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Trachoma Control Program - Articles By Carter Center Experts

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 DOI: 10.1371/journal.pntd.0005658.
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. 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.

Jan. 13, 2016
Posterior Lamellar Versus Bilamellar Tarsal Rotation Surgery for Trachomatous Trichiasis in Ethiopia: A Randomised Controlled Trial
The Lancet Global Health
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 DOI: 10.1371/journal.pntd.0004254.
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. 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-study control in Amhara Region, Ethiopia.

Nov. 23, 2015
Trachoma and Relative Poverty: A Case-Control Study
Published by PLOS Neglected Tropical Diseases DOI: 10.1371/journal.pntd.0004228.
Esmael Habtamu, Tariku Wondie, Sintayehu Aweke, Zerihun Tadesse, Mulat Zerihun, Zebideru Zewudie, 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. 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.

March 13, 2015
Epilation for Minor Trachomatous Trichiasis: Four-Year Results of a Randomised Controlled Trial (PDF)
Published by PLoS Neglected Tropical Diseases DOI: 1PLoS-epilation-trichiasis-march2015.pdf0.1371/journal.pntd.0003558.
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 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.

Nov. 3, 2014
Building is Only the Start
Published by The New York Times.
TO THE EDITOR: Re "Latrines May Not Improve Health of Poor Children" (Global Health, Oct. 28): I am surprised by a recent study published in The Lancet that found the prevalence of diarrhea and intestinal worms among children in a district of 51,000 people in India had not improved two years after a latrine-building campaign.

Sept. 18, 2014
Trachoma Control As a Vehicle Toward International Development and Achievement of the Millennium Development Goals
Published by PLoS Neglected Tropical Diseases DOI: 10.1371/journal.pntd.0003137.
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.

Aug. 14, 2014
'A Living Death': A Qualitative Assessment of Quality of Life Among Women with Trichiasis in Rural Niger
Published by International Health (Oxford Journals)
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, and Paul M. Emerson. Reposted by permission of Oxford University Press on behalf of the Royal Society of Tropical Medicine and Hygiene.

Nov. 25, 2013
Trachoma Prevalence in Niger: Results of 31 District Level Surveys (PDF)
Published in the August edition of Transactions of the Royal Society of Tropical Medicine and Hygiene and is reprinted with permission. Trans R Soc Trop Med Hyg (2013) doi: 10.1093/trstmh/trt101.
Authors: Elizabeth A. Cromwell, Abdou Amza, Boubacar Kadri, Nassirou Beidou, Jonathan D. King, Dieudonne Sankara, Aryc W. Mosher, Sabo Hassan, Salissou Kane, and Paul M. Emerson. 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.

Oct. 30, 2013
Trachoma Among Children in Community Surveys from Four African Countries and Implications of Using School Surveys for Evaluating Prevalence (PDF)
Published in International Health. Int.Health (2013) 5 (4): 280-287. doi:10.1093/inthealth/iht027.
Authors: Jonathan D. King, Peter Odermatt, Ju¨ rg 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.
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 analysed data from community-based trachoma surveys conducted from 2008–2011 in Ethiopia, Mali, Niger and Nigeria. We concluded that Estimating the prevalence of trachoma through examination of only school-going children risks underestimating the true prevalence.

Sept. 27, 2013
Preferred Practices for Zithromax Mass Drug Administration (PDF)
Published by the International Coalition for Trachoma Control.
Mass drug administration (MDA) with Zithromax®, the Pfizer, Inc. donated antibiotic, is a key component of the SAFE strategy to combat trachoma that is endorsed by the World Health Organization. The goal of this "toolbox" is to share experiences and provide country managers, regional coordinators, and others with preferred practices for trachoma MDA. Issues addressed in this document cover a range of topics from national coordination to local implementation. While this document focuses on African-based trachoma programmes, we believe the preferred practices will not only benefit national trachoma programmes globally, but they may be relevant to other neglected tropical diseases (NTDs) that include an MDA component.

