@article{97484,
  keywords = {Infectious Diseases, Public Health, Environmental and Occupational Health, General Medicine, Parasitology},
  author = {Whitson CC and Nute AW and Hailemariam B and Deathe AR and Astale T and Ayele Z and Gessese D and Sata E and Zerihun M and Melak B and Haile M and Zeru T and Getnet B and Wondimteka B and Kabtu E and Getachew H and Shibiru M and Bayecha S and Aragie S and Wittberg DM and Tadesse Z and Callahan EK and Keenan JD and Admassu F and Nash SD},
  title = {Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia},
  abstract = {<p>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.</p>

<p>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.</p>

<p>Results: A total of 4953 photographs of 2477 conjunctivae from 1241 participants in 10 communities were graded over 5&nbsp;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). \</p>

<p>Conclusions: Conjunctival photography may be a solution for programs near the elimination threshold where there are few available community cases for training field graders.</p>
},
  year = {2022},
  journal = {Transactions of The Royal Society of Tropical Medicine and Hygiene},
  publisher = {Oxford University Press (OUP)},
  issn = {0035-9203, 1878-3503},
  url = {https://academic.oup.com/trstmh/advance-article-pdf/doi/10.1093/trstmh/trac090/46052480/trac090.pdf},
  doi = {10.1093/trstmh/trac090},
  language = {eng},
}