TRACHOMA SURVEY REPORT

JINJA DISTRICT

SEPTEMBER 2008

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TABLE OF CONTENTS

Acronyms ................................................................................................................................... 3

Foreword .................................................................................................................................... 4

Executive Summary ................................................................................................................... 5

1.0 Introduction ................................................................................................................... 7

2.0 Background .................................................................................................................... 9

2.1 Global Situation ................................................................................................... 10 2.2 Literature Review ............................................................................................... 10

3.0 Trachoma in Uganda .................................................................................................. 11

4.0 Risk Factors for Active Disease ................................................................................. 12

4.1 Water ..................................................................................................................... 12 4.2 Flies ....................................................................................................................... 12 4.3 Cattle ...................................................................................................................... 13 4.4 Hygiene .................................................................................................................. 13 4.5 Crowding ............................................................................................................... 13

5.0 Control Strategies ....................................................................................................... 13

5.1 Control Strategies in Uganda ................................................................................. 14 6.0 Rationale for the Surveys ........................................................................................... 15

7.0 Aim of the surveys ....................................................................................................... 15

8.0 Objectives of the surveys ............................................................................................. 15

9.0 Methodology ................................................................................................................ 16

9.1 Planning ................................................................................................................ 16 9.2 District survey team ............................................................................................... 16 9.3 Study setting .......................................................................................................... 17 9.4 Sampling methodology .......................................................................................... 19

9.4.1 Sample size ...................................................................................................... 19 9.4.2 Sampling Procedure ......................................................................................... 19

9.5 Procedure of fieldwork .......................................................................................... 20 9.5.1 Household selection ......................................................................................... 20 9.5.2 Interviews and examination ............................................................................. 20

9.6 Ethical issues ........................................................................................................ 21 9.7 Data management ................................................................................................. 21

10.0 Results ........................................................................................................................ 22

10.1 Response Rate ........................................................................................................ 22 10.2 Able to read ........................................................................................................... 22 10.3 Education Status of study Population .................................................................... 23 10.4 Source of water ...................................................................................................... 23 10.5 Time to walk to main source ................................................................................. 24 10.6 Availability of water throughout the year .............................................................. 24 10.7 Garbage Disposal ................................................................................................... 25 10.8 Presence of Cowpen .............................................................................................. 25 10.9 Distance Pen from Household ............................................................................... 25 10.10 Bicycle and Radio Ownership ............................................................................... 26

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10.11 Toilet facility ......................................................................................................... 26 10.12 Human excreta in Surroundings ............................................................................ 27 10.13 Garbage within 15m from the house ..................................................................... 27 10.14 Time lived in Parish ............................................................................................... 28 10.15 Facial cleanliness .................................................................................................. 28 10.16 Knowledge about face washing and trachoma ...................................................... 28 10.17 Environment and trachoma .................................................................................... 29 10.18 TT & CO Cases ..................................................................................................... 29 10.19 TF Cases ................................................................................................................ 29 10.20 Practicing Epilation ............................................................................................... 30 10.21 Evidence of epilation ............................................................................................. 30 10.22 TT surgery ............................................................................................................. 30 10.23 Cataract .................................................................................................................. 30 10.24 Summary of some variables within parishes ......................................................... 31

11.0 Discussion ................................................................................................................... 32

12.0 Conclusions ................................................................................................................ 34

13.0 Recommendations ...................................................................................................... 34

REFERRENCES ..................................................................................................................... 36

ACKNOWLEDGEMENT ....................................................................................................... 37

APPENDICES ......................................................................................................................... 37

Summary of vital variables within the surveyed parishes ................................................... 38 Survey questionnaires .......................................................................................................... 39

 

 

 

 

 

 

 

 

 

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Acronyms  CMD - Community Medicine Distributors

CO - Corneal Opacity

GDP - Gross Domestic Product

HHs - Households

HSSP II - Health Sector Strategic Plan, second phase

ITI - International Trachoma Initiative

MDA - Mass Drug Administration

MOH - Ministry of Health

NTDs Neglected Tropical Diseases

OA - Ophthalmic Assistant

OCO - Ophthalmic Clinical Officer

PPS -Probability Proportionate Sampling

RTI -Research Triangle Institute

SAFE - Surgery, Antibiotics, Face washing, Environmental improvement

TF - Trachomatous inflammation Follicular

TI - Trachomatous inflammation intense

TOT - Trainer of Trainers

TS - Trachomatous scarring

TT - Trachoma trichiasis

UBOS - Uganda Bureau of Statistics

UDHS - Uganda Demographic and Health Survey

USAID United States Agency International Development

WHO - World Health Organization

 

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  Foreword  The Ministry of Health and Eye Care Development partners are glad that data on Trachoma

and the associated risk factors in the suspected endemic districts in the country continue to be

enriched through prevalence studies. This information is crucial for proper planning and

management of programmes targeting the control and elimination of Trachoma.

The National Health policy and Health Sector Strategic Plan11 (HSSPII) emphasize delivery

of a minimum Health care package in order to efficiently and equitably address most of the

pressing health problems in the country. Eye care is one of the key components of this

minimum health care package. Trachoma is one of the diseases being targeted for elimination

in HSSP II.

In order to achieve this goal, it is necessary to bring on board all our Development Partners

involved in eye care so as improve resource mobilization, coordination and networking.

These elements are key for proper response to the Trachoma burden in our communities.

The report presents findings of the population-based surveys conducted in May 2008 in Jinja

district. Trachoma burden and the associated risk factors are clearly outlined in this report so

as facilitate health care intervention programmes with relevant information for proper

planning and management. All policy makers and implementers at all levels (National,

Regional, Districts and Health Sub districts) should therefore take advantage of this

information during implementation of the SAFE Strategy. Until recently, various

stakeholders were implementing isolated and not well coordinated Trachoma control

programmes based on Trachoma Rapid Assessments and not addressing all components of

SAFE Strategy. This state of affairs cannot offer sufficient opportunity to control and

eliminate trachoma.

The challenges ahead of us are: to mobilize resources for Surveys in the remaining endemic

districts, to raise awareness about the need to control Trachoma, to properly implement and

monitor SAFE strategy at all levels, and to strengthen intersectoral collaboration and

promotion of integration. It is our strong belief that if these challenges are adequately

addressed Trachoma Control and Elimination will be achieved.

Dr.Sam Zaramba

Director General Health Services

Ministry of Health.

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  Executive  Summary   In its 5 year Health Sector Strategic Plan (HSSP II), MOH earmarked Trachoma for

elimination from the 24 affected districts. The government is implementing the SAFE

strategy using a multi-pronged approach at national and district levels. One of the activities is

mass distribution of antibiotics in seven districts with TF prevalence of 10% and above. Jinja

is among the suspected endemic districts, which should benefit from MDA. However,

Trachoma prevalence data for this district is not available yet it is a requirement that this

should be defined if it is to benefit from the Pfizer-donated Azithromycin. This donation is

coordinated by the International Trachoma Initiative (ITI).

Trachoma Prevalence studies in this district was conducted under the guidance of a National

Trachoma Task Force which was mandated by the National Prevention of Blindness

Committee (NPBC) of MOH. Funds were availed by Sight Savers International (SSI).

The survey was conducted using the WHO standardized protocol. The research team

comprised of Ophthalmologist and Ophthalmic Clinical Officers. The aim was to estimate the

prevalence of trachoma and its risk factors in the district. We intend to use the results to guide

trachoma control activities and as a baseline for assessing the impact of the control

programme in the district.

Twenty parishes (clusters) were selected in the district by systematic random sampling with

PPS. In each cluster 34 households were randomly selected and all eligible individuals:

children 1-9 years old and persons aged 15 years and above were enumerated and those

present during household visits were included in the study after obtaining consent. Cases with

active trachoma were given 1% tetracycline eye ointment and those with TT were given

appointment for corrective lid surgery at the nearest health facility.

