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Trachoma elimination moves one step closer with Global Trachoma Mapping Project
Android phone technology was used by 611 trained teams to survey data from remote areas in 29 countries worldwide.
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A 3-year disease mapping project screening 2.6 million people in 29 countries worldwide provided an unprecedented amount of data on the magnitude, geographic distribution and burden of trachoma. In addition, it is now giving further impetus to the implementation of the WHO strategy of surgery, antibiotics, facial cleanliness and environmental improvement, or SAFE, for trachoma elimination.
Launched in 2012, the Global Trachoma Mapping Project (GTMP) is the largest infectious disease mapping initiative ever attempted.
“It has provided us with a roadmap of where we should intervene or not intervene with the SAFE strategy around the world. It has also set a new standard in survey methodologies, field operations and data analysis,” Anthony Solomon, MBBS, MRCP, PhD, DTM&H, PGCAP, WHO medical officer for trachoma and GTMP chief scientist, said.
Solomon originally came from Australia, the only developed country that still has trachoma as a public health problem.
“I went to medical school there, worked as an ophthalmology senior house officer, and practiced in the bush, but it was only when I joined the London School of Hygiene & Tropical Medicine that I learned that trachoma still existed in my country. That was a real surprise, and I am now very proud to be involved in the drive to eliminate trachoma,” he said.
The project started as an active partnership between the London School of Hygiene & Tropical Medicine, Sightsavers and the International Trachoma Initiative, with funding of £10.6 million from the U.K. Department for International Development. Many non-governmental organizations, charities and foundations joined in later, as did the United States Agency for International Development, which contributed a further £6 million.
“The objective was to accurately capture, with a standardized methodology, the prevalence of trachoma in districts suspected to be endemic in order to understand what intervention would be required to eliminate trachoma by 2020,” Siobhain McCullagh, GTMP operations director at Sightsavers, said.
“We set up the project with local ministries of health in 29 countries, agreed to map trachoma as a collaborative effort and submit prevalence category data to the Global Atlas of Trachoma. Ministries of health provided staff, technical support, supervision and vehicles for the projects.”
Data collection
Solomon was personally involved in training field teams of surveyors, which included data collectors, nurses, ophthalmologists and epidemiologists. Over a period of 3 years, 611 teams visited millions of people in sampled households in the most remote locations of 29 countries, including Chad, Eritrea, Pakistan, Papua New Guinea, Solomon Islands, Colombia and Yemen.
“They trekked across deserts and snowy mountains, reached remote islands by boat, canoed along rivers, crossed jungles by light aircraft. Twenty-five to 30 households were randomly selected in each village, and eye examination was performed for every inhabitant. We were able to reach communities where data had never been previously recorded. On average, one person was examined every 40 seconds during the 3-year project,” Solomon said.
Android mobile phones were used to record and send data to a processing center in Atlanta, USA. From there, the information was sent back to local governments.
“Android phones are great tools because they are quite large, easy to use and affordable. We downloaded the survey forms, sent the phones to the countries or, in some instances, when there were issues with customs clearance, we purchased the telephones locally. After completion of the project, we donated them to the ministries of health for trachoma impact surveys and other disease control applications,” Rebecca Willis, GTMP data manager at the International Trachoma Initiative, said.
McCullagh estimated that approximately 2,500 people were involved in field work.
“We encouraged the recruitment of mainly local people to make sure they were culturally accepted and able to speak the language,” she said.
“The money was also managed by charities or NGOs within the country. This was one of the secrets of our success because these organizations have had long-standing good relationships with local governments, know trachoma, are able to get projects running quickly, and facilitate and manage any issue that may occur immediately. They have been a great strength,” McCullagh said.
A roadmap for intervention
The results of the survey, added to data accumulated prior to the project’s commencement, collectively demonstrated that 200 million people globally live in areas that are considered trachoma endemic. The GTMP also demonstrated that 120 million people living in areas previously suspected to be endemic do not require public health level interventions, focusing attention on places where trachoma is a problem.
“Mapping gives us a comprehensive picture of where we should intervene. The distinction between endemic and non-endemic districts allows us to concentrate resources where they are needed,” Solomon said. “Hopefully we will now go on to implement the SAFE strategy everywhere where it’s required. We have the roadmap. We have great partnerships around the world, fantastic committed donors and NGOs, academics and ministries of health who want to help.”
Mapping will continue in the few places where it was not possible during the life of the project, with discussions already underway with more countries.
“We exclude districts with a low evidence base for trachoma. We also do not do mapping in areas that are considered insecure. Trachoma is a horrible disease, causing a lot of pain and blindness, but it doesn’t cause death, and we do not want to put our teams at risk. It is frustrating, but part of our good results is that during the course of the project nobody has been significantly hurt,” McCullagh said.
From a project director perspective, McCullagh said she was amazed at the willpower and efforts of the people involved.
“Everything has been done amazingly quickly and efficiently: mobilizing the project, raising funds, organizing the teams. There has been great collaborative spirit, and whenever there was a need we got a quick answer. If you think how slow things can be in public health, that’s pretty remarkable,” she said. – by Michela Cimberle
- For more information:
- Siobhain McCullagh can be reached at Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex RH16 3BW England; email: smccullagh@sightsavers.org.
- Anthony Solomon, MBBS, MRCP, PhD, DTM&H, PGCAP, can be reached at Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland; email: solomona@who.int.
- Rebecca Willis can be reached at the International Trachoma Initiative, 325 Swanton Way, Decatur, GA 30030, USA; email: rwillis@taskforce.org.
Disclosures: McCullagh reports she is GTMP operations director at Sightsavers. Solomon reports he is an employee of WHO and the GTMP chief scientist. Willis reports she is a GTMP data manager. The views expressed in this article are those of the individuals quoted alone and do not necessarily represent the decisions or the stated policy of WHO.