Accuracy Of Trachomatous Trichiasis Case Identification By Community Health Volunteers In East Pokot, Baringo County

Abstract

Introduction: Trachoma is the leading infectious cause of blindness and a public health problem globally and in Kenya. Repeated infections cause trachomatous conjunctival scarring leading to trachomatous trichiasis(TT), which left untreated results in visual impairment or blindness. East Pokot in Baringo County is a trachoma endemic area. Community health volunteers in this area play a central role in identification and referral of TT cases to existing health care systems. Their ability to correctly identify people with TT ensures that no cases are left in the community thus reducing the backlog of cases. Correctly identifying people without TT reduces overload on the health care system and saves time and resources. Objective: Broad objective was to assess the accuracy of TT case identification by community health volunteers in East Pokot, Baringo County. Study design:Cross-sectional community based study. Study setting: East Pokot sub-County in Baringo County. Study population: All persons who turned up for screening during community TT surgical camps in East Pokot, Baringo County within the study period. Data collection and analysis:Selected participants were first examined by the CHVs then confirmed by the principal investigator. Data was collected using a pre designed questionnaire to record all the information needed. Descriptive statistics were used to summarize the data. Ethical approval: Permission and authority to conduct the study was obtained from the Ethics and Research Committee of University of Nairobi/Kenyatta National Hospital. Results: This study revealed that the ability of community health volunteers to identify people with or without TT had a sensitivity of 85.9% for all grades of TT and a specificity of 82.4%. The positive and negative predictive value for identification of cases was 80.3% and 87.5% respectively. Sensitivity for identifying minor and moderate/major TT was 61.5% and 95.0% respectively. The prevalence of TT was 46.0% (38.0% - 53.7%) Conclusion: The community health volunteers in East Pokot can identify people with TT and those without TT with a high level of accuracy. The accuracy of diagnosing moderate/major TT was higher than for minor TT.CHVs can therefore be relied upon to identify and refer TT cases to the health care system. Recommendation: CHVs in East Pokot can be used as the main personnel to identify and refer TT cases to health care system. Training of CHVs to increase accurate diagnosis of minor TT.