{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T06:51:50Z","timestamp":1793170310685,"version":"4.5.0"},"reference-count":41,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,4]]},"abstract":"<jats:p>At baseline in 2006, Amhara National Regional State, Ethiopia, was the most trachoma-endemic region in the country. Trachoma impact surveys (TIS) were conducted in all districts between 2010 and 2015, following 3\u20135 years of intervention with the WHO-recommended SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) strategy. A multistage cluster random sampling design was used to estimate the district-level prevalence of trachoma. In total, 1,887 clusters in 152 districts were surveyed, from which 208,265 individuals from 66,089 households were examined for clinical signs of trachoma. The regional prevalence of trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense among children aged 1\u20139 years was 25.9% (95% CI: 24.9\u201326.9) and 5.5% (95% CI: 5.2\u20136.0), respectively. The prevalence of trachomatous scarring and trachomatous trichiasis among adults aged \u2265 15 years was 12.9% (95% CI: 12.2\u201313.6) and 3.9% (95% CI: 3.7\u20134.1), respectively. Among children aged 1\u20139 years, 76.5% (95% CI: 75.3\u201377.7) presented with a clean face; 66.2% (95% CI: 64.1\u201368.2) of households had access to water within 30 minutes round-trip, 48.1% (95% CI: 45.5\u201350.6) used an improved water source, and 46.2% (95% CI: 44.8\u201347.5) had evidence of a used latrine. Nine districts had a prevalence of TF below the elimination threshold of 5%. In hyperendemic areas, 3\u20135 years of implementation of SAFE is insufficient to achieve trachoma elimination as a public health problem; additional years of SAFE and several rounds of TIS will be required before trachoma is eliminated.<\/jats:p>","DOI":"10.4269\/ajtmh.19-0450","type":"journal-article","created":{"date-parts":[[2019,9,23]],"date-time":"2019-09-23T07:01:09Z","timestamp":1569222069000},"page":"1286-1295","source":"Crossref","is-referenced-by-count":44,"title":["Progress to Eliminate Trachoma as a Public Health Problem in Amhara National Regional State, Ethiopia: Results of 152 Population-Based Surveys"],"prefix":"10.4269","volume":"101","author":[{"given":"Aisha E. P.","family":"Stewart","sequence":"first","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulat","family":"Zerihun","sequence":"additional","affiliation":[{"name":"The Carter Center, Bahir Dar, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demelash","family":"Gessese","sequence":"additional","affiliation":[{"name":"The Carter Center, Bahir Dar, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berhanu","family":"Melak","sequence":"additional","affiliation":[{"name":"The Carter Center, Bahir Dar, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu","family":"Sata","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew W.","family":"Nute","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tigist","family":"Astale","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tekola","family":"Endeshaw","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tesfaye","family":"Teferi","sequence":"additional","affiliation":[{"name":"International Trachoma Initiative, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zerihun","family":"Tadesse","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Kelly","family":"Callahan","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melsew","family":"Chanyalew","sequence":"additional","affiliation":[{"name":"Amhara National Regional Health Bureau, Bahir Dar, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birhan","family":"Gaudie","sequence":"additional","affiliation":[{"name":"Dr. Abdu Higher Eye Clinic, Bahir Dar, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Emerson","sequence":"additional","affiliation":[{"name":"International Trachoma Initiative, Atlanta, 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":"Scott D.","family":"Nash","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Validation of the Elimination of Trachoma as a Public Health Problem","author":"WHO","year":"2016"},{"key":"b2","series-title":"Future Approaches to Trachoma Control","author":"WHO","year":"1997"},{"key":"b3","series-title":"Report of the Third Global Scientific Meeting on Trachoma Elimination","author":"WHO","year":"2010"},{"key":"b4","series-title":"National Survey on Blindness, Low Vision and Trachoma in Ethiopia","author":"Berhane","year":"2006"},{"key":"b5","series-title":"Trans R Soc Trop Med Hyg","first-page":"1001","article-title":"Evaluation of three years of the safe strategy (surgery, antibiotics, facial cleanliness and environmental improvement) for trachoma control in five districts of Ethiopia hyperendemic for trachoma","volume":"103","author":"Ngondi","year":"2009"},{"key":"b6","series-title":"Clin Infect 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Prevalence of trachoma three years after stopping mass distribution of antibiotics in the regions of Kayes and Koulikoro, Mali","volume":"4","author":"Bamani","year":"2010"},{"key":"b26","series-title":"J Infect Dis","first-page":"268","article-title":"Number of years of annual mass treatment with azithromycin needed to control trachoma in hyper-endemic communities in Tanzania","volume":"204","author":"West","year":"2011"},{"key":"b27","series-title":"PLoS Med","first-page":"e1002633","article-title":"Mass azithromycin distribution for hyperendemic trachoma following a cluster-randomized trial: a continuation study of randomly reassigned subclusters (TANA II)","volume":"15","author":"Keenan","year":"2018"},{"key":"b28","series-title":"Lancet","first-page":"143","article-title":"Comparison of annual versus twice-yearly mass azithromycin treatment for hyperendemic trachoma in Ethiopia: a cluster-randomised 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