Field trial of applicability of lot quality assurance sampling survey method for rapid assessment of prevalence of active trachoma.

OBJECTIVE To test the applicability of lot quality assurance sampling (LQAS) for the rapid assessment of the prevalence of active trachoma. METHODS Prevalence of active trachoma in six communities was found by examining all children aged 2-5 years. Trial surveys were conducted in these communities. A sampling plan appropriate for classifying communities with prevalences < or =20% and > or =40% was applied to the survey data. Operating characteristic and average sample number curves were plotted, and screening test indices were calculated. The ability of LQAS to provide a three-class classification system was investigated. FINDINGS Ninety-six trial surveys were conducted. All communities with prevalences < or =20% and > or =40% were identified correctly. The method discriminated between communities with prevalences < or =30% and >30%, with sensitivity of 98% (95% confidence interval (CI)=88.2-99.9%), specificity of 84.4% (CI=69.9-93.0%), positive predictive value of 87.7% (CI=75.7-94.5%), negative predictive value of 97.4% (CI=84.9-99.9%), and accuracy of 91.7% (CI=83.8-96.1%). Agreement between the three prevalence classes and survey classifications was 84.4% (CI=75.2-90.7%). The time needed to complete the surveys was consistent with the need to complete a survey in one day. CONCLUSION Lot quality assurance sampling provides a method of classifying communities according to the prevalence of active trachoma. It merits serious consideration as a replacement for the assessment of the prevalence of active trachoma with the currently used trachoma rapid assessment method. It may be extended to provide a multi-class classification method.