Current Status of Trachoma Among Underserved Population of India: Results from the National Trachoma Rapid Assessment Survey 2014-17.

Purpose: To determine the burden of trachoma and its related risk factors among the underserved population of sixteen states/union territories (UTs) in India.

Methods: Trachoma rapid assessment (TRA) was conducted in seventeen Enumeration Units (EUs) spanning sixteen states/UTs in India according to standard WHO guidelines. A total of ten clusters were selected in each EU and 50 children aged 1-9 years were assessed clinically for signs of active trachoma and facial cleanliness in each cluster. Additionally, all adults aged 15 years and above in the same households were examined for evidence of trachomatous trichiasis (TT) and corneal opacity. Environmental risk factors contributing to trachoma were also noted in all households.

Results: Out of 766 districts in India, seventeen EUs were selected for TRA depending on evidence of socio-developmental indicators like poverty and suboptimal access to water, sanitation, and healthcare facilities. The total population of the selected clusters was 21,774 in the 17 EUs. Overall, 104 of 8807 children (1.2%; CI: 0.9-1.4) had evidence of follicular or inflammatory stages of trachoma. Nearly 16.6% (CI:15.8-17.4) children were noted to have unclean faces in the 170 clusters. Trichiasis was noted in 19 adults (2.1 per 1000; CI:1.2-3.2 per 1000). Environmental sanitation was found to be unsatisfactory in two-thirds (67.8%) of the surveyed households in the clusters mainly due to improper garbage disposal.

Conclusion: Active trachoma was not a public health problem in any of the EUs surveyed. However, burden of TT among adults was found to be above 0.2% in two EUs; hence, further public health interventions like trichiasis surgery were recommended.