Elizabeth A. Cromwell

A novel electronic data collection system for large-scale surveys of neglected tropical diseases.

Background 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. Methodology We conducted a needs assessment to design an Android-based electronic data collection and management system. We then evaluated the system by reporting results of a pilot trial and from comparisons of two, large-scale surveys; one with traditional paper questionnaires and the other with tablet computers, including accuracy, person-time days, and costs incurred. Principle Findings The electronic data collection system met core functions in household surveys and overcame constraints identified in the needs assessment. Pilot data recorders took 264 (standard deviation (SD) 152 sec) and 260 sec (SD 122 sec) per person registered to complete household surveys using paper and tablets, respectively (P = 0.77). Data recorders felt a lack of connection with the interviewee during the first days using electronic devices, but preferred to collect data electronically in future surveys. Electronic data collection saved time by giving results immediately, obviating the need for double data entry and cross-correcting. The proportion of identified data entry errors in disease classification did not differ between the two data collection methods. Geographic coordinates collected using the tablets were more accurate than coordinates transcribed on a paper form. Costs of the equipment required for electronic data collection was approximately the same cost incurred for data entry of questionnaires, whereas repeated use of the electronic equipment may increase cost savings. Conclusions/Significance Conducting a needs assessment and pilot testing allowed the design to specifically match the functionality required for surveys. Electronic data collection using an Android-based technology was suitable for a large-scale health survey, saved time, provided more accurate geo-coordinates, and was preferred by recorders over standard paper-based questionnaires.

The excess burden of trachomatous trichiasis in women: A systematic review and meta-analysis

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. Of 53 identified studies, 24 studies from 12 different countries met the inclusion criteria. Prevalence data were pooled in a meta-analysis to estimate an overall odds ratio (OR). The overall odds of trichiasis in women compared with men was 1.82 (95% CI 1.61-2.07). Individual survey ORs ranged from 0.83 (95% CI 0.40-1.73) in Myanmar to 3.82 (95% CI 2.36-6.19) in Ethiopia. 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.

The Geographical Distribution and Burden of Trachoma in Africa

Background There remains a lack of epidemiological data on the geographical distribution of trachoma to support global mapping and scale up of interventions for the elimination of trachoma. The Global Atlas of Trachoma (GAT) was launched in 2011 to address these needs and provide standardised, updated and accessible maps. This paper uses data included in the GAT to describe the geographical distribution and burden of trachoma in Africa. Methods Data assembly used structured searches of published and unpublished literature to identify cross-sectional epidemiological data on the burden of trachoma since 1980. Survey data were abstracted into a standardised database and mapped using geographical information systems (GIS) software. The characteristics of all surveys were summarized by country according to data source, time period, and survey methodology. Estimates of the current population at risk were calculated for each country and stratified by endemicity class. Results At the time of writing, 1342 records are included in the database representing surveys conducted between 1985 and 2012. These data were provided by direct contact with national control programmes and academic researchers (67%), peer-reviewed publications (17%) and unpublished reports or theses (16%). Prevalence data on active trachoma are available in 29 of the 33 countries in Africa classified as endemic for trachoma, and 1095 (20.6%) districts have representative data collected through population-based prevalence surveys. The highest prevalence of active trachoma and trichiasis remains in the Sahel area of West Africa and Savannah areas of East and Central Africa and an estimated 129.4 million people live in areas of Africa confirmed to be trachoma endemic. Conclusion The Global Atlas of Trachoma provides the most contemporary and comprehensive summary of the burden of trachoma within Africa. The GAT highlights where future mapping is required and provides an important planning tool for scale-up and surveillance of trachoma control.

Effect of a community intervention with pit latrines in five districts of Amhara, Ethiopia:

Objective  To evaluate the change in household latrine coverage and investigated predictors of latrine uptake after 3 years of implementation of trachoma control interventions in Dera, Ebinat, Estie, Enebsie Sarmedir and Huleteju Enese districts of Amhara, Ethiopia.

Incremental Cost of Conducting Population-Based Prevalence Surveys for a Neglected Tropical Disease: The Example of Trachoma in 8 National Programs

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. Methodology and Findings Data were collected retrospectively from reports for 165 districts surveyed for trachoma prevalence using a cluster random sampling methodology in Ethiopia, Ghana, Mali, Niger, Nigeria, Sudan, Southern Sudan and The Gambia. The median cost per district survey was

Estimation of effects of community intervention with Antibiotics, Facial cleanliness, and Environmental improvement (A,F,E) in five districts of Ethiopia hyperendemic for trachoma.

4,784 (inter-quartile range [IQR] = 

Monitoring of mass distribution interventions for trachoma in Plateau State, Nigeria.

3,508–

Trachoma among children in community surveys from four African countries and implications of using school surveys for evaluating prevalence

6,650) while the median cost per cluster was

The Prevalence of Blinding Trachoma in Northern States of Sudan

311 (IQR = 

Estimation of population coverage for antibiotic distribution for trachoma control: a comparison of methods.

119–