title: Agreement between novice and experienced trachoma graders improves after a single day of didactic training.
abstract: OBJECTIVE
  Prevalence estimates and treatment decisions for trachoma are based entirely on ocular clinical examination. The aim of the current study is to demonstrate that ophthalmic assistants can be trained and certified to provide trachoma grading within a single day.
  
  
  METHODS
  Conjunctival photographs from an area with endemic trachoma were randomised into two sets of 60 cases. Photographs were graded for trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI) by three experienced graders. Inter-rater reliability of eight ophthalmic assistants and three experienced graders were compared before and after training.
  
  
  RESULTS
  The mean κ agreement between the ophthalmic assistants and the consensus grades of the experienced graders for TF was 0.38 (95% CI 0.18 to 0.58) before training, and increased to 0.60 (95% CI 0.42 to 0.78) after training (p=0.07). The mean κ agreement for TI was 0.16 (95% CI 0.02 to 0.30) before training, and increased to 0.39 (95% CI 0.20 to 0.58) after training (p=0.02).
  
  
  CONCLUSIONS
  A single day of training improves agreement between prospective and experienced trachoma graders, and provides the basis for certification of workers who are able to accurately grade trachoma and generate reliable prevalence estimates.
authors.affiliation: Geta Eye Hospital, Geta, Dhangadhi, Nepal.
authors.forename: Bidya P
authors.initials: BP
authors.lastname: Prasad
authors.affiliation: Geta Eye Hospital, Geta, Dhangadhi, Nepal.
authors.forename: Ramesh C
authors.initials: RC
authors.lastname: Bhatta
authors.affiliation: Geta Eye Hospital, Geta, Dhangadhi, Nepal.
authors.forename: Jsp
authors.initials: J
authors.lastname: Chaudhary
authors.affiliation: National Trachoma Program, Nepal Netra Jyoti Sangh, Tripureswor, Kathmandu, Nepal.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Sharma
authors.affiliation: National Trachoma Program, Nepal Netra Jyoti Sangh, Tripureswor, Kathmandu, Nepal.
authors.forename: Sailesh
authors.initials: S
authors.lastname: Mishra
authors.affiliation: F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.
authors.forename: Puja A
authors.initials: PA
authors.lastname: Cuddapah
authors.affiliation: F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Stoller
authors.affiliation: F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.
authors.forename: Sun N
authors.initials: SN
authors.lastname: Yu
authors.affiliation: F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.
authors.forename: Salman A
authors.initials: SA
authors.lastname: Rahman
authors.affiliation: Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Deiner
authors.affiliation: F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.affiliation: F.I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Gaynor
mesh_terms: D002568:Certification; D003228:Conjunctiva / Q000473:pathology*; D003657:Decision Making; D006801:Humans; D010781:Photography / Q000145:classification*; D010808:Physical Examination / Q000145:classification*; D015995:Prevalence; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014141:Trachoma / Q000145:classification* / Q000175:diagnosis*
keywords: Eye (Globe)