title: Follicular trachoma and trichiasis prevalence in an urban community in The Gambia, West Africa: is there a need to include urban areas in national trachoma surveillance?
abstract: OBJECTIVE
  Urban areas are traditionally excluded from trachoma surveillance activities, but due to rapid expansion and population growth, the urban area of Brikama in The Gambia may be developing social problems that are known risk factors for trachoma. It is also a destination for many migrants who may be introducing active trachoma into the area. This study aimed to determine the prevalence and risk factors for follicular trachoma and trichiasis in Brikama.
  
  
  METHODS
  A community-based cross-sectional prevalence survey including 27 randomly selected households in 12 randomly selected enumeration areas (EAs) of Brikama. Selected households were offered eye examinations, and the severity of trachoma was graded according to WHO's simplified grading system. Risk factor data were collected from each household via a questionnaire.
  
  
  RESULTS
  The overall prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years was 3.8% (95% CI 2.5-5.6), and the overall prevalence of trichiasis in adults aged ≥15 years was 0.46% (95% CI 0.17-1.14). EA prevalence of TF varied from 0% to 8.4%. The major risk factors for TF were dirty faces (P < 0.01, OR = 9.23, 95% CI 1.97-43.23), nasal discharge (P = 0.039, OR = 5.11, 95% CI 1.08-24.10) and residency in Brikama for <1 year (P = 0.047, OR = 7.78, 95% CI 1.03-59.03).
  
  
  CONCLUSIONS
  Follicular trachoma can be considered to have been eliminated as a public health problem in Brikama according to WHO criteria. However, as the prevalence in some EAs is >5%, it may be prudent to include Brikama in surveillance programmes. Trichiasis remains a public health problem (>0.1%), and active case finding needs to be undertaken.
authors.affiliation: School of Medicine, University of Birmingham, Birmingham, UK.
authors.forename: E
authors.initials: E
authors.lastname: Quicke
authors.forename: A
authors.initials: A
authors.lastname: Sillah
authors.forename: E M
authors.initials: EM
authors.lastname: Harding-Esch
authors.forename: A
authors.initials: A
authors.lastname: Last
authors.forename: H
authors.initials: H
authors.lastname: Joof
authors.forename: P
authors.initials: P
authors.lastname: Makalo
authors.forename: R L
authors.initials: RL
authors.lastname: Bailey
authors.forename: S E
authors.initials: SE
authors.lastname: Burr
mesh_terms: D001766:Blindness / Q000209:etiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D002692:Chlamydia trachomatis; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration; D005145:Face; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D006920:Hygiene; D007223:Infant; D008297:Male; D009093:Mucus; D009666:Nose; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014141:Trachoma / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D014171:Transients and Migrants; D058457:Trichiasis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D014505:Urban Population
keywords: The Gambia; prevalence; trachoma; trichiasis; urban
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