02588nas a2200385   4500000000100000008004100001260003400042653005700076653002100133653002800154653001300182653001100195653001300206100001300219700001900232700001300251700001300264700001200277700001400289700001300303700002100316700001200337700001200349700001200361700001300373700001200386700001700398700001300415245019200428856009300620300001400713490000700727520144300734022002502177       2023                            d  bOxford University Press (OUP)10aPublic Health, Environmental and Occupational Health10aGeneral Medicine10aHealth (social science)10amismatch10asurvey10aTrachoma1 aMwangi G1 aHarding-Esch E1 aKabona G1 aWatitu T1 aMpyet C1 aGemechu A1 aAbdeta A1 aWamyil-Mshelia T1 aAjege G1 aKelly M1 aAbony M1 aOtinda P1 aChege M1 aCourtright P1 aGeneau R00aExplaining the continuing high prevalence of trachomatous trichiasis unknown to the health system in evaluation units: a mixed methods explanatory study in four trachoma-endemic countries  uhttps://academic.oup.com/inthealth/article-pdf/15/Supplement_2/ii44/53979147/ihad085.pdf  aii44-ii520 v153 a<p><strong>Background:</strong> We explored reasons for continuing higher-than-anticipated prevalence of trachomatous trichiasis (TT) unknown to the health system in population-based prevalence surveys in evaluation units where full geographical coverage of TT case finding was reported.</p>

<p><strong>Methods:</strong> A mixed-methods study in Ethiopia, Kenya, Nigeria and Tanzania was conducted. We compared data from clinical examination, campaign documentation and interviews with original trachoma impact survey (TIS) results.</p>

<p><strong>Results:</strong> Of 169 TT cases identified by TIS teams, 130 (77%) were examined in this study. Of those, 90 (69%) were a match (both TIS and study teams agreed on TT classification) and 40 (31%) were a mismatch. Of the 40 mismatches, 22 (55%) were identified as unknown to the health system by the study team but as known to the health system by the TIS team; 12 (30%) were identified as not having TT by the study team but as having TT by the TIS team; and six (15%) were identified as unknown to the health system in the TIS team but as known to the health system by the study team based on documentation reviewed.</p>

<p><strong>Conclusions:</strong> Incorrectly reported geographical coverage of case-finding activities, and discrepancies in TT status between TIS results and more detailed assessments, are the key reasons identified for continuing high TT prevalence.</p>
  a1876-3413, 1876-3405