The district has a population of 1,555,600 (UBOS Projected Population 2008) people. The

study included 1805 children 1-9 years old and 1732 individuals aged 15 years old and above.

The overall response rate in the district was 80.7%. The prevalence of TF was 10.1%, TT

2.1% and CO 0.6%.

Water availability throughout the year was 96%.

Facial cleanliness among children 1-9 years was 75%.

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Toilet ownership was 84.9% while garbage disposal practices was generally poor with about

69.8% of the households throwing in the surroundings.

The results from this survey show that Trachoma is a significant public health problem in

Jinja district. There is need to initiate Trachoma Control activities and integrate them in the

existing PHC services in the district.

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1.0    Introduction  The Republic of Uganda is located in East Africa and lies astride the equator. It is a land

locked country bordering Kenya in the east, Tanzania in the south, Rwanda in the southwest,

Democratic Republic of Congo in the west, and Sudan in the North. The country has an area

of 241,039 square kilometers and is administratively divided into 81 districts.

Uganda has a decentralized system of governance and several functions have been ceded to

the local governments. However, the central government retains the role of policymaking,

setting standards and guidelines, supervision, monitoring and evaluation.

Uganda has a favorable climate because of its relatively high altitude. The Central, Eastern,

and Western regions of the country have two rainy seasons per year, with heavy rains from

March to May and light rains between September and December. The level of rainfall

decreases towards the North, turning into one rainy season a year. The soil fertility varies

accordingly, being generally fertile in the Central and Western regions and less fertile in the

East and North. Due to the combinations of climatic conditions, Uganda’s vegetation varies

between tropical rain forest in the South, Savannah woodlands in the north and semi-desert

vegetation in the north-east. The climatic conditions determine the agricultural potential and

thus the land’s population carrying capacity, with high population densities in the Central and

Western regions and declining densities towards the North.

The economy is predominantly agricultural with the majority of the population dependent on

subsistence farming and agro-based industries. The country is self sufficient in food, although

the distribution is uneven in some areas. Coffee, Tea, and cotton are the major foreign

exchange earners. During the period immediately following independence, from 1962 to

1970, Uganda had a flourishing economy with a Gross Domestic Product (GDP) growth rate

of 5% per annum, compared with a population growth rate of 2.6% per annum. However, in

the 1970s through to early 1980s, Uganda experienced a period of civil and military unrest,

resulting in the destruction of the economic and social infrastructure. This seriously affected

the growth of the economy and the provision of social services such as education and health

care.

Since 1986, however, the government has introduced and implemented several reform

programmes that have steadily reversed the set backs and steered the country towards

economic prosperity. Consequently, between 1996 and 2000, the country’s GDP grew at an

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average rate of 6.2% per annum. This is far higher than the population growth rate, which

was estimated at 2.9%with per capita growth rate of 2.6% per annum. It is therefore hoped

that if this positive economic change is sustained, Uganda may be able to address some of the

pressing health problems such as Trachoma in the near future.

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2.0  Background  

Basing on previous surveys and routine data from district reports, Trachoma is thought to be

endemic in 24 districts. It is estimated that about 700,000 children below 10 years of age have

active disease and about 7 million people are at risk of being infected. It is further estimated

that 12,000 people are blind from trachoma while 35,000 have blinding trachomatous

trichiasis (TT).

Trachoma is the leading cause of preventable blindness in the developing countries. The

population in these areas is at risk of blindness because of poor living conditions i.e. dry rural

areas, poor environmental sanitation, inadequate water supply and generally poor socio-

economic status.

Trachoma is caused by Chlamydia trachomatis, a bacterium transmitted by direct spread of

infected ocular material from one person to another. The spread of trachoma is by flies

(Musca sorbens), fingers and formites. The environmental risk factors that facilitate

transmission include dry environment, dirty home environment and discharge (on face, eyes,

nose & ears) from the infected individual. Trachoma is a disease of poverty particularly

affecting children and their mothers.

The World Health Organization (Thylefors et al, 1987) has graded trachoma into five main

categories: Trachomatous inflammation follicular (TF), Trachomatous inflammation intense

(TI), Trachoma Scarring (TS), Trachomatous Trichiasis (TT) and Corneal Opacity (CO).

Trachomatous inflammation follicular and Trachomatous inflammation intense are the active

grades of trachoma and are more common in children who act as a reservoir for infection. Re-

infections perpetuate severe tarsal conjunctival inflammation leading to scarring and

trichiasis.

Trichiasis (in-turning of eye lashes) leads to constant rubbing on the cornea, causing corneal

ulcerations which heal by scaring and thus leading to corneal opacity. Corneal opacity over

the pupil leads to substantial visual loss and this usually occurs in mid to late adulthood.

Blinding trachoma is more common in females than males and this is attributed to the role of

women as caretakers of children who are the main reservoir of infection. A community with

blinding trachoma is one in which a substantial proportion of individuals have visual loss due

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to corneal opacity from trachoma (CO) and one in which a substantial proportion of children

have severe trachoma inflammation intense (TI).

2.1 Global Situation Trachoma is the leading cause of preventable blindness globally and is responsible for 1.3

million cases of blindness, which is 3.6% of global blindness. At a recent WHO meeting it

was estimated that trachoma is endemic in 56 countries. These are mainly in Africa, Asia,

Middle East, Latin America and Australia. It is also estimated that 84 million people have

active trachoma while 7.6 million have Trichiasis requiring corrective surgery.

This denotes a decrease in the global burden of disease possibly due to concerted efforts by

national programmes, improved political and professional commitments to prevention of

blindness plus patient awareness and socio- economic development.

2.2 Literature Review In order to tackle trachoma in a community, it is important to assess the prevalence of

trachoma in that community. This survey can look for active inflammatory trachoma (TF &

TI) in 1-9 year old children and for blinding trachoma (TT & CO) in adults.

The proportion of TF with or without TI among children less than 10 years will demonstrate

how widespread the infection is in the community. The proportion of TI in children less than

10 years will demonstrate how severe the disease is in the community. The proportion of

conjunctival scarring (TS) demonstrates how common trachoma was in the past, while TT

indicates the immediate need for surgical services for lid correction and the proportion of

people with corneal opacity will demonstrate the impact of trachoma in the community in

terms of visual loss.

Trachoma is no longer a public health problem in the western world but continues to be a

major cause of blindness in the developing countries. In these countries trachoma is found

mainly in the economically under-developed areas without adequate water and basic

sanitation services.

Trachoma is an infectious disease and transmission can occur by sharing clothes, towels or

overcrowded sleeping quarters and is therefore passed among family members in households

that are in close proximity.

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Age distribution of different signs of trachoma depends on endemicity of the disease in the

community. In hyper-endemic areas, active disease is most common in preschool children. In

some cases prevalences as high as 60-90% (West et al 1991). The prevalence of active

trachoma decreases with increasing age. In areas where trachoma has been endemic for a

long time, the presence of conjunctival scars increases with age.

As a general pattern, females seem to be at a higher risk of having every sign of trachoma as

compared with males especially the blinding stages of TT & CO. This excess risk among

women is believed to be related to the relatively closer contact they have with young children

who are the main reservoir of infection (Congdon et al 1993).

3.0       Trachoma  in  Uganda  Trachoma remains uncontrolled in the areas of high prevalence. Routine screening systems

like school examinations are no longer done, there is no organized community education even

in endemic areas, and amount of medications provided in the drug kit for health facilities are

insufficient.

Few studies have been carried out in Uganda to determine the prevalence of trachoma.

In Matheniko sub county of Moroto district, Okwana et al 1984, (using the McCallam’s

classification) found a prevalence of stage I trachoma in 3.6% and stage II trachoma in 27%

of children 0-9 years old.

