Photographic grading to evaluate facial cleanliness and trachoma among children in Amhara region, Ethiopia.

Autor: Caleon RL; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States of America., Admassu F; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Aragie S; The Carter Center Ethiopia, Addis Ababa, Ethiopia.; Francis I Proctor Foundation, University of California, San Francisco, California, United States of America., Hailu D; The Carter Center Ethiopia, Addis Ababa, Ethiopia., Dagnew A; The Carter Center Ethiopia, Addis Ababa, Ethiopia., Zeru T; Amhara Public Health Institute, Bahir Dar, Ethiopia., Wittberg DM; Francis I Proctor Foundation, University of California, San Francisco, California, United States of America., Thompson IJB; Francis I Proctor Foundation, University of California, San Francisco, California, United States of America., Abdu S; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Beyecha S; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Birhanu T; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Getachew H; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Getnet B; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Kabtu E; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Shibiru M; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Tekew S; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Wondimteka B; Department of Ophthalmology, University of Gondar, Gondar, Ethiopia., Lietman TM; Francis I Proctor Foundation, University of California, San Francisco, California, United States of America.; Department of Ophthalmology, University of California, San Francisco, California, United States of America., Nash SD; The Carter Center, Atlanta, Georgia, United States of America., Freeman MC; Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America., Keenan JD; Francis I Proctor Foundation, University of California, San Francisco, California, United States of America.; Department of Ophthalmology, University of California, San Francisco, California, United States of America.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2024 Jul 11; Vol. 18 (7), pp. e0012257. Date of Electronic Publication: 2024 Jul 11 (Print Publication: 2024).
DOI: 10.1371/journal.pntd.0012257
Abstrakt: Background: Promotion of facial cleanliness is recommended for the elimination of blinding trachoma, largely because of observational studies that have found an association between various measures of facial uncleanliness and trachoma. However, when a field grader assesses both facial cleanliness and trachoma, associations may be biased. Assessment of photographs of the face and conjunctiva by masked graders may provide a less biased estimate of the relationship between facial cleanliness and trachoma.
Methods: Face photographs, conjunctival photographs, and conjunctival swabs were obtained on a random sample of 0-9-year-old children from each of 40 communities in Amhara region, Ethiopia. Face photographs were assessed for the presence of seven measures of an unclean face (i.e., wet nasal discharge, dry nasal discharge, wet ocular discharge, dry ocular discharge, food, dust/dirt, and flies) by three independent masked photo-graders. Conjunctival photographs were similarly graded in a masked fashion for signs of clinically active trachoma. Conjunctival swabs were processed for Chlamydia trachomatis DNA.
Results: Of 2073 children with complete data, 808 (39%) had evidence of clinically active trachoma, 150 (7%) had evidence of ocular chlamydia infection, and 2524 (91%) had at least one measure of an unclean face. Dry ocular discharge had the strongest association with clinically active trachoma (age- and sex-adjusted prevalence ratio [PR] 1.4, 95% CI 1.2-1.6) and ocular chlamydia infection (PR 1.9, 95%CI 1.3-2.9), although significant associations were observed between each of the measures of facial uncleanliness and trachoma.
Conclusions: Masked assessment of face and conjunctival photographs confirmed prior observational studies that have noted associations between various measures of facial uncleanliness and trachoma. The causal relationship between facial uncleanliness and trachoma is unclear since many features used to measure facial cleanliness (e.g., ocular discharge, nasal discharge, and flies) could be consequences of antecedent ocular chlamydia infection.
Trial Registration: NCT02754583, clinicaltrials.gov.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Caleon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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