Photographic grading to evaluate facial cleanliness and trachoma outcomes among children in Amhara region, Ethiopia Open Access

Abstract

Background

Facial cleanliness is an integral part of the SAFE strategy for trachoma. However, facial cleanliness is typically assessed by simple visual inspection in the field at the time of a trachoma survey, which is subject to bias. We performed and graded face photographs among children in a hyperendemic region of Ethiopia to assess for the presence of facial cleanliness measures and their relationship with trachoma outcomes.

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 photos were assessed for the presence of 7 measures of an unclean face (i.e., wet nasal secretions, dry nasal secretions, wet ocular secretions, dry ocular secretions, food, dust/dirt, and flies). Conjunctival photos were graded for signs of clinically active trachoma. Conjunctival swabs were processed for the presence of Chlamydia trachomatis DNA.

Results

Inter-rater agreement between graders ranged from poor for food (Kappa -0.18 [95% CI -0.19 to -0.17]) to substantial for flies (Kappa 0.80 [95% CI 0.79 to 0.82]). On multivariable analysis of 8,717 children, dry ocular secretion was the facial feature with the strongest association to trachoma outcomes, with age- and gender-adjusted prevalence ratios of 1.29 (95% CI 1.22–1.37) for trachomatous inflammation–follicular, 1.57 (95% CI 1.47–1.68) for trachomatous inflammation–intense, 1.32 (95% CI 1.26–1.39) for active trachoma, and 1.56 (95% CI 0.56–4.30) for ocular chlamydia. Measures of an unclean face exhibited a dose-dependent relationship with trachoma outcomes.

Conclusions

Our more objective method of assessing measures of an unclean face through photography found a strong association between dry ocular discharge and trachoma outcomes, and thus has the potential to aid in trachoma survey programs.

Table of Contents

Introduction 2

Methods 2

Results 5

Discussion 11

Acknowledgments 18

References 19

Supporting Information 21

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Ophthalmology Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	hygiene trachoma sanitation conjunctiva Chlamydia trachomatis
Committee Chair / Thesis Advisor	Matthew Freeman, Emory University

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