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Allison N. McCoy, Beatriz E. Munoz, Harran Mkocha, Sheila K. West; Effectiveness Of A Community Screening Program For Trachomatous Trichiasis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1017.
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To determine the effectiveness of training community workers to identify trachomatous trichiasis and refer patients for surgery in a trachoma hyperendemic region.
A census list was obtained for all residents in the Kongwa district of Tanzania identified by community treatment assistant (CTA) workers as having trachomatous trichiasis or other ocular disease from 2008-10. 379 individuals in 32 villages were identified. These residents were re-examined by a community eye surgeon and an ophthalmologist over a period of 3 weeks using 2.5x magnifying loupes and a hand-held lamp. Visual acuity, trichiasis, evidence for epilation, degree of entropion, evidence for previous surgery, and presence of other ocular disease were assessed.
Of the 276 patients said by the CTA to have trichiasis, trichiasis was correctly identified in 45% percent. Other ocular conditions found in those who were said to have trachomatous trichiasis but did not on examination were primarily cataract and corneal opacity. 10% of communities had CTAs with 100% correct identification of TT, and 1/3 of communities had less than 50% correct identification of TT.
Community workers need more rigorous training to correctly identify trichiasis, as it is clear most are relying on self-report of vision loss or other symptoms. However, very few referral cases had no eye problems at all. Because these workers interact with nearly all residents in the community, they are in a position to screen for visual loss due to other blinding eye diseases. Additional resources are needed to help these communities treat the patients identified with trachomatous trichiasis and other eye conditions in order to prevent blindness.
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