing methods when measuring seroprevalence of antibodies. In the present study, we assess the precision of an MBA platform, testing the variability of results when performing the test on two DBS from the same child, and when altering the number of beads used to determine the MFI of the response.

March 31, 2021
Complex Emergencies and the Control and Elimination of Neglected Tropical Diseases in Africa: Developing a Practical Approach for Implementing Safe and Effective Mapping and Intervention Strategies
Published by Conflict and Health.
Authors: Louise A. Kelly-Hope, Angelia M. Sanders, Emma Harding-Esch, Johan Willems, Fatima Ahmed, Fiona Vincer, and Rebecca Hill.
Description: Complex emergencies resulting from conflict and political instability are a major challenge for national neglected tropical diseases (NTDs) control and elimination programmes, especially in sub-Saharan Africa. Currently, there are no formal guidelines for national programmes to use and plan activities in these humanitarian situations, therefore the aim of this study was to develop a new methodological approach for making decisions about the implementation of safe and effective mapping and mass drug administration (MDA) intervention strategies.

Feb. 22, 2021
WASH Upgrades for Health in Amhara (WUHA): Study Protocol for a Cluster- Randomised Trial in Ethiopia
Published by BMJ Open.
Authors: Dionna M. Wittberg, Solomon Aragie, Wondyifraw Tadesse, Jason S. Melo, Kristen Aiemjoy, Melsew Chanyalew, Paul M. Emerson, Matthew C. Freeman, Scott D. Nash, E. Kelly Callahan, Zerihun Tadesse, Mulat Zerihun, Travis C. Porco, Thomas M. Lietman, and Jeremy D. Keenan.
Description: Facial hygiene promotion and environmental improvements are central components of the global trachoma elimination strategy despite a lack of experimental evidence supporting the effectiveness of water, sanitation, and hygiene (WASH) measures for reducing trachoma transmission. The objective of the WUHA (WASH Upgrades for Health in Amhara) trial is to evaluate if a comprehensive water improvement and hygiene education programme reduces the prevalence of ocular chlamydia infection in rural Africa.

Feb. 17, 2021
Modelling Trachoma Post-2020: Opportunities for Mitigating the Impact of COVID-19 and Accelerating Progress Towards Elimination
Published by Transactions of the Royal Society of Tropical Medicine and Hygiene.
Authors: Anna Borlase, Seth Blumberg, E. Kelly Callahan, Michael S. Deiner, Scott D. Nash, Travis C. Porco, Anthony W. Solomon, Thomas M. Lietman, Joaquin M. Prada, and T. Dèirdre Hollingsworth.
Description: The COVID-19 pandemic has disrupted planned annual antibiotic mass drug administration (MDA) activities that have formed the cornerstone of the largely successful global efforts to eliminate trachoma as a public health problem. Using a mathematical model we investigate the impact of interruption to MDA in trachoma-endemic settings. We evaluate potential measures to mitigate this impact and consider alternative strategies for accelerating progress in those areas where the trachoma elimination targets may not be achievable otherwise.

Oct. 26, 2020
Population-Based Prevalence of Chlamydia trachomatis Infection and Antibodies in four Districts with Varying Levels of Trachoma Endemicity in Amhara, Ethiopia
Published by The American Journal of Tropical Medicine and Hygiene.
Authors: Scott D. Nash, Tigist Astale, Andrew W. Nute, Danaya Bethea, Ambahun Chernet, Eshetu Sata, Mulat Zerihun, Demelash Gessese, Gedefaw Ayenew, Zebene Ayele, Berhanu Melak, Mahteme Haile, Taye Zeru, Zerihun Tadesse, Benjamin F. Arnold, E. Kelly Callahan, Diana L. Martin
Description: The Trachoma Control Program in Amhara region, Ethiopia, scaled up the surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy in all districts starting in 2007. Despite these efforts, many districts still require additional years of SAFE. In 2017, four districts were selected for the assessment of antibody responses against Chlamydia trachomatis antigens and C. trachomatis infection to better understand transmission.

