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Judging a 'clean face' for trachoma

PLOS

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IMAGE: Boy in Tanzania washing his face. view more 

Credit: Harran Mkocha, 2017

Part of the control strategy for trachoma--repeated eye infections caused by the bacterium Chlamydia trachomatis--is facial cleanliness. Now, researchers reporting in PLOS Neglected Tropical Diseases have shown that properly trained graders can reliably reproduce assessments of facial cleanliness. The findings suggest that measures of facial cleanliness can be added to trachoma surveys in the developing countries where the infection is a public health problem.

Trachoma is the leading infectious cause of blindness worldwide and is a known public health problem in rural areas of 41 countries of Africa, Central and South America, Asia, Australia and the Middle East. The elimination strategy is encapsulated by the acronym "SAFE": Surgery for advanced disease, Antibiotics to clear infections, Facial cleanliness and Environmental improvement.

In the new work, Sheila West of Johns Hopkins University, and colleagues trained seven staff in Tanzania, with a variety of educational backgrounds, on how to assess the presence and absence of nasal and ocular discharge on children's faces. Then, sixty children ages 1 through 7 were evaluated by the graders at two time points, approximately 50 minute apart for presence or absence of a clean face.

The variation between graders and between grading sessions was quantified using unweighted kappa statistics. The average inter-observer agreement was kappa=0.78 and the average intra-observer agreement was kappa=0.72. These are better reliability measures than were previously reported in a study assessing the reliability of ocular and nasal discharge observations.

"As long as training is provided, the estimate of clean faces in children should be reliable, and reflect the effort of families to keep ocular and nasal discharge off the faces," the authors say. "We recommend conducting more inter-observer trials in various trachoma settings and that assessing clean faces be added to surveys to trachoma control, which already measure environmental improvements, in districts."

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In your coverage please use this URL to provide access to the freely available article in PLOS Neglected Tropical Diseases: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006019

Funding: Support provided by International Trachoma Initiative. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

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