Another study, done in Jie County in Kotido district (Siegelaar et al 1996) to establish the

prevalence of trachoma, revealed 29.6% prevalence of active trachoma (TF) among children

1-8yrs.

A study in Nakepelimoru Sub-county in Kotido district (Eretu et al 1999) revealed a

prevalence of 33% for active trachoma (TF) among children 1-10 years.

In a study done in Moroto district (Emusu et al 2000), the prevalence of blindness due to

trachoma was 3.7% and the prevalence of active trachoma (TF) in children 1-10 was 38%.

In Mayuge district the prevalence of TF was 18.1% in children 1-9 years, TT was 11.8% and

CO 7.7% (Nseko 2003).

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A study to identify blinding trachoma in Kabale district (Mayeku 2004) revealed a prevalence

of 14% of active trachoma (TF) in children 1-9 years and blinding trachoma (TT) in 9% of

persons 15 years and above in three sub-counties.

More recent prevalence studies have been carried out in Karamoja region (Kotido, Kabong,

Abim) and Busoga Region,( Iganga, Kaliro , Kamuli and Namutumba districts) The results

from these studies indicate that Karamoja region TF prevalence was 65.7% while in Busoga

region it ranged from 20.1% to 33.6%. (Trachoma Survey Report MOH, July 2006).

 

4.0       Risk  Factors  for  Active  Disease  Blinding Trachoma remains a problem where living conditions facilitate continuous

transmission of Chlamydia trachomatis among family members.

4.1 Water Lack of water leading to poor hygiene conditions, has been associated with the risk of

trachoma although other studies have found that hygiene conditions don’t follow

automatically from provision of a convenient water point. Several population-based cross-

sectional studies have found a positive association between the distance from the household

to the water source and the prevalence of active trachoma in the household or among

children. However, a study in Ethiopia (Zerihum N, 1997) found that villages further away

from a water source had less trachoma than those within 15 minutes’ walk to a water point.

4.2 Flies One of the earliest risk factors noted for trachoma was the presence of flies. Prevalence

studies in Tanzania have found an association between fly density in the household or the

presence of flies on children’s faces and the presence/severity of trachoma (Taylor et al 1989)

Flies act as physical vectors for transmission of Chlamydia trachomatis. The responsible

vector, Musca sorbens, preferentially breeds in human excreta on the ground surface

(Emerson PM et al, 2001). Fly control with insecticides reduced trachoma prevalence by 61%

in the study villages in The Gambia (Emmerson PM and Bailey RL, 1999)

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4.3 Cattle Presence of cattle has been associated with trachoma in some prevalence studies in African

countries. Emmerson and colleagues found that Musca sorbens also breeds in livestock

excreta so presence of livestock dung in the household proximity increases the fly population.

4.4 Hygiene Poor hygiene conditions favor the transmission of Chlamydia trachomatis through contact

with ocular and other secretions (Jones 1980). The presence of functional latrines near the

house has been associated with lower trachoma prevalence in different cross-sectional

surveys. A study in Egypt (Courtright P. et al, 1991) found a lower prevalence of trachoma in

homes with pit latrines than those without. The latrines may be a marker for families with

better hygiene practices. Improved hygiene reduces the fly population in homes and the

surroundings.

4.5 Crowding Crowded living conditions in the family unit seem to increase the risk of trachoma. This is

due to more exposure to infection or disease via close contact with infected or diseased

individuals through the sharing of sleeping rooms. In Malawi, Thielsh JM and colleagues

found a close correlation between crowding and a higher prevalence of trachoma in

households.

5.0       Control  Strategies  In 1997, WHO formed an Alliance to work towards the Global Elimination of Trachoma by

year 2020 (GET2020) using the SAFE strategy. This is contained in the Vision 2020 program

for the Global elimination of Avoidable blindness by year 2020:

The International Trachoma Initiative (ITI) was established in 1999 by the Edna McConnell

Clark Foundation & Pfizer Inc. to spearhead the elimination of trachoma through the SAFE

strategy.

SAFE involves:

S- Surgery to correct trichiasis

A- Anti biotic to treat infection

F- Facial cleanliness

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E- Environmental improvement to interrupt transmission of Chlamydia trachomatis.

The evidence base supporting the cost- effectiveness of the different components of the

SAFE strategy is varied but S and A have been reported to be cost-effective especially if

surgery is done in the community by trained personnel and mass antibiotic distribution is

implemented. Tetracycline is an effective anti-chlamydial agent. However tetracycline eye

ointment is difficult and unpleasant to apply and compliance for a full six-week course is

poor. During the 1990s, it was shown that ocular C. trachomatis infections can successfully

be cleared with a single oral dose of the Azithromycin antibiotic and that treatment of all

communities is practical, and effective. However, coverage is a critical determinant of

recurrence after mass treatment. Less recurrence is reported when coverage is over 80% of

the target population.

5.1 Control Strategies in Uganda

The MOH Uganda adopted the WHO Strategy of integrated disease control in 2004.

Trachoma is among the diseases targeted for elimination in the HSSP II (2006-10).

In 2007, Uganda was identified as one of the first five fast track countries to implement

an integrated NTD programme for 5 diseases, Trachoma inclusive. This has enabled more

prevalence studies to establish disease burden. Other interventions so far done include;

♦ Development of Training manuals for CMDs and TOTs.

♦ Training of central Trainers, Sub county Supervisors and CMDs

♦ Registration of eligible population for MDA

♦ Procurement of Azithromycin and conducting the first ever-massive

distribution in seven districts.

♦ Support Supervision of the integrated NTD activities and post MDAs.

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6.0       Rationale  for  the  Surveys  For a long time Trachoma has been known to be a public health problem in Busoga and

Karamoja regions. Recent prevalence studies carried out in Kotido, Kabong, Moroto,

Nakapiripirit, Abim, Iganga, Kaliro, Kamuli, Bugiri, Mayuge and Namutumba districts have

shown that Trachoma still remains a public health problem in these areas.

From the data of the Uganda trachoma mapping exercise done in 2003 eighteen districts (later

re-demarcated into twenty four) were Trachoma endemic. However, the exact prevalence and

pattern of trachoma in the districts was not known. To date the prevalence is known in eleven

of these.

The Ministry of Health intends to continue establishing the magnitude of the trachoma

burden in the remaining suspected endemic districts and institute measures to control or

eliminate trachoma.

The SAFE strategy was endorsed by Government and there is an opportunity to benefit from

the donation of the Azithromycin antibiotic by Pfizer Inc. for mass distribution to the affected

communities. The drug is donated through the International Trachoma Initiative (ITI), which

requires the prospective recipients to provide epidemiological data on trachoma prevalence at

district level using a standardized format for population-based surveys.

7.0  Aim  of  the  surveys  • To estimate the prevalence of trachoma and its risk factors in Jinja

8.0  Objectives  of  the  surveys  • To estimate the prevalence, pattern and distribution of trachoma in Jinja.

• To determine the existence of the known risk factors associated with trachoma

• To identify and prioritize target areas for control interventions.

• To establish baselines for monitoring and evaluation and assessing the impact of control

programmes.

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9.0       Methodology  

9.1 Planning The Ministry of Health prioritized Trachoma for elimination in the 24 affected districts using

the SAFE strategy (HSSP II: 2005-2009)

An interim National Trachoma Task Force was formed and a Training of Trainers (TOT)

workshop was organized in September 2005 and facilitated by ITI experts. The purpose was

to train a national core team comprising a Senior Consultant Ophthalmologist, Regional

ophthalmologists covering the affected districts, the National Eye Care Coordinator and NGO

eye care managers. The task force was appraised on the survey methodology using the WHO

standard protocol for baseline trachoma surveys and mandated to organize and conduct

baseline trachoma surveys in the suspected endemic districts. Several consultative and

planning meetings were held to make the survey timetable, develop questionnaires, organize

logistics and constitute the district survey teams. The survey team was trained prior to the

fieldwork.