Oct. 5, 2020
Comparison of Smartphone Photography, Single-Lens Reflex Photography, and Field-Grading for Trachoma
Published by American Journal of Tropical Medicine and Hygiene.
Authors: John M. Nesemann, Michael I. Seider, Blake M. Snyder, Robi N. Maamari, Daniel A. Fletcher, Berhan A. Haile, Zerihun Tadesse, Nicole E. Varnado, Sun Y. Cotter, Elizabeth Kelly Callahan, Paul M. Emerson, Todd P. Margolis, Thomas M. Lietman, and Jeremy D. Keenan
Description: Conjunctival examination for trachomatous inflammation—follicular (TF) guides public health decisions for trachoma. Smartphone cameras may allow remote conjunctival grading, but previous studies have found low sensitivity. In this study, we evaluate an enhanced smartphone system with a novel attachment to magnify smartphone images. We assess the agreement of smartphone images with SLR images and test diagnostic accuracy relative to a latent class, hypothesizing that the smartphone attachment will improve smartphone sensitivity for TF.

Sept. 24, 2020
The Use of Serology for Trachoma Surveillance: Current Status and Priorities for Future Investigation
Published by PLOS Neglected Tropical Diseases.
Authors: Diana L. Martin, Martha Idalí Saboyà-Díaz, Aida Abashawl, Wondu Alemayeh, Sarah Gwyn, Pamela J. Hooper, Jeremy Keenan, Khumbo Kalua, Celia Landmann Szwarcwald, Scott Nash, Catherine Oldenburg, Sheila K. West, Michael White, Anthony W. Solomon.
Description: Programs seeking to eliminate the eye disease trachoma use prevalence of the clinical sign tra- chomatous inflammation–follicular (TF) in 1- to 9-year-olds as a proxy for population-level transmission of ocular Chlamydia trachomatis (Ct). The World Health Organization (WHO) set trachoma’s elimination prevalence thresholds for validation of elimination of trachoma as a public health problem. However, no guidance is in place for how programs should monitor for potential recrudescence after the elimination criteria for TF have been met. A postvalidation surveillance system for trachoma that could provide a quantitative measure of ocular Ct transmission would be valuable. Serological testing has a potential role in this, in the same way that antibody acquisition is used as a proxy measure of transmission for malaria and several other infectious diseases.

Sept. 3, 2020
A Cost-analysis of Conducting Population-based Prevalence Surveys for the Validation of the Elimination of Trachoma as a Public Health Problem in Amhara, Ethiopia Development and Validation of a Smartphone-based Contrast Sensitivity Test
Published by PLOS Neglected Tropical Diseases.
Authors: Randal P. Slaven, Aisha E.P. Stewart, Mulat Zerihun, Eshetu Sata, Tigist Astale, Berhanu Melak, Melsew Chanyalew, Demelash Gessese, Paul M. Emerson, Zerihun Tadesse, E. Kelly Callahan, Scott D. Nash, Deborah A. McFarland.
Description: Population-based trachoma surveys are necessary to determine the impact of interventions and to build the case for the validation of elimination of trachoma as a public health problem. Many trachoma-endemic areas are currently receiving mass drug administration, which require trachoma impact and surveillance surveys. This paper analyzed the costs accrued by the implementing non-governmental organization during 8 rounds of trachoma surveys in Amhara, Ethiopia.

Sept. 13, 2019
Development and Validation of a Smartphone-Based Contrast Sensitivity Test
Published by Translational Vision Science & Technology.
Authors: Esmael Habtamu, Andrew Bastawrous, Nigel M. Bolster, Zerihun Tadesse, E. Kelly Callahan, Bizuayehu Gashaw, David Macleod, Matthew J. Burton.
Description: Contrast sensitivity (CS) testing is an important measure of visual function reflecting variations in everyday visual experience in different conditions and helps to identify more subtle vision loss. However, it is only infrequently used. To make this more accessible, we have developed and validated a smartphone-based CS test.

