Biomedical subjects

Muluken Melese

Publications and source records attributed to Muluken Melese.

11 recordsLinked to original sources

PubMed2006

Effect of a single mass antibiotic distribution on the prevalence of infectious trachoma.

CONTEXT: The World Health Organization recommends mass antibiotic distributions in its strategy to eliminate blinding trachoma as a public health concern. Some hypothesize that a single distribution is sufficient to control the ocular strains of chlamydia that cause trachoma. Others believe infection will inevitably return and periodic treatments or other measures are essential. OBJECTIVE: To determine whether ocular chlamydial infection returns to the community up to 24 months after a single mass antibiotic distribution in a hyperendemic region of Ethiopia. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study conducted March 2003 to March 2005 in the Gurage Zone of Ethiopia. Eight randomly selected villages were assessed for ocular chlamydial infection. Fifteen untreated villages were randomly chosen at 12 months to allow assessment of a secular trend. INTERVENTION: A single dose of oral azithromycin was offered to all residents of the 8 selected villages who were aged 1 year or older. MAIN OUTCOME MEASURE: Prevalence of ocular chlamydial infection in all children aged 1 to 5 years from each intervention village prior to treatment and 2, 6, 12, 18, and 24 months after mass antibiotic treatment, and also in untreated villages enrolled at 12 months. RESULTS: Five hundred fifteen children were examined for ocular chlamydial infection at baseline. For the follow-up examinations, the mean participation rate was 83%. The mean prevalence of infection in children aged 1 to 5 years decreased from 43.5% (95% confidence interval [CI], 35.0%-52.0%) to 5.1% (95% CI, 1.1%-9.2%) after treatment. On average, infection returned gradually over 24 months to 11.3% (95% CI, 4.5%-18.1%; P = .001). In 7 of 8 villages, infection was higher at 24 months than at 2 months. In the remaining village, no infection could be identified at any point after treatment. Villages enrolled at 12 months had significantly fewer infections than those enrolled 12 months earlier, suggesting a secular trend (P<.001). CONCLUSIONS: Ocular chlamydial infection was not eliminated in children aged 1 to 5 years after a single mass azithromycin distribution; it slowly returned over 24 months, although not to baseline levels. Repeated treatments or other effective measures will be necessary for elimination.

Anti-Bacterial Agents↗

PubMed2006

Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia.

BACKGROUND: Trichiasis recurrence following surgery is a serious problem for trachoma programs. OBJECTIVE: To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year, and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient. DESIGN: A randomized, single-masked, clinical trial was conducted in Ethiopia. A total of 1452 patients with trichiasis were randomized 1:1:1 to the following 3 arms: single-dose (1 g) oral azithromycin alone, single-dose azithromycin for household members (20 mg/kg up to 1 g) plus the patient, or topical tetracycline (twice per day for 6 weeks). MAIN OUTCOME MEASURES: Trichiasis recurrence within 1 year following surgery. RESULTS: The combined azithromycin groups had significantly fewer recurrences, 6.9 of 100 person-years overall, compared with topical tetracycline, 10.3 of 100 person-years (P = .047). There was no additional reduction in the arm that also treated household members, 8.1 of 100 person-years, compared with treating the surgical patients alone, 5.8 of 100 person-years (P = .19). CONCLUSIONS: In trachoma-endemic areas, a single dose of azithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline. Application to Clinical Practice In countries where azithromycin is part of the Trachoma Control Program, patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.

Administration, Oral↗

PubMed2005

Active trachoma in children in central Ethiopia: association with altitude.

A cross-sectional study was conducted in the dry month of February 2000 in the Gurage Zone of Ethiopia (population over 1.5 million) to determine the magnitude of trachoma and blindness. A multistage cluster sampling was applied to identify the study subjects. Pre-school children (1-6 years) were examined for active trachoma by trained ophthalmic nurses. The prevalence of active trachoma in the 1-6-year-old age group was 56.5%, ranging from 5.7% (altitude > 3000 m) to 73.4% (altitude less than 2000 m) (P < 0.001). Active trachoma was more common in male children than in female children and peaked in the 3-year-old age group (63.2%), declining with age. The distance to a source of water for 45% of these households was only 15 min. Only 6% of the households had latrines. Confirmation of the association between active disease and altitude may assist with mapping of trachoma in Ethiopia and elsewhere. It is possible that fly density, higher in villages at low altitudes, contributed to the differences seen.

