02676nas a2200457   4500000000100000008004100001260003400042653002400076653005700100653002100157653001700178100001500195700001200210700001800222700001400240700001300254700001200267700001400279700001100293700001400304700001200318700001200330700001100342700001300353700001700366700001200383700001500395700001400410700001400424700001300438700001600451700001400467700001600481700001400497700001400511700001200525245010600537856010400643520144600747022002502193       2022                            d  bOxford University Press (OUP)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10aGeneral Medicine10aParasitology1 aWhitson CC1 aNute AW1 aHailemariam B1 aDeathe AR1 aAstale T1 aAyele Z1 aGessese D1 aSata E1 aZerihun M1 aMelak B1 aHaile M1 aZeru T1 aGetnet B1 aWondimteka B1 aKabtu E1 aGetachew H1 aShibiru M1 aBayecha S1 aAragie S1 aWittberg DM1 aTadesse Z1 aCallahan EK1 aKeenan JD1 aAdmassu F1 aNash SD00aPhotographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia  uhttps://academic.oup.com/trstmh/advance-article-pdf/doi/10.1093/trstmh/trac090/46052480/trac090.pdf3 a<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>
  a0035-9203, 1878-3503