Progress to Eliminate Trachoma as a Public Health Problem in Amhara National Regional State, Ethiopia: Results of 152 Population-Based Surveys

National trachoma programs conduct impact and surveillance surveys to assess the prevalence of clinical signs of trachoma and progress toward elimination as a public health problem. For trachoma, the targets for elimination as a public health problem include a prevalence of trachomatous inflammation-follicular (TF) among children aged 1–9 years of less than 5% at the health district level and a prevalence of trachomatous trichiasis (TT) unknown to the health system among the total population of less than one case per 1,000 at the health district level.1 Trachoma impact surveys (TIS) are presently conducted following 1–7 years of implementation of the WHO-endorsed surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategy2; however, previous guidance, followed until roughly 2017, called for TIS following 3–5 years of SAFE implementation.3 The National Survey on Blindness, Low Vision, and Trachoma, conducted in 2006, suggested Ethiopia to be the most trachoma-endemic country, among countries with available data. Within Ethiopia, the survey demonstrated that the Amhara Region harbored the highest regional prevalence of active trachoma (TF and/or trachomatous inflammation-intense [TI]) among children aged 1–9 years, 62.6%.4 Although trachoma interventions started in 2001 in Amhara, they were established in only four districts.5 Following the 2006 National Survey, further baseline data were collected during a 2007 zonal-level survey, which provided needed evidence to determine the zones (administrative unit below a region with about 2,000,000 population and made up of districts) that warranted SAFE intervention. The 2007 baseline survey demonstrated that trachoma was endemic in all 10 zones in the region, each requiring full implementation of the SAFE strategy. Resultingly, SAFE interventions were gradually scaled up to all 152 districts between 2007 and 2010. Following 3–5 years of SAFE implementation, in accordance with global recommendations at the time, TIS were conducted in all districts between 2010 and 2015 to assess progress toward elimination.6,7 This article presents these aggregate TIS results, providing regional-, zonal-, and district-level summaries of progress toward trachoma elimination targets.