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Purpose: Trachoma was suspected to be endemic in parts of the Democratic Republic of the Congo (DRC). We aimed to estimate prevalences of trachomatous inflammation–follicular (TF), trichiasis, and water and sanitation (WASH) indicators in suspected-endemic Health Zones. Methods: A population-based prevalence survey was undertaken in each of 46 Health Zones across nine provinces of DRC, using Global Trachoma Mapping Project methods. A two-stage cluster random sampling design was used in each Health Zone, whereby 25 villages (clusters) and 30 households per cluster were sampled. Consenting eligible participants (children aged 1–9 years and adults aged ≥15 years) were examined for trachoma by GTMP-certified graders; households were assessed for access to WASH. Results: A total of 32,758 households were surveyed, and 141,853 participants (98.2% of those enumerated) were examined for trachoma. Health Zone-level TF prevalence in 1–9-year-olds ranged from 1.9–41.6%. Among people aged ≥15 years, trichiasis prevalences ranged from 0.02–5.1% (95% CI 3.3–6.8). TF prevalence in 1–9-year-olds was ≥5% in 30 Health Zones, while trichiasis prevalence was ≥0.2% in 37 Health Zones. Conclusion: Trachoma is a public health problem in 39 of 46 Health Zones surveyed. To meet elimination targets, 37 Health Zones require expanded trichiasis surgery services while 30 health zones require antibiotics, facial cleanliness and environmental improvement interventions. Survey data suggest that trachoma is widespread: further surveys are warranted.

Correspondence: eugene Justine Kongnyuy Child and reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom Tel +44 151 705 3705 Fax +44 151 705 3329 email kongnyuy@liverpool.ac.uk. Background: Clinical audit has been showed to improve professional practice from the providers’ perspective. However, little is known about the effect of audit on the quality of care from clients’ perspective. Objective: To assess the effectiveness of criterion-based audit to improve obstetric care from both the health professionals’ and clients’ perspectives. Methods: We conducted electronic searches of MEDLINE, EMBASE, and Cochrane Library in June 2009 for randomized controlled trials (RCTs) and before-and-after studies that assessed the effect of criterion-based audit on health outcomes or mothers/clients’ perception of obstetric care. Results: Twenty-three studies (one RCT and 22 before-and-after studies) involving 33,911 participants met our inclusion criteria. Only one of these studies assessed the effect of audit on quality of care from the mothers/clients’ perspective. Ninety-six percent (22/23) of studies showed significant improvement in at least one standard measured. In general clinical audit led to moderate improvements in obstetric care and the effect of audit depended on baseline adherence to clinical standards. Conclusions: Clinical audit is associated with moderate improvements in obstetric care from both the health professionals’ and mothers/clients’ perspectives. Audit has been used in obstetrics to improve quality mainly from one dimension, namely the health professionals’ perspective. Midwives/doctors should consider the use of audit to improve quality of care from the mothers/clients’ view.