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Cluster Sampling Method

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Comparing the performance of cluster random sampling and integrated threshold mapping for targeting trachoma control,

Jennifer L Smith1, Hugh J W Sturrock, Casey Olives

  • 1London School of Hygiene and Tropical Medicine, London, United Kingdom. jennifer.l.smith@lshtm.ac.uk

Plos Neglected Tropical Diseases
|August 31, 2013
PubMed
Summary

Integrated Threshold Mapping (ITM) may underestimate trachoma prevalence and misclassify districts more than cluster randomized surveys (CRS). This risk increases with higher TF prevalence, impacting trachoma control strategies.

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Area of Science:

  • Ophthalmology
  • Public Health
  • Epidemiology

Background:

  • Trachoma control relies on accurate district-level prevalence data, typically from cluster randomized surveys (CRS).
  • Integrated Threshold Mapping (ITM) offers a cost-effective alternative for rapid trachoma surveying.
  • ITM employs a school-based sampling for children aged 1-9, differing from CRS protocols.

Purpose of the Study:

  • To compare the performance of ITM and CRS survey designs using computer simulations.
  • To evaluate the impact of varying key parameters on survey accuracy.
  • To assess the risk of misclassification for trachoma treatment thresholds.

Main Methods:

  • Generated realistic pseudo gold standard data for 100 districts.
  • Simulated ITM and CRS sampling approaches with 20 clusters per district.
  • Analyzed disease prevalence, relative risk between enrolled/non-enrolled children, and school enrollment rates.

Main Results:

  • ITM generally underestimated true trachoma prevalence (TF) across various settings.
  • ITM introduced more district misclassification regarding treatment thresholds compared to CRS.
  • Underestimation and misclassification were influenced by TF prevalence, relative risk, and enrollment rates.

Conclusions:

  • ITM can introduce bias, particularly as TF prevalence increases, elevating misclassification risk around treatment thresholds.
  • The choice of survey methodology impacts the reliability of trachoma control program decisions.
  • Simulation approaches are valuable for operational research in neglected tropical diseases (NTDs).