Risk factors for active trachoma and ocular Chlamydia trachomatis infection in treatment-naïve trachoma-hyperendemic communities of the Bijagós Archipelago, Guinea Bissau

Trachoma, caused by ocular infection with Chlamydia trachomatis, is hyperendemic on the Bijagós Archipelago of Guinea Bissau. An understanding of the risk factors associated with active trachoma and infection on these remote and isolated islands, which are atypical of trachoma-endemic environments d...

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Published inPLoS neglected tropical diseases Vol. 8; no. 6; p. e2900
Main Authors Last, Anna R, Burr, Sarah E, Weiss, Helen A, Harding-Esch, Emma M, Cassama, Eunice, Nabicassa, Meno, Mabey, David C, Holland, Martin J, Bailey, Robin L
Format Journal Article
LanguageEnglish
Published United States Public Library of Science 01.06.2014
Public Library of Science (PLoS)
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Summary:Trachoma, caused by ocular infection with Chlamydia trachomatis, is hyperendemic on the Bijagós Archipelago of Guinea Bissau. An understanding of the risk factors associated with active trachoma and infection on these remote and isolated islands, which are atypical of trachoma-endemic environments described elsewhere, is crucial to the implementation of trachoma elimination strategies. A cross-sectional population-based trachoma prevalence survey was conducted on four islands. We conducted a questionnaire-based risk factor survey, examined participants for trachoma using the World Health Organization (WHO) simplified grading system and collected conjunctival swab samples for 1507 participants from 293 randomly selected households. DNA extracted from conjunctival swabs was tested using the Roche Amplicor CT/NG PCR assay. The prevalence of active (follicular and/or inflammatory) trachoma was 11% (167/1508) overall and 22% (136/618) in 1-9 year olds. The prevalence of C. trachomatis infection was 18% overall and 25% in 1-9 year olds. There were strong independent associations of active trachoma with ocular and nasal discharge, C. trachomatis infection, young age, male gender and type of household water source. C. trachomatis infection was independently associated with young age, ocular discharge, type of household water source and the presence of flies around a latrine. In this remote island environment, household-level risk factors relating to fly populations, hygiene behaviours and water usage are likely to be important in the transmission of ocular C. trachomatis infection and the prevalence of active trachoma. This may be important in the implementation of environmental measures in trachoma control.
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Conceived and designed the experiments: ARL EMHE SEB MJH RLB. Performed the experiments: ARL EC MN. Analyzed the data: ARL HAW. Contributed reagents/materials/analysis tools: ARL SEB MN MJH. Wrote the paper: ARL RLB MJH DCM. Obtained the funding: ARL RLB MJH DCM. Coordinated the field project: ARL EC MN SEB. Interpreted the data: ARL HAW RLB EMHE.
The authors have declared that no competing interests exist.
ISSN:1935-2735
1935-2727
1935-2735
DOI:10.1371/journal.pntd.0002900