Prevalence of Trachoma in Senegal: Results of Baseline Surveys in 17 Districts

Purpose: Senegal is endemic for trachoma, an infectious and potentially blinding eye disease. To complete the country's district-level baseline map of trachoma, we conducted population-based surveys in 17 health districts that were suspected-endemic but had yet to be surveyed. Methods: We randomly selected 30 clusters (villages) per district and 30 households per village, and estimated the district-level prevalences of trachomatous inflammation-follicular (TF) in children aged 1-9 years, and trichiasis in persons aged >= 15 years. Data on household-level water, sanitation, and hygiene variables were also collected. Global Trachoma Mapping Project methods were followed in training, fieldwork, and data handling. Results: 25,704 children aged 1-9 years and 30,345 adults aged 15 years and above were examined. In children aged 1-9 years, the prevalence of TF was <5% in all 17 districts, with the exception of Saint-Louis (5.1%, 95% CI 3.2-7.5). Trichiasis prevalence in participants aged 15 years and above ranged by district from 0%-1.1% (95% CI 0.7-1.5), with 9 districts having trichiasis prevalences above the elimination threshold of 0.2%. Trichiasis was seen to be significantly less frequent in males than in females (0.17% [95% CI 0.12-0.24] versus 0.49% [95% CI 0.38-0.61], p < 0.001). The prevalence of trichiasis rose steeply with age; 62% of cases were observed in people aged 55 years or above. Conclusions: Active trachoma is not a public health problem in 16 of the 17 surveyed districts, and implementation of the full Surgery (S) - Antibiotics (A) - Facial cleanliness (F) - Environmental improvement (E) strategy is not a programmatic priority. Increased provision of trichiasis surgery is warranted in nine districts.