School-Based versus Community-Based Sampling for Trachoma Surveillance

Joseph P. Sheehan Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California;
Department of Ophthalmology, University of California, San Francisco, San Francisco, California;

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Sintayehu Gebresillasie The Carter Center Ethiopia, Addis Ababa, Ethiopia;

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Ayalew Shiferaw The Carter Center Ethiopia, Addis Ababa, Ethiopia;

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Solomon Aragie The Carter Center Ethiopia, Addis Ababa, Ethiopia;

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Zerihun Tadesse The Carter Center Ethiopia, Addis Ababa, Ethiopia;

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Demelash Tadesse Goncha Siso Enese Woreda Education Office, Amhara Region, Ethiopia;

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Thanapong Somkijrungroj Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California;

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Nicole E. Stoller Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California;

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E. Kelly Callahan The Carter Center, Atlanta, Georgia;

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Paul M. Emerson The Carter Center, Atlanta, Georgia;

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Thomas M. Lietman Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California;
Department of Ophthalmology, University of California, San Francisco, San Francisco, California;
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California;
Institute for Global Health, University of California, San Francisco, San Francisco, California

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Jeremy D. Keenan Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California;
Department of Ophthalmology, University of California, San Francisco, San Francisco, California;

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Trachoma surveillance is typically performed via random sampling of endemic districts. This strategy minimizes bias and allows examination of preschool children, but is also expensive. Surveillance for some other neglected tropical diseases is carried out in schools, which is logistically easier. In the present study, the prevalence of trachomatous inflammation–follicular (TF) from a population-based sample of children from each of 70 communities in Ethiopia was compared with the corresponding school-based estimate, which was calculated for each community by performing examinations in all primary schools in the district. The overall prevalence of TF was 39.1% (95% confidence interval [CI]: 35.0–43.1%) among children aged 1–9 years in the community-based sample and 18.8% (95% CI: 15.9–21.7%) among children in grades 1–3 of the school-based sample. School-based estimates of TF explained 35% of the variation in the community-based prevalences (P < 0.001). When TF prevalence was used as a diagnostic test for detecting a community with > 5% prevalence of ocular chlamydia, the area under the receiver operating characteristic curve was 0.73 (95% CI: 0.60–0.85) for the school-based sample and 0.71 (0.58–0.83) for the community-based sample (P = 0.76). Thus, although school-based monitoring was necessarily biased relative to population-based monitoring of 1- to 9-year olds, the two methods provided a similar amount of information about the community burden of ocular chlamydia in this trachoma-hyperendemic setting. The generalizability of these findings to areas with less prevalent trachoma is unclear.

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Author Notes

Address correspondence to Jeremy D. Keenan, Francis I. Proctor Foundation, University of California, San Francisco, 513 Parnassus Ave., MedSci S334B, San Francisco, CA 94143. E-mail: jeremy.keenan@ucsf.edu

Authors’ addresses: Joseph P. Sheehan, Thanapong Somkijrungroj, and Jeremy D. Keenan, Francis I. Proctor Foundation and Department Francisco, CA, E-mails: jsheehan@uw.edu, thanapongmd@gmail.com, and jeremy.keenan@ucsf.edu. Sintayehu Gebresillasie, Ayalew Shiferaw, and Solomon Aragie, The Carter Center Ethiopia, Addis Ababa, Ethiopia, E-mails: sintayehugs@gmail.com, ayalew.shiferaw@cartercenter.org, and solomon.aragie@cartercenter.org. Zerihun Tadesse and E. Kelly Callahan, The Carter Center, Trachoma Control Program, Addis Ababa, Ethiopia, E-mails: zerihun.tadesse@cartercenter.org and kelly.callahan@cartercenter.org. Demelash Tadesse, Goncha Siso Enese Woreda Education Office, Amhara Region, Ethiopia, E-mail: demelasht67@gmail.com. Nicole E. Stoller and Thomas M. Lietman, Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, E-mails: nicolestoller@gmail.com and tom.lietman@ucsf.edu.

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