Persistence and recrudescence of trachoma in Kajiado County, Kenya: evidence-based programmatic adaptions to achieve elimination

• To validate and investigate the reasons for persistence and recrudescence in four sub-counties in Kajiado County
• To evaluate the effectiveness in evidence-based programmatic adaptations, in improving coverage of mass drug administration (MDA) and ultimately ensure the sub-counties are back on track for elimination of trachoma as a public health problem

This study will employ a mixed methods design involving document and data reviews and population-based surveys. Document and data review will involve a review of treatment and programmatic reporting documents, historical research investigating coverage of mass drug administration (MDA) and past impact survey data to understand potential programmatic reasons for the failure of Kajiado County to achieve and maintain trachoma elimination thresholds.

Population-based surveys using alternative indicators (ocular swabs for detection of Chalmydia trachomatis (CT), CT infection and dried blood spots for detection of anti-chlamydial antibodies) will be conducted at the sub-county level to understand the transmission dynamics across the county.

The study will also evaluate how alternative programmatic interventions (such as enhanced support supervision, accelerated rounds of MDA, tracking of community drug distributors through GIS and satellite maps and use of social media influencers in urban areas) can be used to address problematic districts that have evidence of recrudescence and/or persistent CT infection. This will be done through a comparative analysis of interventions in Kajiado and through monitoring transmission dynamics at the level of evaluation unit.

Added value of the study

Although operational research is on-going in a few countries especially on trying to address persistence of trachoma follicular (TF) infection (for example, Ethiopia, Tanzania and Niger), the context is quite different to Kenya. This is an area of the Maasai corridor where there are unique challenges likely facilitating on-going challenges. It is imperative to know what local context drivers are contributing to persistence and recrudescence, and to evaluate what works to address them. 

Policy and practice implications

Study findings will hopefully inform and feed into guidance for other areas with similar issues of recrudescence or persistence of trachoma (and even other preventative chemotherapy (PC) NTDs).