{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T18:04:01Z","timestamp":1785780241435,"version":"3.56.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2018,5,5]],"date-time":"2018-05-05T00:00:00Z","timestamp":1525478400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>World Health Organization (WHO) recommendations for starting and stopping mass antibiotic distributions are based on a clinical sign of trachoma, which is indirectly related to actual infection with the causative agent, Chlamydia trachomatis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study aimed to understand the effect of SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) interventions on ocular chlamydia in Amhara, Ethiopia, by describing the infection prevalence in a population-based sample of children aged 1\u20135 years. Trachoma surveys were conducted in all districts of Amhara, from 2011 to 2015 following approximately 5 years of SAFE. Ocular swabs were collected from randomly selected children to estimate the zonal prevalence of chlamydial infection. The Abbott RealTime polymerase chain reaction assay was used to detect C. trachomatis DNA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 15632 samples were collected across 10 zones of Amhara. The prevalence of chlamydial infection in children aged 1\u20135 years was 5.7% (95% confidence interval, 4.2%\u20137.3%; zonal range, 1.0%\u201318.5%). Chlamydial infection and trachomatous inflammation\u2013intense (TI) among children aged 1\u20139 years were highly correlated at the zonal level (Spearman correlation [r] = 0.93; P &amp;lt; .001), while chlamydial infection and trachomatous inflammation\u2013follicular were moderately correlated (r = 0.57; P = .084).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>After 5 years of SAFE, there is appreciable chlamydial infection in children aged 1\u20135 years, indicating that transmission has not been interrupted and that interventions should continue. The sign TI was highly correlated with chlamydial infection and can be used as a proxy indicator of infection.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciy377","type":"journal-article","created":{"date-parts":[[2018,5,4]],"date-time":"2018-05-04T19:11:14Z","timestamp":1525461074000},"page":"1840-1846","source":"Crossref","is-referenced-by-count":19,"title":["Ocular <i>Chlamydia trachomatis<\/i> Infection Under the Surgery, Antibiotics, Facial Cleanliness, and Environmental Improvement Strategy in Amhara, Ethiopia, 2011\u20132015"],"prefix":"10.1093","volume":"67","author":[{"given":"Scott D","family":"Nash","sequence":"first","affiliation":[{"name":"The Carter Center, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha E P","family":"Stewart","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulat","family":"Zerihun","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu","family":"Sata","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demelash","family":"Gessese","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berhanu","family":"Melak","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tekola","family":"Endeshaw","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melsew","family":"Chanyalew","sequence":"additional","affiliation":[{"name":"Amhara Regional Health Bureau, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambahun","family":"Chernet","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belay","family":"Bayissasse","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne","family":"Moncada","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation"},{"name":"Department of Laboratory Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M","family":"Lietman","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M","family":"Emerson","sequence":"additional","affiliation":[{"name":"International Trachoma Initiative, Decatur, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D","family":"King","sequence":"additional","affiliation":[{"name":"World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zerihun","family":"Tadesse","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E Kelly","family":"Callahan","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,5,5]]},"reference":[{"key":"2024111411404158200_CIT0001","volume-title":"Report of the 3rd global scientific meeting on trachoma, Baltimore, 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