9.2 District survey team The team was selected by the respective Regional ophthalmologist in consultation with the

District Health Officer and the District Ophthalmic Clinical Officer. The composition of each

district survey team was:

• Ophthalmologist

• 12 Ophthalmic Clinical officers1

• Drivers

• Guides- these were civic or political leaders or community resource persons.

• The District Health Officer linked the team to the District leadership, secured the

permission for conducting the survey and offered some logistical support to the team.

The district survey team underwent a one-day training by the National Trachoma Task Force

members and a statistician. The day was for reorientation training in the WHO standardized

methodology for Trachoma baseline surveys, WHO simplified Trachoma grading system,

using the questionnaires, ethical issues and guidelines for fieldwork. Standardization and

inter-observer agreement were ensured by using a gallery of standard WHO grading system

slides with hidden answers, for the training. Each team member made a record of the grading

for a series of projected slides and exchanged the answers for marking by colleagues. A 1 Ophthalmic Clinical Officer is a medical worker with a diploma in ophthalmology.

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minimum of 80% concordance for all research assistants was ensured during the slide session

before proceeding for pre-testing of questionnaires. The survey programme was made and

dispatched to the respective parish leaders together with a letter from the District Health

Office urging for community mobilization and sensitization for the survey. The

ophthalmologists strictly verified the research assistants’ examination findings during the pre-

test and especially the first week of the survey.

Study Design

♦ The survey was a population-based cross-sectional study using the WHO standardized

protocol for trachoma baseline surveys where the district is the survey universe.

9.3 Study setting ♦ The survey was conducted in Jinja district in May 2008. In the district, 20 clusters

(parishes) were pre-selected for the survey. The type of settlement in Jinja is urban,

peri-urban and rural.

Map 1: Map of Uganda highlighting the surveyed district.

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9.4 Sampling methodology

 9.4.1    Sample  size  The sample size was calculated using the formula:

Where:

§ n = minimum number of respondents required for the survey

• p = anticipated population prevalence

• d = level of absolute precision: should be as small as resources allow

• Z1-α for 95% confidence level = 1.96

• Non-response rate (10%): added to sample size to compensate for expected attrition

in study subjects

• Design effect: a multiplier used to correct for an increase in sampling variability

introduced by cluster sampling

The sample size for TF was calculated as 956 children 1-9 years and for TT & CO was 1656

persons 15 years and above.

Based on the average household size of 4.7 in Uganda, the number of households required

per cluster was calculated to be 35. All eligible individuals: children 1-9 years old and

persons 15 years or older were enumerated and those who were present and consented were

examined.

9.4.2    Sampling  Procedure  ♦ The number of parishes and their populations were ascertained from the population

data availed by the District Population Offices. Village household registers were also

available in some villages.

♦ The sampling frame for parishes was developed.

♦ Systematic random sampling with probability proportional to size (PPS) was used for

the primary sampling units. In each district 20 parishes were selected.

♦ Households were selected by systematic random sampling using the village registers.

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9.5 Procedure of fieldwork

9.5.1    Household  selection  The survey team had obtained population data of the survey districts prior to cluster selection.

The parish populations, the number and names of LC1s (villages) and the number of

households per village were therefore available to the team. The required number of

households in a parish was divided by the number of villages in the parish to determine how

many households to visit in each village.

The households to visit were selected by systematic random sampling with equal probability:

the total number of households in the village was divided by the required number of

households to get the sampling interval (SI). A random number between 1 and the SI was

generated by a lottery method. This random number represented the first household on the list

of villages. Subsequent households were selected by adding the SI to the previous household

number until the required number of households was obtained.

Each selected household was visited with the help of guides. Verbal consent was obtained

from the household heads or their representatives before proceeding with the interviews. The

purpose of the survey was briefly explained in areas where prior sensitization had not been

done. The selected households were allocated serial numbers and the research assistant(s)

were assigned specific households and a record of the allocated households was kept by the

supervisors. This was necessary for cross-checking and collating data from the field.

9.5.2    Interviews  and  examination  The parish questionnaires were mainly administered by the supervisors during the brief

consultations with the parish leaders on the day of the survey. The teams were split into

smaller groups of 2-4 interviewers and each group covered a village or more depending on

the need. The supervisors joined the groups and participated in data collection. All eligible

individuals in a selected household who were aged 1-9 and 15 or more years were examined

in bright daylight or using a torch with a x2.5 magnifying loupe. Children with active

trachoma infection were given 1% Tetracycline eye ointment with instructions on dosage to

the parents. Individuals with trichiasis were registered, had their visual acuity taken and

advised to seek corrective lid surgery at the nearest health facility.

Households with absent individuals were revisited. At the end of the day’s fieldwork all

research assistants checked their data for completeness before handing them to the

supervisors for cross-checking. Necessary corrections were made and the questionnaires

filed.

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9.6 Ethical issues ♦ Ethical clearance was sought from the district authorities and adherence to the

stipulated ethical guidelines was ensured during the survey.

♦ Examination of household members was done after securing consent from heads of

households and eligible members or their parents/guardians.

♦ All cases requiring corrective lid surgery were referred to the nearest health unit for

surgery as soon as possible while those with active trachoma were treated with

tetracycline eye ointment.

9.7 Data management ♦ Collected data was edited in the field by the supervisors, compiled, coded, filed

according to clusters and submitted to data entry Unit.

♦ Data cleaning was done for consistencies.

♦ Data was merged and exported to STATA 9 for analysis.

♦ Univariate analysis was done for frequencies and other descriptive statistics.

22

  10.0       Results  

10.1 Response Rate

Age Group Total Eligible Total Interviewed Response rate Male Female Total Male Female Total Male Female Total

1-9 885 920 1,805 821 868 1,689 92.8 94.3 93.6 15-19 134 187 321 76 149 225 56.7 79.7 70.1 20-24 55 142 197 30 127 157 54.5 89.4 79.7 25-29 63 134 197 28 119 147 44.4 88.8 74.6 30-34 96 142 238 29 122 151 30.2 85.9 63.4 35-39 113 105 218 36 89 125 31.9 84.8 57.3 40-44 83 77 160 26 69 95 31.3 89.6 59.4 45-49 74 49 123 31 34 65 41.9 69.4 52.8 50-54 52 38 90 20 36 56 38.5 94.7 62.2 55+ 99 89 188 62 81 143 62.6 91.0 76.1 Total 1654 1,883 3,537 1,159 1694 2,853 70.1 90.0 80.7 A total of 20 parishes, 680 households were covered in Jinja District. The response rate was

93.6% for 1-9 years, while for 15 years and above was 67.2%. . Over all response rate for

females was 90% while for males it was 70.1%

Of 3537 eligible respondents 1805 were aged 1-9 years while 1732 were 15 years and above.

10.2 Able to read

Sex of Respondent

Able to Read read

Yes No Total Male 686 86 772 Percentage 88.9 11.1 100 Female 700 263 963 Percentage 72.7 27.3 100 Total 1,386 349 1,735 Percentage 79.9 20.1 100

Literacy rate in Jinja is higher for males compared to females. In males it stands at 88.9%

while for females it is 72.7%. The over all literacy rate in Jinja is 79.9%

23

10.3 Education Status of study Population Education status in Jinja is that 77.4% of the surveyed populations have ever attended school.

Only 22.6 never attended school.