Age Distribution↗

PubMed2005

Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial methodology.

Trachoma is the leading infectious cause of blindness worldwide. Surgery is available to correct trichiasis, which results from repeated episodes of infection with C. trachomatis. However, trichiasis recurrence rates post-surgery are very high. Methods for reducing post-surgical trichiasis recurrence need to be explored. This paper outlines the design of the Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial currently underway in Ethiopia. The STAR trial, funded by The National Eye Institute, is a randomized, controlled clinical trial of antibiotic use at time of trichiasis surgery, comparing topical tetracycline to single-dose azithromycin for the surgical patient and single-dose azithromycin for the surgical patient and all household members. The primary outcome is trichiasis recurrence at one-year. Data from this trial will be critical in helping to determine future policy on antibiotic treatment for C. trachomatis following surgery.

Adolescent↗

PubMed2004

Mass antibiotic treatment and community protection in trachoma control programs.

Azithromycin is highly effective against trachoma, but the practical difficulties of community-wide distribution often leave many individuals untreated. We demonstrate, after mass azithromycin treatment of a population in Ethiopia, an indirect protective effect that occurred among untreated children who resided in villages in which most individuals had been treated. Similarities with the indirect protection within a treated community (i.e., "herd protection") that has been observed in vaccination programs are discussed.

Anti-Bacterial Agents↗

PubMed2004

Feasibility of eliminating ocular Chlamydia trachomatis with repeat mass antibiotic treatments.

CONTEXT: Mass antibiotic administrations for ocular chlamydial infection play a key role in the World Health Organization's trachoma control program. Mathematical models suggest that it is possible to eliminate trachoma locally with repeat mass treatment, depending on the coverage level of the population, frequency of mass treatments, and rate that infection returns into a community after each mass treatment. Precise estimates of this latter parameter have never been reported. OBJECTIVE: To determine the rate at which chlamydial infection returns to a population after mass treatment and to estimate the treatment frequency required for elimination of ocular chlamydia from a community. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study of 24 randomly selected villages from the Gurage Zone in Ethiopia conducted February 2003 to October 2003. A total of 1332 children aged 1 to 5 years were monitored for prevalence of ocular chlamydial infection pretreatment and 2 and 6 months posttreatment. INTERVENTIONS: All individuals older than 1 year were eligible for single-dose oral azithromycin treatment. Pregnant women were offered tetracycline eye ointment. MAIN OUTCOME MEASURES: Prevalence of ocular chlamydial infection, measured by polymerase chain reaction, in children aged 1 to 5 years, in each of 24 villages at each time point was used to estimate the rate of return of infection and the treatment frequency necessary for elimination. RESULTS: The prevalence of infection was 56.3% pretreatment (95% confidence interval [CI], 47.5%-65.1%), 6.7% 2 months posttreatment (95% CI, 4.2%-9.2%), and 11.0% 6 months posttreatment (95% CI, 7.3%-14.7%). Infection returned after treatment at an exponential rate of 12.3% per month (95% CI, 4.6%-19.9% per month). The minimum treatment frequency necessary for elimination was calculated to be once every 11.6 months (95% CI, 7.2-30.9 months), given a coverage level of 80%. Thus, biannual treatment, already being performed in some areas, was estimated to be more than frequent enough to eventually eliminate infection. CONCLUSION: The rate at which ocular chlamydial infection returns to a community after mass treatment suggests that elimination of infection in a hyperendemic area is feasible with biannual mass antibiotic administrations and attainable coverage levels.

Anti-Bacterial Agents↗

PubMed2004

Surgery for trichiasis by ophthalmologists versus integrated eye care workers: a randomized trial.