Sept. 26, 2013
Integration of Water, Sanitation, and Hygiene for thePrevention and Control of Neglected Tropical Diseases: A Rationale for Inter-Sectoral Collaboration (PDF)
Published in PLoS Neglected Tropical Diseases and is reprinted with permission. PLoS Negl Trop Dis 7(9): e2439. doi:10.1371/journal.pntd.0002439.
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, Ju¨ rg Utzinger. 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. 16, 2013
A Novel Electronic Data Collection System for Large-Scale Surveys of Neglected Tropical Diseases (PDF)
Published in PLoS ONE and is reprinted with permission. PLoS ONE 8(9): e74570. doi:10.1371/journal.pone.0074570.
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, Jurg Utzinger, Peter Odermatt, Paul M. Emerson. 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.

Sept. 3, 2013
The Association Between Latrine Use and Trachoma: A Secondary Cohort Analysis from a Randomized Clinical Trial (PDF)
American Journal of Tropical Medicine and Hygiene, 2013 doi: 10.4269/ajtmh.13-0299.
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 and Jeremy D. Keenan. 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.

Aug. 22, 2013
The Outcome of Trachomatous Trichiasis Surgery in Ethiopia: Risk Factors for Recurrence
Published in PLoS Neglected Tropical Diseases. PLoS Negl Trop Dis 7(8): e2392. doi:10.1371/journal.pntd.0002392.
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.
Trachomatous trichiasis (TT) affects over eight million people, 1.2 of whom live in Ethiopia – the most affected country worldwide. Surgery is the mainstay of treatment for TT. However, results of surgery in the field are often very mixed. We investigated the surgical outcomes of one of the two most widely used surgical techniques (posterior lamellar rotation), in 1300 individuals in the Amhara Region of Ethiopia. We found that recurrence occurred frequently: 315/1276 (24.7%) participants. However, recurrence was rarely severe (greater than 5 lashes): 42 participants (3.3%).

June 21, 2013
Children as Agents of Change in Trachoma Control (PDF)
Published in Community Eye Health Journal and reprinted with permission. Community Eye Health Journal 26(81).
Authors: Dickman, Lisa, and Melek, Berhanu. 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 programme to cover the entire region. In total, 7,822 primary schools now have ongoing health education.

June 6, 2013
Intestinal Parasite Prevalence in an Area of Ethiopia after Implementing the SAFE Strategy, Enhanced Outreach Services, and Health Extension Program (PDF)
Published on June 6, 2013, in PLoS Neglected Tropical Diseases and is reprinted with permission. PLoS Negl Trop Dis 7(6):e2223. doi:10.1371/journal.pntd.0002223
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. Part of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement) to eliminate blinding trachoma involves improving access to, and use of, water and sanitation. We combined the assessment of parasitic worm and intestinal protozoa infections with surveys of trachoma in an area of Ethiopia where the SAFE strategy, together with enhanced outreach services and the health extension program, had been implemented for more than 5 years.

Jan. 10, 2013
Monitoring of Mass Distribution Interventions for Trachoma in Plateau State Nigeria (PDF)
Published on Jan. 10, 2013, in PLoS Neglected Tropical Diseases and is reprinted with permission.
PLoS Negl Trop Dis 7(1):e1995. doi: 10.1371/journal.pntd.0001995

Authors: Cromwell EA, King JD, McPherson S, Jip FN, Patterson AE, Mosher AW, Evans DS, Emerson PM. 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 (MOH). In Plateau State, Nigeria, the existing network of volunteer Community Directed Distributors (CDD) was used for the first trachoma MDA.

Aug. 28, 2012
How Communities Can Control Trachoma Without a Big Budget (PDF)
Published in Community Eye Health Journal and reprinted with permission.
Community Eye Health Journal 25 (19 & 80). Authors: Ogden, Stephanie, and Emerson, Paul . 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, and 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.

Aug. 28, 2012
Why Do People Not Attend for Treatment for Trachomatous Trichiasis in Ethiopia? A Study of Barriers to
Surgery (PDF)

Published on Aug. 28, 2012, in PLoS Neglected Tropical Diseases and is reprinted with permission.
PLoS Negl Trop Dis 6(8): e1766. doi:10.1371/journal.pntd.0001766. Authors: Rajak SN, Habtamu E, Weiss HA, Bedri A, Zerihun M, et al. Trachoma is the commonest infectious cause of blindness worldwide. It causes trichiasis (inturning of the eyelashes to touch the eye), which can cause visual loss. Trachomatous trichiasis (TT) affects over eight million people, of whom 1.2 million live in Ethiopia – the most affected country worldwide. Surgery is the mainstay of treatment for TT. Despite the provision of free surgery in many areas, attendance rates are frequently low. An understanding of these barriers is fundamental for instituting measures to increase surgical uptake.