10.4 Source of water Type of Water

source Number Percent

Piped Water 57 8.4

Public water tap 200 29.5

Deep public well 1 0.2

Hand pump

residence 1 0.2

Public Handpump

well 254 37.4

Public open well 7 1.0

Spring 141 20.8

River Stream 7 1.0

Lake 11 1.6

Total 679 100

The main source of water is from a public hand pump well with 37.4%.Other main sources is

from a public water tap (29.5%) and spring (20.8%)

Age group

None Primary Secondary Post Secondary

Number

5-9 35.2 64.9 0.0 0.0 1,007

15-19 1.3 49.5 46.1 3.1 321 20-24 7.14 42.4 39.8 10.7 196 25-29 11.8 49.7 34.4 4.1 195 30-34 14.8 58.2 22.8 4.2 237 35-39 11.1 58.8 25.0 5.1 216 40-44 15.7 48.4 28.9 6.9 159 45-49 17.1 56.9 22.8 3.3 123 50-54 30.7 50.0 18.2 1.1 88 55+ 48.4 37.2 11.7 2.7 188

Total 22.6 55.6 18.8 3.0 2,730

618 1,518 513 81

Water sources

0 10 20 30 40

Piped Water

Deep public w ell

Public Handpump w ell

Spring

lake

Wat

er s

ourc

e

Percent

Percent

24

10.5 Time to walk to main source

Time Number Percent

Less than 30 minutes 467 68.9

31-60 minutes 174 25.6

61-90 minutes 29 4.3

91-120 minutes 9 1.3

Total 679 100

The majority of household 68.9% reported taking less than 30 minutes to walk to a water

source. 5.6% took more than an hour to walk to a water source.

10.6 Availability of water throughout the year Parish Name Yes No BUGEMBE 33 97.1 1 2.9

BUGOBYA 33 97.1 1 2.9

BUWAGI 33 100.0 0 0.0

BUWEKULA 26 76.5 8 23.5

BUWENDA 34 100.0 0 0.0

CENTRAL_EAST 34 100.0 0 0.0

IZIRU 32 94.1 2 5.9

KAGAIRE 33 97.1 1 2.9

KAGOMA 34 100.0 0 0.0

KASALINA 33 100.0 0 0.0

KAYIRA 27 79.4 7 20.6

KISASI 31 91.2 3 8.8

KITANABA 34 100.0 0 0.0

MAFUBIRA 34 100.0 0 0.0

MASESE 34 100.0 0 0.0

MAWOITO 33 97.1 1 2.9

NAMAGERA 31 91.2 3 8.8

NAWAMPANDA 34 100.0 0 0.0

WAIRAKA 34 100.0 0 0.0

WANSIMBA 33 100.0 0 0.0

TOTAL 650 96.0 27 4.0

Surveyed parishes had availability of water through out the year, the overall availability

standing at 96.0%.

25

10.7 Garbage Disposal

Disposal of Garbage Number Percent

Burn 63 9.38

Refuse pit 84 12.5

Throw in surrounding area 469 69.8

Other 56 8.3

Total 672 100

Surveyed households reported throwing garbage in the surrounding area accounting to 69.8%

10.8 Presence of Cowpen

Cow pen

present

Freq. Percent

Yes 151 22.5

No 520 77.5

Total 671 100

About 22.5% of the households surveyed, reported having a cow pen.

10.9 Distance Pen from Household

Distance of pen from Household

Number

Percent

<11 metres 92 61.3

11-15metres 33 22.0

16-20 metres 7 4.7

More than 24 metres 18 12.0

Total 150 100

It was found out that 83.3% of households surveyed had a cow pen less than 15metres from

the household.

26

10.10 Bicycle and Radio Ownership

Bicycle

Radio

Parish Name Number % age

Number

% age

BUGEMBE 12 35.3 26 76.5 BUGOBYA 24 70.6 25 73.5 BUWAGI 28 82.4 30 88.2 BUWEKULA 19 55.9 27 81.8 BUWENDA 25 73.5 30 88.2 CENTRAL_EAST 3 8.8 33 97.1 IZIRU 25 73.5 22 64.7 KAGAIRE 25 73.5 32 94.1 KAGOMA 26 76.5 25 73.5 KASALINA 21 63.6 31 91.2 KAYIRA 20 58.8 24 70.6 KISASI 27 79.4 25 73.5 KITANABA 26 76.5 30 88.2 MAFUBIRA 22 66.7 27 81.8 MASESE 6 17.7 19 55.9 MAWOITO 20 60.6 26 76.5 NAMAGERA 17 50.0 22 64.7 NAWAMPANDA 24 70.6 24 70.6 WAIRAKA 18 52.9 28 82.4 WANSIMBA 22 66.7 25 75.8 Total 410 60.7 531 78.4

Bicycle and radio ownership in Jinja is high. On average 60.7% of households own a bicycle

while 78.4% own a radio.

10.11 Toilet facility

Toilet Facility Number Percent

Flush Toilet 13 1.9

Shared flush toilet 23 3.4

Traditional pit Latrine 506 74.9

VIP 32 4.7

None 102 15.1

Total 676 100

In the survey findings it was found out that 84.9% of households have a toilet facility. While

those without a toilet facility accounted to 15.1%

Type  of  toilet  f ac ility

0 20 40 60 80

F lush  Toilet

S hared  f lushtoilet

Tradit ional  pitL atrine

VIP

None

P erc ent

P erc ent

27

10.12 Human excreta in Surroundings

Human

faeces near the house Freq. Percent

Yes 62 9.2

No 614 90.8

Total 676 100

The presence of human excreta in surroundings accounted to 9.2%.

10.13 Garbage within 15m from the house

Garbage

within 15m

from House Number

Percent

Yes 534 79.0

No 142 21.0

Total 676 100

It was found that the surveyed parishes were lacking proper garbage disposal. 79 % disposed

garbage within 15m from the household.

Garbage 15m from the House

yes

no

Human excreta in The sorroundings

yes

no

28

10.14 Time lived in Parish Number of years living in current

residence

Number

Percent

<3 years 500 17.5 3-5 years 704 24.7 6-9 years 812 28.5

10-20 years 465 16.3 More than 20 years 373 13.1 Total 2,854 100.0

A big percentage at time of survey had stayed in the parish for more than 5 years which stood

at 57.8%

10.15 Facial cleanliness

Face clean

Number Percent

Yes 1,265 75.0

No 422 25.0

Total 1687 100

Facial cleanliness among children aged 1-9 years stood at 75.0%

10.16 Knowledge about face washing and trachoma

Heard relation

between environment and

trachoma

Number

Percent

Yes 1,034 88.8

No 130 11.2

Total 1,164 100

Knowledge about face washing and trachoma was found out to be 88.8% in Jinja district

29

10.17 Environment and trachoma

Heard relation between

environment and trachoma

Number

Percent

Yes 991 85.1

No 173 14.9

Total 1164 100

Knowledge of environment and trachoma was found to be 85.1%

10.18 TT & CO Cases

Age group

in 5 years TT

CO

15-19 - -

20-24 1 -

25-29 - -

30-34 - -

35-39 - 1

40-44 1 -

45-49 - -

50-54 3 1

55+ 19 5

Total Cases 25 7

Total examined 1164 1164

Prevalence 2.1 0.6

Prevalence of TT in Jinja was found out to be 2.1%. Prevalence of CO is 0.6%

10.19 TF Cases

Age Total

Examined

Total

Cases

TF

Prevalence

1-9 1689 170 10.1

TF Prevalence is 10.1%

30

10.20 Practicing Epilation

Practice epilation Number Percent

Yes 11 44.0

No 14 56.0

Total 25 100

Examined respondents who had TT and had practiced epilation accounted to 44.0%

10.21 Evidence of epilation

Evidence of

epilation Number Percent

Yes 11 44.0

No 14 56.0

Total 25 100

Examined respondents who had TT and had evidence of epilation accounted to 44.0%

10.22 TT surgery

Previous

Surgery

right eye Number Percent

Previous

surgery

left eye Number Percent

Yes 6 24.0 Yes 5 20.0

No 19 76.0 No 20 80.0

Total 25 100.0 Total 25 100.0

10.23 Cataract

Cataract Number Percent

Yes 10 0.9

No 1,149 99.1

Total 1,159 100

31

10.24 Summary of some variables within parishes

Parish Name ,,,,,,,,,,,,,,,,,, ……..

