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D. E. Stare, E. Ssemanda, H. Mkocha, B. Munoz, S. K. West, D. Mabey, R. Bailey, E. Harding-Esch, PRET Study Group; Mass Treatment Clustering by Household in Tanzania and The Gambia. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1317.
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Azithromycin mass treatment to trachoma endemic communities is a critical part of the World Health Organization’s SAFE strategy to eliminate trachoma-related blindness. We describe the clustering of treatment at the household level using baseline data from 32 villages in central Tanzania and 48 villages in The Gambia who are enrolled in the Partnership for Rapid elimination of Trachoma (PRET) project.
A detailed census was undertaken followed by mass treatment with Azithromycin in 32 communities in Tanzania and 48 Enumeration Areas in The Gambia. The target treatment coverage in each country was greater than 80% in children age less than ten years. In each country, treatment was observed and compliance noted in census books, allowing for the calculation of exact household and community coverage. Within each community, the actual proportion of households where all, some, or none of the target children were treated was calculated. These proportions were then compared with the results from 500 simulations, assuming the overall coverage for the community was as observed and non-treatment occurred at random.
Tanzanian and Gambian community mass treatment coverage for children under 10 years of age ranged from 81.8-100% and 62.2-99.0%, respectively. Clustering of households where all children were treated or no children were treated was greater than expected in both settings. Compared to model simulations, 29 of 32 (90.6%) Tanzanian villages and 44 of 48 (91.7%) Gambian villages had significantly higher proportions of households where all children were treated. Furthermore, 29 of 32 (90.6%) Tanzanian villages and 34 of 48 (70.8%) of Gambian villages had a significantly elevated proportion of households where no children were treated. The ICC for Tanzania was 0.78 (95% CI=0.74-0.82) and for the Gambia, was 0.55 (95% CI=0.51-0.59).
Uptake of community-based mass treatment is not random, but rather it clusters at the household level. Further analysis of household factors that influence the decision to participate in mass treatment programs is warranted to optimize trachoma control programs designed for high coverage.
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