July 7, 2012
SAFE Strategy for Blinding Trachoma Addresses Sanitation, the Other Half of MDG7
This article was published online on June 20, 2011, in The Lancet. Subscription may be required to read the full article.
Authors: Paul Emerson, Martin Kollmann, Chad MacArthur, Simon Bush, Danny Haddad. The Lancet, 380(9836). doi:10.1016/S0140-6736(12)61122-2. We share your concern (March 17, p 978),1 that only passing comments on improvement of water and sanitation were made at the recent launch of the WHO roadmap Accelerating Work to Overcome the Global Impact of Neglected Tropical Diseases (NTDs).

March 6, 2012
The Burden of Trachoma in South Sudan: Assessing the Health Losses from a Condition of Graded
Severity (PDF)

This article was published in the March 6, 2012 edition of PLoS Neglected Tropical Diseases and is reprinted with permission.
Authors: Gouda H, Powles J, Barendregt J, Emerson P, Ngondi J. PLoS Neglected Tropical Diseases 6(3): e1538. doi:10.1371/journal.pntd.0001538. 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.

Jan. 14, 2012
Comparison of Annual Versus Twice-Yearly Mass Azithromycin Treatment for Hyperendemic Trachoma in Ethiopia: A Cluster-Randomised Trial (PDF)
This article was published online on Dec. 21, 2011 in The Lancet. The Lancet 379 (9811). DOI:10.1016/S0140-6736(11)61515-8. Reprinted with permission.
Authors: Teshome Gebre, Berhan Ayele, Mulat Zerihun, Asrat Genet, Nicole E Stoller, Zhaoxia Zhou, Jenafi r I House, Sun N Yu, Kathryn J Ray, Paul M Emerson, Jeremy D Keenan, Travis C Porco, Thomas M Lietman, Bruce D Gaynor. In trachoma control programmes, 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.

Dec. 21, 2011
Surgery Versus Epilation for the Treatment of Minor Trichiasis in Ethiopia: A Randomised Controlled Noninferiority Trial (PDF)
This article was published in the December issue of PLoS Medicine. PLoS Med 8(12): e1001136. doi:10.1371/journal.pmed.1001136. Reprinted with permission.
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. Trachomatous trichiasis can cause corneal damage and visual impairment. WHO 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. 21, 2011
Absorbable Versus Silk Sutures for Surgical Treatment of Trachomatous Trichiasis in Ethiopia: A Randomized Controlled Trial (PDF)
This article was published in the December issue of PLoS Medicine. PLoS Med 8(12): e1001137. doi:10.1371/journal.pmed.1001137. Reprinted with permission.
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. 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.

Dec. 21, 2011
Comparison of Annual Versus Twice-Yearly Mass Azithromycin Treatment for Hyperendemic Trachoma in Ethiopia: a Cluster-Randomised Trial
Published on December 21, 2011 in The Lancet. doi:10.1016/S0140-6736(11)61515-8
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, Prof Thomas M Lietman, Dr Bruce D Gaynor. In trachoma control programmes, azithromycin is distributed to treat the strains of chlamydia that cause ocular disease. We aimed to compare the eff ect of annual versus twice-yearly distribution of azithromycin on infection with these strains. Subscription is required for full text version.

Oct. 11, 2011
Conjunctival Transcriptome in Scarring Trachoma (PDF)
Published in Infection and Immunity, 2011, 79(1):499. DOI: 10.1128/IAI.00888-10.Reprinted with permission.
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, and Robin L. Bailey. 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.

Sept. 7, 2011
Latrine Promotion for Trachoma: Assessment of Mortality from a Cluster-Randomized Trial in Ethiopia
Published in American Journal of Tropical Medicine and Hygiene,85(3), 2011, pp. 518–523, doi: 10.4269/ajtmh.2011.10-0720
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 and Jeremy D. Keenan. 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 subkebeles (administrative geographic units) in Ethiopia were offered a single mass azithromycin treatment, and half were randomized to receive an intensive latrine promotion.