Water through out the

year

Bicycle Radio With Toilet

Feaces within 15m from

house

Cow pen

present

TT CO TF

BUGEMBE 97.1 35.3 76.5 100.0 0.0 0.0 1.4 0 4.8 BUGOBYA 97.1 70.6 73.5 67.7 8.8 32.3 3.6 0 6.0 BUWAGI 100.0 82.4 88.2 82.4 2.9 43.8 0.0 0 13.8 BUWEKULA 76.5 55.9 81.8 82.4 2.9 20.6 2.8 0 15.1 BUWENDA 100.0 73.5 88.2 97.1 12.1 26.5 4.3 1.4 15.6 CENTRAL_EAST 100.0 8.8 97.1 100.0 0.0 3.0 1.6 1.6 25.0 IZIRU 94.1 73.5 64.7 64.7 15.2 26.5 1.8 0.0 13.3 KAGAIRE 97.1 73.5 94.1 97.1 2.9 14.7 4.8 0.0 17.7 KAGOMA 100.0 76.5 73.5 76.5 8.8 27.3 10.2 0.0 17.7 KASALINA 100.0 63.6 91.2 97.1 2.9 23.5 1.7 0.0 6.7 KAYIRA 79.4 58.8 70.6 82.4 14.7 23.5 0.0 0.0 10.6 KISASI 91.2 79.4 73.5 64.7 23.5 17.7 1.5 0.0 6.0 KITANABA 100.0 76.5 88.2 90.9 11.8 44.1 1.8 0.0 3.7 MAFUBIRA 100.0 66.7 81.8 91.2 11.8 8.8 1.7 1.7 2.4 MASESE 100.0 17.7 55.9 82.4 14.7 6.1 0.0 0.0 0.0 MAWOITO 97.1 60.6 76.5 81.3 3.0 5.9 0.0 0.0 12.2 NAMAGERA 91.2 50.0 64.7 88.2 5.9 23.5 1.9 1.9 10.6 NAWAMPANDA 100.0 70.6 70.6 79.4 26.5 32.4 1.9 0.0 4.9 WAIRAKA 100.0 52.9 82.4 91.2 5.9 29.4 0.0 4.7 3.9 WANSIMBA 100.0 66.7 75.8 81.8 9.1 42.4 1.5 1.5 4.9 Total 96.0 60.7 78.4 84.9 9.2 22.5 2.1 0.6 10.1

32

11.0       Discussion  A total of 20 parishes, 680 households were covered. The over all response rate was 90% for

females and 70.1% for males. In the age group 1-9 years the response rate was 93.6% while

for the age group 15 years and above was 67.2%.

Literacy rate was lowest was79.9%. This literacy rate closely agrees with UDHS 2006

findings. This high literacy rate in Jinja can be attributed to most of the district being urban.

Radio ownership was 78.4 % while bicycle ownership was 60.7%. The national average for

radio and bicycle ownership is 61% and 38% respectively (UDHS 2006).

The majority of the population gets water from a public hand pump well. However a

significant proportion (38.0%) use piped water. Other significant sources of water are rivers

/streams and springs.

About 96% of the households have water available at their main water source throughout the

year. About 70% of the surveyed households in the districts take less than 30 minutes to

reach the main water source. This is mainly attributed to the presence of public hand-pump

wells within the settlements in the district and availability of piped water in the urban part of

the district.

In the district, 69.8% of the households throw rubbish in the surrounding areas. Reason for

this practice is that majority of these households live on small pieces of land.

Availability of toilets was found in 84.9% of the surveyed households. This toilet coverage is

not far from national rural coverage which is 86 % (UDHS 2006).

In the district cowpens were found in 22.6% of the households and most of them are located

within 11 metres from the households. This can be explained by the fact that most of

households have individual cowpens and live on small pieces of land as earlier indicated.

The proportion of children 1-9 years who had clean faces was 75%. In previous studies low face

cleanliness was found to be associated with high TF prevalence.

Knowledge of relationship between face washing and trachoma is high (88.8%) This could be due to

availability of health education activities in the district.

33

Prevalence of TF was found to be 10.1%. This finding is above the WHO threshold of a TF

prevalence of 10% and above which posses a public health concern. This suggests that the

communities in the district qualify for mass Azithromycin Antibiotic administration.

The prevalence of TT was 2.1%.

The knowledge about trachoma and its associated risk factors in the district is high. The

relationship between face washing and trachoma was 88.8%, while that for environment and trachoma

was 85.1%.

The prevalence of TT was 2.1% while that of CO was 0.6%. According to WHO guidelines

TT prevalence of 4 % or above, and CO of 1% or above is a public health concern. In the

district, cases of TT and CO tended to increase with increasing age as expected in any trachoma

endemic population.

The practice of epilation in the district was found to be 44%. The low prevalences of TT and CO, and

a relatively low practice of epilation in the district could be due to availability of surgical services.

34

12.0       Conclusions  1. Active trachoma (TF) is a significant public health problem in Jinja (10.1%).

2. A TT prevalence of 2.1% found in Jinja poses a public health concern.

3. Among the factors known to be associated with trachoma, poor garbage disposal was

significant.

4. In spite of latrine coverage and water availability being relatively high, the prevalence

of TF and TT were significant.

13.0       Recommendations    1. There is need to expand and strengthen the F and E components of SAFE strategy in

Jinja district.

2. Health education programs geared towards promotion of proper use of toilets and

good personal hygiene in the communities and schools should be implemented.

3. There is need to start mass distribution of Azithromycin in the district.

4. There is an urgent need to intensify corrective lid surgery in the district to prevent

blindness.

5. Prevalence studies should be extended to other suspected endemic districts.

6. Qualitative research to determine the relationship between trachoma and the

knowledge/ attitudes / practices among the affected communities should be

conducted.

35

Trachoma task force report writing

36

REFERRENCES  1. Baseline trachoma prevalence survey report for Kenya.

2. Baseline trachoma prevalence survey report for Tanzania.

3. Congdon N,West,S.K.,Vital,S. et al (1993). Exposure to children and risk of active

trachoma in Tanzania Women. A.M.J Epidemiol.

4. Courtright P, Sheppard J et al. Latrine ownership as a protectie factor in inflammatory

trachoma in Egypt. Br J Ophthalmol 1991; 75(6): 322-5

5. Emmerson PM et al. Human and other faeces as breeding media of the trachoma

vector Musca sorbens. Medical and Veterinary Entomology; 2001; 15; 314-320.

6. Emmerson PM, Bailey RL. Trachoma and fly control. J Comm Eye Health, Vol 12

No. 32, 1999.

7. Jones,B.R (1980) Changing concepts of trachoma and its

control.Trans.Ophthalmol.Soc.UK

8. Mayeku Robert (2004 -2005) Is there Blinding Trachoma in Kabale District,South

Western Uganda? Unpublished data.

9. Ngondi J et al. The Epidemiology of trachoma in Eastern Equatoria and Upper Nile

States, Southern Sudan. Bulletin of World Health Organisation 2005; 83: 904-912.

10. Nseko 2002, The Prevalence of Trachoma and Factors Associated with its

Transmission in Buwaya Sub-county, Mayuge district Uganda. Unpublished data.

11. Prevalence of Trachoma and blindness in Moroto district Emusu D,Muron V and

Poya N.2002. Unpublished data.

12. Prevalence of Trachoma in Jie County –Kotido district. Sigelaar en Bonsma 1996.

Unpublished data.

13. Solomon AW et al. Mass treatment with single-dose Azithromycin for trachoma. N

Engl J Med. 2004 Nov4; 351(19): 1962-71

14. Taylor,H.R.,West, S.K., Mmbaga,B.B.O et al. Hygiene factors and increased risk of

trachoma in Central Tanzania. Arch. Ophthalmol 1989.

