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A new system to support effective monitoring of trichiasis surgery

Why monitor? To reduce visual loss from trachomatous trichiasis (TT) and move towards elimination of trachoma as a public health problem it is important to know:

  • where patients with trichiasis live
  • whether they have been treated, and
  • what are the results of treatment.

Monitoring systems for trichiasis surgery have, in the past, mostly been developed by national trachoma elimination programmes. Some donors have also introduced their own monitoring systems.

TT Case Manager - A management tool

Different data management and reporting systems for different purposes make things difficult for surgeons, their supervisors and programme managers. It would be helpful to have one system which is simple, low cost and meets the key requirements of all stakeholders.

The World Health Organization (WHO) has recognised this need and led the development of a common system - the TT Case Manager - for registering patients with trichiasis and tracking them through the patient pathway.

Who needs this system?

The information and reports managed by TT Case Manager are needed by trichiasis surgeons, their supervisors, trachoma programme managers, the ministries of health, and by supporting partners.

Information provided by the system

  • How many people have been identified with trichiasis?
  • Where do they live?
  • Who has been treated and how?
  • What are the results of treatment?

Who manages the system?

Once set up, TT Case Manager is solely maintained by the national programme; there is no centralised data management. The national programme controls who has access and how it is used.

How does the system track trichiasis patients?

The system integrates data from key sources to track trichiasis patients at initial visit and follow up.

TT Case Manager: WHO monitoring system for trichiasis surgery (Click to expand)

How does the system provide information on where trichiasis patients live?

GPS data are collected each time a surgeon registers a patient, showing where the patient was first seen. Information about the patient’s village and household is also collected.

Screengrab from the system showing how patients locations are displayed visually

Geographical distribution display (Click to expand) © WHO CC BY-NC-SA

How does the system provide information on people with trichiasis?

TT Case Manager provides information on individual patients. The demonstration screengrab below shows how the system displays examination findings for both eyes and the surgeon’s management decision for a patient.

System output showing how patient records are displayed

Patient record display (Click to expand) © WHO CC BY-NC-SA

The next screengrab shows how TT Case Manager collates information on individual patients for monitoring reports. Here, the system shows how many trichiasis patients are waiting for follow-up visits in Lagos, Nigeria. These figures are for illustrative purposes only!

Waiting for follow-up

Numbers waiting for follow up (Click to expand) © WHO CC BY-NC-SA

Using the system

Using TT Case Manager a district level trachoma coordinator can monitor:

  • Numbers of trichiasis surgeries done per month, by gender, by location
  • Outcomes from surgery on follow up by surgeon and severity of disease

A national coordinator can follow up on:

  • how districts are doing to reach the set annual targets for trichiasis surgery, and
  • if they are on track to reach the elimination target of less than 1 trichiasis case per 1000 population.

Regular monitoring can be used to support, motivate and provide appropriate resources for efficient and effective trichiasis management.

Screengrab of the surgeon dashboard

Surgeon’s dashboard. (Click to expand) © WHO CC BY-NC-SA

TT Case Manager will be provided and supported free of charge to national trachoma programmes. For further information, please contact Tropical Data Support at support@tropicaldata.org

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This article is from the free online course:

Eliminating Trachoma

London School of Hygiene & Tropical Medicine

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