{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T06:14:53Z","timestamp":1762064093105,"version":"build-2065373602"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T00:00:00Z","timestamp":1664150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>As countries reach the trachoma elimination threshold and cases of trachomatous inflammation follicular (TF) become rare, it becomes difficult to train survey graders to recognize clinical signs. We assess the use of photography as a grading tool, the efficiency of an in-country grading center and the comparability of field and photographic grading.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>During January\u2013February 2017 surveys in Amhara, Ethiopia, field graders assessed TF, trachomatous inflammation intense (TI) and trachomatous scarring (TS). Photographs were taken from each conjunctiva and later graded at the Gondar Grading Center (GGC) at the University of Gondar in Amhara. Two trained ophthalmology residents graded each set of photographs and a third grader provided an adjudicating grade when needed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 4953 photographs of 2477 conjunctivae from 1241 participants in 10 communities were graded over 5\u00a0d at the GGC. Six examined participants were not photographed. Agreement between field and photographic grades were for TF: percent agreement (PA) 96.7%, \u03ba=0.70 (95% confidence interval [CI] 0.64 to 0.77; for TI: PA 94.7%, \u03ba=0.32 (95% CI 0.20 to 0.43); and for TS: PA 83.5%, \u03ba=0.22 (95% CI 0.15 to 0.29).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Conjunctival photography may be a solution for programs near the elimination threshold where there are few available community cases for training field graders.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/trac090","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T20:08:32Z","timestamp":1664222912000},"page":"111-117","source":"Crossref","is-referenced-by-count":3,"title":["Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia"],"prefix":"10.1093","volume":"117","author":[{"given":"Cassidy C","family":"Whitson","sequence":"first","affiliation":[{"name":"Rollins School of Public Health, Emory University , Atlanta , GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew W","family":"Nute","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Atlanta , GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Begashaw","family":"Hailemariam","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew R","family":"Deathe","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Atlanta , GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tigist","family":"Astale","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zebene","family":"Ayele","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Demelash","family":"Gessese","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eshetu","family":"Sata","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mulat","family":"Zerihun","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berhanu","family":"Melak","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahteme","family":"Haile","sequence":"additional","affiliation":[{"name":"Research and Technology Transfer Directorate, Amhara Public Health Institute , Bahir Dar , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taye","family":"Zeru","sequence":"additional","affiliation":[{"name":"Research and Technology Transfer Directorate, Amhara Public Health Institute , Bahir Dar , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Banchalem","family":"Getnet","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Gondar , Gondar , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bilen","family":"Wondimteka","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Gondar , Gondar , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Endale","family":"Kabtu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Gondar , Gondar , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Habib","family":"Getachew","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Gondar , Gondar , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meskerem","family":"Shibiru","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Gondar , Gondar , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Social","family":"Bayecha","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Gondar , Gondar , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon","family":"Aragie","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dionna M","family":"Wittberg","sequence":"additional","affiliation":[{"name":"Francis I. Proctor Foundation, University of California , San Francisco , San Francisco, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zerihun","family":"Tadesse","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E Kelly","family":"Callahan","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center , Atlanta , GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy D","family":"Keenan","sequence":"additional","affiliation":[{"name":"Francis I. 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