OBJECTIVE: To study the outcome of bilamellar tarsal rotation (BTR) trichiasis surgery performed by ophthalmologists versus that done by integrated eye care workers (IECWs). DESIGN: Randomized prospective interventional trial. PARTICIPANTS: Nine hundred eighty-two patients with various degrees of trachomatous trichiasis in central Ethiopia. METHODS: Trachomatous trichiasis patients in 3 woredas (districts) in central Ethiopia were enrolled. Trichiasis severity was graded. Patients were randomly assigned to surgery by 2 ophthalmologists and 2 IECWs. On the seventh day postoperatively, patients were evaluated for undercorrection or other complications. If trichiasis was present, it was considered a failure of surgery (technical failure), and patients were excluded from the follow-up study, but repeat surgery was performed. Those patients with good correction at the seventh day were examined again on the third and sixth months. Further follow-up evaluation is planned for the first, second, and third years postoperatively. MAIN OUTCOME MEASURES: Recurrence rate, recurrence difference in the various grades, and difference between surgeries done by ophthalmic surgeons and those done by IECWs. RESULTS: In the third month of follow-up, it was possible to locate 713 (73.0%) of the operated patients. Eighty-one of 713 (11.4%) individuals and 94 of 1286 (5.4%) operated lids developed recurrent trichiasis in this period. There was a linear trend of recurrence with grading (severity) at baseline (chi(2) = 22.017, P<0.001), but there was no difference in recurrence by age (chi(2) =1.53, P = 0.9 at the third month; chi(2) = 1.43, P = 0.9 at the sixth month). There was also no difference with regard to gender (0.38 < odds ratio < 1.14, P = 0.1). The recurrence observed in the group of individuals operated on by ophthalmologists at the 3-month follow-up was 47 (12.1%) lids, and the recurrence observed in the group operated on by the IECWs was 34 (9.9%) lids, with no statistically significant difference (chi(2) =1.38, P = 0.24, 95% confidence interval [CI], -18% to 74%). At the 6-month follow-up, 43 (6.2%) persons had recurrence (95% CI, 4.4%-8%). There was no statistically significant difference between the 2 groups of surgeons at the 6-month point of follow-up examination (chi(2) = 4.46, P = 0.2). The overall recurrence was 124 (14.3%) lids within the first 6 months. CONCLUSION: Recurrent trichiasis is common, especially in cases where the degree of trichiasis is severe at baseline. This suggests that these patients may need surgical overcorrection to decrease the recurrence rate. The outcome of BTR surgery done by IECWs is similar to that of the ophthalmic surgeons. Because of these findings, we recommend that training of IECWs in trichiasis surgery may help to ameliorate the effects of the eye care worker shortage in developing countries.

Adolescent↗

PubMed2004

How reliable is the clinical exam in detecting ocular chlamydial infection?

PURPOSE: To describe the relationship between the clinical exam for trachoma and the polymerase chain reaction (PCR) for ocular chlamydia. METHODS: One hundred children in a trachoma-endemic area of Ethiopia were examined three times and swabbed twice for PCR analysis. The assays were compared, and an analysis of the variance between exam and PCR was performed. RESULTS: Inter-examiner agreement was 0.57 (Cohen's kappa), inter-PCR agreement 0.98, and agreement between examiner and PCR, 0.26-0.34. The positive predictive value of the exam in identifying infection was 66%. Inter-examiner variance accounted for 30% of the total variance between the exam and PCR, with the remainder presumably due to an underlying difference in what the exam and PCR measure. CONCLUSIONS: Despite modest inter-grader reliability and correlation with evidence of infection, the clinical exam is widely used due to its convenience and low cost. Efforts to make laboratory tests for ocular Chlamydia trachomatis more affordable would be useful.

Child↗

PubMed2004

Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia.