15. Thylefors et al. Bulletin of World Health Organisation, October 1987.

16. Trachoma in Nakapelimoru Subcouny Kotido district Eretu John Calvin, Ytje Van der

veen et al 1999. Unpublished data.

17. Trachoma Survey Report July 2006 MOH.

18. Trachoma Survey Report May 2008 MOH.

19. UDHS 2006 report pp 23

20. West, SK, Munoz, B., Turner, V.M et al (1991).The epidemiology of Trachoma in

Central Tanzania.

37

  ACKNOWLEDGEMENT    

Trachoma as a health burden in our country is well known. This is gathered from our Health

management information systems returns. Although the actual prevalence in some of the

endemic districts is known since population based surveys have been conducted there, in the

remaining thirteen it is not known. This makes the implementation of the SAFE strategy in

these districts difficult. We are therefore grateful to the interim Trachoma Task force for the

dedication and work while preparing for the surveys, and steering data compilation and

analysis on which this report is based. We wish also to acknowledge the contribution from

our Development Partners namely:

• United States Agency for International Development (USAID)

• Research Triangle Institute (RTI)

• International Trachoma Initiative (ITI)

• Sight savers international (SSI)

• Lions Aid Norway (LAN)

We further appreciate the collaboration from;

• District Authorities

• Local Communities

• Survey teams

We thank you very much and look forward to continued collaboration as we endeavor to

eliminate Trachoma in our communities.

Special thanks go to the Neglected Tropical Diseases country office, Vector Control Division

and entire Ministry of Health for the untiring efforts to Control and Eliminate Trachoma from

Uganda and the Disability Prevention and Rehabilitation Section in particular for effective

coordination.

 

38

APPENDICES  

Summary of vital variables within the surveyed parishes Appendix 1: Jinja District

Parish Name ,,,,,,,,,,,,,,,,,, ……..

Water through out the year

Bicycle Radio With Toilet

Feaces within 15m from house

Cow pen present

TT CO TF

BUGEMBE 97.1 35.3 76.5 100.0 0.0 0.0 1.4 0 4.8 BUGOBYA 97.1 70.6 73.5 67.7 8.8 32.3 3.6 0 6.0 BUWAGI 100.0 82.4 88.2 82.4 2.9 43.8 0.0 0 13.8 BUWEKULA 76.5 55.9 81.8 82.4 2.9 20.6 2.8 0 15.1 BUWENDA 100.0 73.5 88.2 97.1 12.1 26.5 4.3 1.4 15.6 CENTRAL_EAST 100.0 8.8 97.1 100.0 0.0 3.0 1.6 1.6 25.0 IZIRU 94.1 73.5 64.7 64.7 15.2 26.5 1.8 0.0 13.3 KAGAIRE 97.1 73.5 94.1 97.1 2.9 14.7 4.8 0.0 17.7 KAGOMA 100.0 76.5 73.5 76.5 8.8 27.3 10.2 0.0 17.7 KASALINA 100.0 63.6 91.2 97.1 2.9 23.5 1.7 0.0 6.7 KAYIRA 79.4 58.8 70.6 82.4 14.7 23.5 0.0 0.0 10.6 KISASI 91.2 79.4 73.5 64.7 23.5 17.7 1.5 0.0 6.0 KITANABA 100.0 76.5 88.2 90.9 11.8 44.1 1.8 0.0 3.7 MAFUBIRA 100.0 66.7 81.8 91.2 11.8 8.8 1.7 1.7 2.4 MASESE 100.0 17.7 55.9 82.4 14.7 6.1 0.0 0.0 0.0 MAWOITO 97.1 60.6 76.5 81.3 3.0 5.9 0.0 0.0 12.2 NAMAGERA 91.2 50.0 64.7 88.2 5.9 23.5 1.9 1.9 10.6 NAWAMPANDA 100.0 70.6 70.6 79.4 26.5 32.4 1.9 0.0 4.9 WAIRAKA 100.0 52.9 82.4 91.2 5.9 29.4 0.0 4.7 3.9 WANSIMBA 100.0 66.7 75.8 81.8 9.1 42.4 1.5 1.5 4.9 Total 96.0 60.7 78.4 84.9 9.2 22.5 2.1 0.6 10.1

39

Survey questionnaires

Appendix 2: Parish Questionnaire

1. Date Day Month Year date

2. Interviewer’s Initials intials

3 Interviewees title

Parish chairperson=1

Parish Executive Officer=2

Other Parish leader=3

Specify……………………….…….…………………

interv

4. District name district

5. District ID Number dnumber

6. Parish name pname

7. Parish ID Number pnumber

8. Number of LC.Is in the Parish NLCI

9 Local Council I names

1. 2.

3. 4.

5. 6.

7. 8.

9. 10.

11. 12.

13. 14.

15. 16.

17. 18.

19. 20.

40

21. 22.

23. 24.

10. Number of Households in the Parish NHhold

11 Number of Primary schools in the

Parish NPSch

12.

Health services available in the

Parish

Yes=1

No=2 Number

Parish Development Committee (PDCs)

Drug shop

Dispensary Health Centre II

Health Centre III

Health Centre IV

Hospital

13. Type of man-made water sources

in the Parish

Tap water (stations)

Yes=1

No=2 Number

Rain water harvest

Deep (drilled) well

Shallow dug well

Dam

Others

Specify

……………………………………………….

14. Do you have a Parish water committee? Yes = 1, No = 2

15. Do you have a Parish water fund? Yes = 1, No = 2

Interviewer’s Name ………………………………………

Signature…………………………………………..

41

Supervisor’s Name ……………………………………… Signature……………………………………

Appendix 3: Household Questionnaire (Interview head of household

or representative)

1. Date Day Month Year Date

2. Interviewers Initials Initials

3. Type of Survey

(Baseline = 0, Follow up= 1) Survey

4. District Name District

5. District ID Number Dnumber

6. Parish Name Pname

7. Parish ID Number Pnumber

8. Local Council I name Local Council I

9. Head of Household name

Hhname

10. Interviewees name IName

11. Household ID Number Hhnumber

12. ID number

[District] [Parish] [Household] Idnum

13. Names of household members

(First and Surname)

Sex Age Can Read

Education Marital

status

Relation to

Head of

Household

None =1

Primary=2

Secondary=3

Post-

secondary= 4

Others=5

Single = 1

Married =

2

Divorced=

3

Widow = 4

Separated

= 5

Head of

Household =1

Wife/Husband

=2

Child=3

Relative=4

Others=5

Male=1

Female=2

Year

s

Mon

ths Yes=1

No=2

1.

2.

3.

42

4.

5.

6.

7.

8.

9.

10.

11.

Please turn over to register more household members

14. Total number of household members Hshnumber

15. Total number of those eligible for the survey Years 1-9 15 years and above

Eligible

16. What is the main water source used by

your household

Piped at residence / plot =1

Public water tap =2

Deep well at residence / plot =3

Deep public well =4

Hand-pump well at residence / plot

=5

Public Hand-pump well =6

Open well at residence / plot=7

Public open well=8

Spring=9

River / Stream=10

Lake=11

Dam=

12

Pond=3

Rain water

Harvest=14

Others=99

Wsource

17. How much time does it take you to walk to

the main water source?

Less than 30 minutes = 1

31 – 60 minutes =2

61 – 90 minutes =3

91 – 120 minutes =4

I20 minutes =5

Time

18. Does your main water source last

throughout the year? Yes=1, No=2 Lyear

43

19. Where do you dispose garbage from your

household?