Oct. 8, 2018
Identifying a Sufficient Core Group for Trachoma Transmission
Published by PLOS Neglected Tropical Diseases.
Authors: Thomas M. Lietman, Michael S. Deiner, Catherine E. Oldenburg, Scott D. Nash, Jeremy D. Keenan, Travis C. Porco.
Description: Groups who are more likely to transmit trachoma infection should be prioritized in control programs, but who are these core groups and how do we identify them? Our team used several models and methods to identify core groups impacting trachoma transmission in Ethiopia. We discuss strategies to reach and monitor these groups.

May 29, 2018
School-Based versus Community-Based Sampling for Trachoma Surveillance
Published by American Journal of Tropical Medicine and Hygiene.
Authors: Joseph P. Sheehan, Sintayehu Gebresillasie, Ayalew Shiferaw, Solomon Aragie, Zerihun Tadesse, Demelash Tadesse, Thanapong Somkijrungroj, Nicole E. Stoller, E. Kelly Callahan, Paul M. Emerson, Thomas M. Lietman, and Jeremy D. Keenan.
Description: Prevalence rates of several other NTDs are routinely estimated using school-based sampling methods. This is not common practice in trachoma surveillance...but can it be? In Ethiopia, we compared estimates of trachoma using school-based sampling and community-based sampling strategies. Within this trachoma hyper-endemic setting, the methods estimated similar rates of infection accurately depicting the burden.

Sept. 16, 2013
A Novel Electronic Data Collection System for Large-Scale Surveys of Neglected Tropical Diseases
Published by PLOS ONE.
Authors: Jonathan D. King, Joy Buolamwini, Elizabeth A. Cromwell, Andrew Panfel, Tesfaye Teferi, Mulat Zerihun, Berhanu Melak, Jessica Watson, Zerihun Tadesse, Danielle Vienneau, Jeremiah Ngondi, Jürg Utzinger, Peter Odermatt, Paul M. Emerson.
Description: Large cross-sectional household surveys are common for measuring indicators of neglected tropical disease control programs. As an alternative to standard paper-based data collection, we utilized novel paperless technology to collect data electronically from over 12,000 households in Ethiopia.

March 8, 2011
Incremental Cost of Conducting Population-Based Prevalence Surveys for a Neglected Tropical Disease: The Example of Trachoma in 8 National Programs
Published by PLOS Neglected Tropical Diseases.
Authors: Chaoqun Chen, Elizabeth A. Cromwell, Jonathan D. King, Aryc Mosher, Emma M. Harding-Esch, Jeremiah M. Ngondi, Paul M. Emerson.
Description: Trachoma prevalence surveys provide the evidence base for district and community-wide implementation of the SAFE strategy and are used to evaluate the impact of trachoma control interventions. An economic analysis was performed to estimate the cost of trachoma prevalence surveys conducted between 2006 and 2010 from 8 national trachoma control programs in Africa.

Aug. 17, 2010
Targeting Trachoma Control through Risk Mapping: The Example of Southern Sudan
Published by PLOS Neglected Tropical Diseases.
Authors: Archie C. A. Clements, Lucia W. Kur, Gideon Gatpan, Jeremiah M. Ngondi, Paul M. Emerson, Mounir Lado, Anthony Sabasio, Jan H. Kolaczinski.
Description: Trachoma is a major cause of blindness in Southern Sudan. Its distribution has only been partially established and many communities in need of intervention have therefore not been identified or targeted. The present study aimed to develop a tool to improve targeting of survey and control activities.

Nov. 28, 2008
Trachoma Survey Methods: A Literature Review
Published by Bulletin of the World Health Organization.
Authors: Jeremiah Ngondi, Mark Reacher, Fiona Matthews, Carol Brayne, Paul Emerson.
Description: Reliable population-based prevalence data are essential for planning, monitoring, and evaluating trachoma control programs and understanding the scale of the problem, yet they are not currently available for 22 out of 56 trachoma-endemic countries. Three survey methods have been advocated for trachoma: cluster random sampling (CRS); trachoma rapid assessment (TRA); and acceptance sampling trachoma rapid assessment (ASTRA). Our review highlights the benefits of CRS being simple, efficient, repeatable, and giving population-based prevalence estimates of all signs of trachoma.