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Completing Baseline Mapping of Trachoma in Nepal: Results of 27 Population-Based Prevalence Surveys Conducted in 2013 and 2014.

  • Author(s): Sharma, Shekhar;
  • Ngondi, Jeremiah M;
  • Mishra, Sailesh;
  • Prasad, Raman D;
  • Crowley, Kathryn;
  • Bonuedi, Delali;
  • Rotondo, Lisa A;
  • Nizigama, Lionel;
  • Mosher, Aryc;
  • Henry, Rob;
  • Willis, Rebecca;
  • Solomon, Anthony W;
  • Global Trachoma Mapping Project
  • et al.
Abstract

Purpose

Trachoma is endemic in parts of Nepal; implementation of the surgery, antibiotics, facial cleanliness, environmental improvement (SAFE) strategy started in 2002. Some suspected-endemic districts had not previously been mapped. We aimed to estimate the prevalences of trachomatous inflammation-follicular (TF) and trichiasis in those districts.

Methods

Population-based prevalence surveys were undertaken in 27 districts. In each of those districts, two-stage cluster sampling was used to select a sample of 2000 children aged 1-9 years and 4000 adults aged ≥15 years from a total of 40 wards (clusters), drawn evenly from two subdistricts. Consenting eligible participants were examined for trachoma by Global Trachoma Mapping Project (GTMP)-certified graders, using the World Health Organization simplified grading system. Data were analyzed at district level using GTMP methods.

Results

A total of 43,200 households were surveyed, and 162,094 people were examined for trachoma. District-level TF prevalence in 1-9-year-olds ranged from 0% to 4.3% (95% confidence interval [CI] 2.4-6.2). Among adults aged ≥15 years, trichiasis prevalence ranged from 0% to 0.33% (95% CI 0.08-0.65).

Conclusion

TF was not a public health problem in any of the 27 districts surveyed; thus, antibiotic mass drug administration is not needed. In two districts (Dhanusa and Gorkha), trichiasis prevalence in adults aged ≥15 years was ≥0.2%; thus, further trichiasis surgery interventions at public health level are warranted to achieve elimination. These findings will facilitate planning for elimination of trachoma as a public health problem in Nepal.

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