Burn=1

Refuse pit=2

Throw in surrounding area =3

Other=4

Dispose

20. Is a cow pen present? Yes=1, No=2 Pen

21. If present, how far is it from the house? Metres Distance

22. Do you have a bicycle in your household? Yes=1, No=2 Bicycle

23. Do you have a radio in your household? Yes=1, No=2 Radio

24. Observe the type of toilet facility at this

Household

flush toilet at the residence =1

Shared flush toilet =2

Traditional pit-

latrine =3

Ventilated improved Pit latrine

(VIP) =4

None =5

Others=99

Toilet

25. If a toilet facility is present, Observe the

following:

Is there a definite pathway to

the latrine (Yes=1, No=2) Pathway

Is there enough privacy?

(Yes=1,No=2) Privacy

Is it being used properly?

(Yes=1, No=2) Usedwell

Does it have a cover? (Yes=1,

No=2) Cover

Walk around the house and observe the following:

26. Are there human faeces within an area of

15metres from the house?

Yes=1, No=2 Hfaeces

27. Is there garbage within an area of 15

meters from the house?

Yes=1, No=2 Garbage

Interviewer’s Name …………………………………………

Signature………………………………............

Supervisor’s Name of ………………………………………

Signature………………………………………

44

Appendix 4: Examination Questionnaire(Age 1-9 years and 15years and

above)

1. Date Days Months Year Date

2.

Id Number

[District][Parish]Household][Household

member]

Idnum

3 Local Council I Name Lname

4. Examinee’s Name Name

5. Sex Male=1, Female=2 Sex

6. Age Years Months Age

7. Head of Household Hhead

8. Interviewer’s Initials Initials

9 How long have you lived in this Parish? Years Months

TimeLive

Trachoma

10. Is the face clean

( Age 1 – 9 years only)

Yes=1

no=2

Not applicable=9

Fclean

11 Have you in the past 6 months heard about the relationship between face

washing and Trachoma?

Yes=1

No=2

No answer=3

Not applicable=9

Face  

12.

Have you in the past 6 months heard about the relationship between your

direct environment and Trachoma?

(Age 15 years and more)

Yes=1

No=2

No answer

=3

Not applicable=9

Environme

nt

13. Trachoma signs for each eye:

Present= 1

CO (15 years

TT (15 years and above)

TF (1-9 years)

45

None= 2

Not applicable= 9

and

above) Upper lid Lower lid

Right Eye

Left Eye

14. Do you practice epilation:

(15 years and above) Yes=1, No=2 Not applicable=9 Pepilate

15. Evidence of epilation?

(15 years and above) Yes=1, No=2 Not applicable=9 Epilate

16. Previous history of TT surgery

If not proceed to question no.19

Right eye Left eye

Surgery Yes=1, No=2,

not

applicable=9

17. IF YES, When?

Right eye

Ryear

Day Month Year

Left eye Lyear

Day Month Year

18 place where last TT surgery was done

In your village – at health station =1

In your village – Outside a health

station = 2

Outside the village – at a health station

= 3

Outside your village – outside a health

station= 4

Place

Complete the section below only if TT is present

19. Visual Acuity Right eye Left eye VA

Other eye diseases(Age 1-9 years, 15 years and above)

20. Cataract Yes=1, No=2

Cataract

Interviewer’s Name………………………..……………

Signature………………………………………..

46

Supervisor’s Name ……………………………………… Signature…………………………………………..

Appendix 5: Map of Jinja District Acronyms ................................................................................................................................... 3

Foreword .................................................................................................................................... 4

Executive Summary ................................................................................................................... 5

1.0 Introduction .................................................................................................................. 7

2.0 Background .......................................................................................................................... 9

2.1 Global Situation ................................................................................................... 10 2.2 Literature Review ............................................................................................... 10

3.0 Trachoma in Uganda .................................................................................................. 11

4.0 Risk Factors for Active Disease ................................................................................. 12

4.1 Water ..................................................................................................................... 12 4.2 Flies ....................................................................................................................... 12 4.3 Cattle ...................................................................................................................... 13 4.4 Hygiene .................................................................................................................. 13 4.5 Crowding ............................................................................................................... 13

5.0 Control Strategies ....................................................................................................... 13

5.1 Control Strategies in Uganda ................................................................................. 14 6.0 Rationale for the Surveys ........................................................................................... 15

7.0 Aim of the surveys ............................................................................................................. 15

8.0 Objectives of the surveys ................................................................................................... 15

9.0 Methodology ............................................................................................................... 16

9.1 Planning ................................................................................................................ 16 9.2 District survey team ............................................................................................... 16 9.3 Study setting .......................................................................................................... 17 9.4 Sampling methodology .......................................................................................... 19

9.4.1 Sample size ...................................................................................................... 19 9.4.2 Sampling Procedure ......................................................................................... 19

9.5 Procedure of fieldwork .......................................................................................... 20 9.5.1 Household selection ......................................................................................... 20 9.5.2 Interviews and examination ............................................................................. 20

9.6 Ethical issues ........................................................................................................ 21 9.7 Data management ................................................................................................. 21

10.0 Results ........................................................................................................................ 22

10.1 Response Rate ........................................................................................................ 22 10.2 Able to read ........................................................................................................... 22 10.3 Education Status of study Population .................................................................... 23 10.4 Source of water ..................................................................................................... 23 10.5 Time to walk to main source ................................................................................ 24 10.6 Availability of water throughout the year .............................................................. 24

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10.7 Garbage Disposal ................................................................................................... 25 10.8 Presence of Cowpen .................................................................................................... 25 10.9 Distance Pen from Household ..................................................................................... 25 10.10 Bicycle and Radio Ownership ............................................................................... 26 10.11 Toilet facility ......................................................................................................... 26 10.12 Human excreta in Surroundings ............................................................................ 27 10.13 Garbage within 15m from the house ..................................................................... 27 10.14 Time lived in Parish ............................................................................................... 28 10.15 Facial cleanliness ................................................................................................. 28 10.16 Knowledge about face washing and trachoma ...................................................... 28 10.17 Environment and trachoma .................................................................................... 29 10.18 TT & CO Cases ..................................................................................................... 29 10.19 TF Cases ................................................................................................................ 29 10.20 Practicing Epilation ............................................................................................... 30 10.21 Evidence of epilation ............................................................................................. 30 10.22 TT surgery ............................................................................................................. 30 10.23 Cataract .................................................................................................................. 30 10.24 Summary of some variables within parishes ......................................................... 31

11.0 Discussion ................................................................................................................... 32

12.0 Conclusions ................................................................................................................ 34

13.0 Recommendations ...................................................................................................... 34

REFERRENCES ..................................................................................................................... 36

ACKNOWLEDGEMENT ....................................................................................................... 37

APPENDICES ......................................................................................................................... 38

Summary of vital variables within the surveyed parishes ................................................... 38 Survey questionnaires .......................................................................................................... 39

Face 44

48

KAKIRA

BUTAGAYA

BUWENGE

BUSEDDE

BUDONDO

MAFUBIRA

BUYENGO

CENTRAL JINJA

MASESE/WALUKUBAKIMAKA/MPUMUDDE/NALUFENYA

KALONGO

KAGOMA

KIBIBI

IZIRU

KISASI

BUDIMA

NAMIZI

KAIIRA

BUWABUZI

BUWEERA

NALINAIBI

BULUGO

NAWANGOMA

LUBANYI

KITANABA

MAGAMAGA

NAMAGERA

ITAKAIBOLUBUTAMIRA

BUGOBYA

WAIRAKA

NAMULESA

NAWAMPANDA

WANSIIMBA

KAKIRA +TOWN COUNCIL

NABITAMBALA

BUGEMBE

IVUNAMBA

NAKAKULWE (KISOZI)

BUWEKULA

BUWAGI (KYOMYA)

MASESE

MAFUBIRA

KIMAKA

BUWENDA +TOWN COUNCIL

OLD BOMA

MPUMUDDE

WANYANGE

NALUFENYAMAGGWA

WALUKUBA WEST

WALUKUBA EAST

1 01 Kilometers

N

EW

S

JINJA DISTRICT

49