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The "F" in SAFE: Reliability of assessing clean faces for trachoma control in the field.

Abstract

BACKGROUND: Although facial cleanliness is part of the SAFE strategy for trachoma there is controversy over the reliability of measuring a clean face. A child's face with no ocular and nasal discharge is clean and the endpoint of interest, regardless of the number of times it must be washed to achieve that endpoint. The issue of reliability rests on the reproducibility of graders to assess a clean face. We report the reproducibility of assessing a clean face in a field trial in Kongwa, Tanzania.

METHODS/FINDINGS: Seven graders were trained to assess the presence and absence of nasal and ocular discharge on children's faces. Sixty children ages 1-7 years were recruited from a community and evaluated independently by seven graders, once and again about 50 minutes later. Intra-and inter-observer variation was calculated using unweighted kappa statistics. The average intra-observer agreement was kappa = 0.72, and the average inter-observer agreement was kappa = 0.78.

CONCLUSIONS: Intra-observer and inter-observer agreement was substantial for the assessment of clean faces using trained Tanzania staff who represent a variety of educational backgrounds. As long as training is provided, the estimate of clean faces in children should be reliable, and reflect the effort of families to keep ocular and nasal discharge off the faces. These data suggest assessment of clean faces could be added to trachoma surveys, which already measure environmental improvements, in districts.

More information

Type
Journal Article
Author
West SK
Ansah D
Munoz B
Funga N
Mkocha H
Year of Publication
2017
Journal
PLoS neglected tropical diseases
Volume
11
Issue
11
Number of Pages
e0006019
Language
eng
ISSN Number
1935-2735
DOI
10.1371/journal.pntd.0006019
Alternate Journal
PLoS Negl Trop Dis
Publication Language
eng