BACKGROUND: The prevalence of blindness and visual impairment are high in Ethiopia and use of services is limited. Determining the barriers to use of eye care services is critical for planning strategies to prevent blindness. METHODS: A population-based survey of the magnitude and causes of blindness and visual impairment in adults 40 years and older in the Gurage Zone, central Ethiopia was conducted. Among those individuals who had binocular or monocular vision <6/18, an interview to assess use of eye care services and reasons for a failure to use such services was undertaken. RESULTS: Of 850 adults with visual impairment or blindness, 802 were interviewed. Cataract surgery accounted for the primary service currently needed by the blind, followed by trichiasis surgery; service needs were higher for women than for men. Use of services (27.8% of sample) was associated with being male, binocular vision loss, and blindness. The primary reason for a failure to use eye care services were indirect costs (overall, reported by 40% of respondents) associated with accessing the service. There were significant differences between men and women in the reasons for not using the services and between cataract and trichiasis cases but not when comparing binocular vs. monocular conditions, or patients with visual impairment vs. blindness. CONCLUSION: The majority of the causes of visual impairment and blindness are treatable (cataract) or preventable (trachomatous trichiasis). The main barrier for seeking service is related to the indirect medical costs of the service. This suggests that efforts are needed to create mechanisms that 'bridge' communities and eye care facilities. A holistic approach that deals both with the organization of services and the sociocultural factors in communities that affect use is needed. The organization of trichiasis surgery at peripheral health centres and screening programmes which identify and facilitate transport to hospital for cataract patients is one approach. The indirect burden of accessing eye care on the family may be lessened by encouraging patients to have surgery earlier (before they require assistance to reach the hospital), and by improving the efficiency of existing services. Promotion of services must be gender-sensitive, ensuring that specific characteristics of the sociocultural roles of women be considered in order to improve uptake among women. Training and placement of cataract surgeons in rural hospitals would also enhance provision of eye care for the rural population.

Adult↗

PubMed2004

Trichiasis among close relatives, central Ethiopia.

Active trachoma is known to cluster in close contacts, such as mother and child and between siblings, but we do not know the pattern for trichiasis. This cross-sectional study was conducted to determine if there is as much trichiasis as active trachoma within families having close contact. This information will be helpful in designing intervention strategies. Trichiasis patients that presented for surgery were interviewed for the presence or absence of trichiasis in the current nuclear family, their parent/s, brother/s, sister/s, aunt/s or uncle/s. Of the 739 trichiasis patients interviewed, 78% were women. Fourteen percent of trichiasis cases had at least one nuclear family member with the same condition, and 20.0% had other relative/s (parent/s, brother/ s, sister/s, aunt/s or uncle/s) with trichiasis. Trichiasis increases in parallel with the increase in family size of the index case (c2 for trend = 70.6; P < 0.001). Sixty-nine percent of affected nuclear family members of the index cases were female members. In the relative with trichiasis, 92.8% of cases were parents, sisters and brothers of the index cases. Out of these, the majority (70%) were mothers and sisters. The chance of a female trichiasis patient having another relative with trichiasis is 70%. The chance of the mother/sister/s of a male trichiasis patient being trichiasis patients themselves is 80%, while that of the father/brother/s is 20% (c2=21.88; P < 0.001). If a female has trichiasis there is a 70% chance of her mother/sister/s, and 30% chance of the father/ brother/s (c2 = 27.52; P <0.001) also being trichiasis patients.

Adult↗

PubMed2003

Modified grading system for upper eyelid trachomatous trichiasis.

AIM: This study was conducted to determine the level of inter-observer agreement in the modified grading scheme for trichiasis of the upper eyelid. METHODS: A grading system that covers the entire spectrum of trachomatous trichiasis, extending from the simple to the severe forms, was initially developed by the first and second authors and field-tested. The grading scheme recognizes three levels of severity, based on deviation of the lid margin (TT1, TT2 and TT3); and four anatomical locations indicating where the eyelashes touch the globe in TT1 (nasal, central, temporal, or combined). The grading of trichiasis patients was then conducted on the basis of the modified grading scheme. RESULTS: The inter-observer agreement between the grades of simple trichiasis (TT1) and entropion (TT2) using Cronbach's alpha was 0.84, and the agreement within each sub-grade was 0.86. The weighted Kappa value was 0.68 (95% CI 0.57-0.79) for the main grades and 0.49 (95% CI 0.23-0.79) for the sub-grades. CONCLUSIONS: The inter-observer agreement was very reliable and could easily be attained by all levels of ophthalmic professionals. As the grading follows the natural progression of trichiasis from the simple to the severe forms in relation to the anatomical site involved, it helps to determine the degree of correction and how far to extend the surgical incision.

Eyelashes↗