May 31, 2011
The Prevalence of Blinding Trachoma in Northern States of Sudan (PDF)
Published in PLoS Journal of Neglected Tropical Diseases,5(5): e1027. doi:10.1371/journal.pntd.0001027. This peer reviewed version is reprinted with permission.
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. 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.

March 8, 2011
Incremental Cost of Conducting Population-Based Prevalence Surveys for a Neglected Tropical Disease: The Example of Trachoma in 8 National Programs (PDF)
Published in PLoS Journal of Neglected Tropical Diseases, volume 5, issue 3, March 8, 2011. This peer reviewed version is reprinted with permission.
Authors: Chen C, Cromwell EA, King JD, Mosher A, Harding-Esch EM, et al. Background: 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 (PDF)
Published in PLoS Journal of Neglected Tropical Diseases, volume 4, issue 8, August 17, 2010. This peer reviewed version is reprinted with permission.
Authors: Archie C. A. Clements, Lucia W. Kur, Gideon Gatpan, Jeremiah M. Ngondi, Paul M. Emerson, Mounir Lado, Anthony Sabasio, Jan H. Kolaczinski. Background: 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.

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 (PDF)
Published in PLoS Journal of Neglected Tropical Diseases, volume 4, issue 7, July 6, 2010. This peer reviewed version is reprinted with permission.
Authors: Sanoussi Bamani, Jonathan D. King, Mamadou Dembele, Famolo Coulibaly, Dieudonne Sankara, Yaya Kamissoko, Jim Ting, Lisa A. Rotondo, Paul M. Emerson. Background: 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 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.

April 27, 2010
Evaluation of the prevalence of trachoma 12?years after baseline surveys in Kidal Region, Mali (PDF)
Published by Dr. Paul Emerson and Jonathan King as well as other authors in the March 2010 issue of the journal Tropical Medicine & International Health, Volume 15, Number 3, pp. 306-311(6)
After prevalence surveys in all eight regions, Mali started a national programme 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. methods A total of 2165 individuals from 477 households were examined for clinical trachoma signs in a cluster survey using the WHO simplified grading system. Individual and household risk factors for trachoma were assessed.

Nov. 1, 2009
Integrating NTD Mapping Protocols: Can Surveys for Trachoma and Urinary Schistosomiasis Be Done Simultaneously (PDF)
American Journal of Tropical Medicine and Hygiene, 2009 Doi:10.4269/ajtmh.2009.09-0236.
Authors: Jonathan D. King*, Abel Eigege, Frank Richards Jr, Nimzing Jip, John Umaru, Michael Deming, Emmanuel Miri, Deborah McFarland and Paul M. Emerson. 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. We conducted two separate integrated surveys in eight districts of central Nigeria: school based and district based. A total of 17,189 children were examined for trachoma and 16,238 children were examined for hematuria from 363 schools and 2,149 households.

Oct. 19, 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 Journal22(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.

Sept. 1, 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 >>

July 1, 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.

April 7, 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.

April 6, 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.

March 17, 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.

March 1, 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 Hygieneand 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.

Feb. 12, 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 Hygieneand 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.

Nov. 24, 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 Hygieneand 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.

Nov. 8, 2008
Trachoma Survey Methods: A Literature Review (PDF)
Published in Bulletin of the World Health Organization, volume 87, issue 2, November 8, 2008. This peer reviewed version is reprinted with permission.
Authors: Jeremiah Ngondi, Mark Reacher, Fiona Matthews, Carol Braynea & Paul Emersond. Background: Reliable population-based prevalence data are essential for planning, monitoring and evaluating trachoma control programmes 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.

Sept. 1, 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 >>

Aug. 22, 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 Hygieneand 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.

June 1, 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: Authors: 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 wiley.com.

Feb. 19, 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.
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.

Oct. 22, 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.

Aug. 28, 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.

July 1, 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.

June 1, 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.

Dec. 1, 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.

Dec. 1, 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.

Sept. 1, 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.

Aug. 11, 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.

Aug. 1, 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 >>

Dec. 1, 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.

Feb. 2, 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.

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