Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia

Author:

Whitson Cassidy C1,Nute Andrew W2,Hailemariam Begashaw3,Deathe Andrew R2,Astale Tigist3,Ayele Zebene3,Gessese Demelash3,Sata Eshetu3,Zerihun Mulat3,Melak Berhanu3,Haile Mahteme4,Zeru Taye4,Getnet Banchalem5,Wondimteka Bilen5,Kabtu Endale5,Getachew Habib5,Shibiru Meskerem5,Bayecha Social5,Aragie Solomon3,Wittberg Dionna M6,Tadesse Zerihun3,Callahan E Kelly2,Keenan Jeremy D6,Admassu Fisseha5,Nash Scott D2ORCID

Affiliation:

1. Rollins School of Public Health, Emory University , Atlanta , GA, USA

2. Trachoma Control Program, The Carter Center , Atlanta , GA, USA

3. Trachoma Control Program, The Carter Center , Addis Ababa , Ethiopia

4. Research and Technology Transfer Directorate, Amhara Public Health Institute , Bahir Dar , Ethiopia

5. Department of Ophthalmology, University of Gondar , Gondar , Ethiopia

6. Francis I. Proctor Foundation, University of California , San Francisco , San Francisco, CA, USA

Abstract

Abstract Background As countries reach the trachoma elimination threshold and cases of trachomatous inflammation follicular (TF) become rare, it becomes difficult to train survey graders to recognize clinical signs. We assess the use of photography as a grading tool, the efficiency of an in-country grading center and the comparability of field and photographic grading. Methods During January–February 2017 surveys in Amhara, Ethiopia, field graders assessed TF, trachomatous inflammation intense (TI) and trachomatous scarring (TS). Photographs were taken from each conjunctiva and later graded at the Gondar Grading Center (GGC) at the University of Gondar in Amhara. Two trained ophthalmology residents graded each set of photographs and a third grader provided an adjudicating grade when needed. Results A total of 4953 photographs of 2477 conjunctivae from 1241 participants in 10 communities were graded over 5 d at the GGC. Six examined participants were not photographed. Agreement between field and photographic grades were for TF: percent agreement (PA) 96.7%, κ=0.70 (95% confidence interval [CI] 0.64 to 0.77; for TI: PA 94.7%, κ=0.32 (95% CI 0.20 to 0.43); and for TS: PA 83.5%, κ=0.22 (95% CI 0.15 to 0.29). Conclusions Conjunctival photography may be a solution for programs near the elimination threshold where there are few available community cases for training field graders.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Public Health, Environmental and Occupational Health,General Medicine,Parasitology

Reference16 articles.

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2. A simple system for the assessment of trachoma and its complications;Thylefors;Bull World Health Org,1987

3. Inter-rater agreement between trachoma graders: comparison of grades given in field conditions versus grades from photographic review;Gebresillasie;Ophthalmic Epidemiol,2015

4. Reliability of trachoma clinical grading—assessing grading of marginal cases;Rahman;PLoS Negl Trop Dis,2014

5. 3D images as a field grader training tool for trachomatous trichiasis: a diagnostic accuracy study in Ethiopia;Hoffman;PLoS Negl Trop Dis,2019

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