The Burden of Trachoma in Ayod County of Southern Sudan

Abstract

BackgroundBlindness due to trachoma is avoidable through Surgery, Antibiotics, Facial hygiene and Environmental improvements (SAFE). Recent surveys have shown trachoma to be a serious cause of blindness in Southern Sudan. We conducted this survey in Ayod County of Jonglei State to estimate the need for intervention activities to eliminate blinding trachoma.Methodology and FindingsA cross-sectional two-stage cluster random survey was conducted in November 2006. All residents of selected households were clinically assessed for trachoma using the World Health Organization (WHO) simplified grading scheme. A total of 2,335 people from 392 households were examined, of whom 1,107 were over 14 years of age. Prevalence of signs of active trachoma in children 1–9 years of age was: trachomatous inflammation follicular (TF) = 80.1% (95% confidence interval [CI], 73.9–86.3); trachomatous inflammation intense (TI) = 60.7% (95% CI, 54.6–66.8); and TF and/or TI (active trachoma) = 88.3% (95% CI, 83.7–92.9). Prevalence of trachomatous trichiasis (TT) was 14.6% (95% CI, 10.9–18.3) in adults over 14 years of age; 2.9% (95% CI, 0.4–5.3) in children 1–14 years of age; and 8.4% (95% CI, 5.5–11.3) overall. The prevalence of corneal opacity in persons over 14 years of age with TT was 6.4% (95% CI, 4.5–8.3). No statistically significant difference was observed in the prevalence of trachoma signs between genders. Trachoma affected almost all households surveyed: 384/392 (98.0%) had at least one person with active trachoma and 130 (33.2%) had at least one person with trichiasis.ConclusionsTrachoma is an unnecessary public health problem in Ayod. The high prevalence of active trachoma and trichiasis confirms the severe burden of blinding trachoma found in other post-conflict areas of Southern Sudan. Based on WHO recommended thresholds, all aspects of the SAFE strategy are indicated to eliminate blinding trachoma in Ayod.

Identification of Novel Single Nucleotide Polymorphisms in Inflammatory Genes as Risk Factors Associated with Trachomatous Trichiasis

“…Also, because subjects under age 20 years can have TS and TT [33]–[35], we felt it was reasonable to include them in our study.…”

Trachoma: Protective and Pathogenic Ocular Immune Responses to Chlamydia trachomatis

“…Females are at increased risk of conjunctival scarring and trichiasis, possibly from greater lifetime Ct exposure through close contact with children [21], [29]. In regions where trachoma is highly endemic, scarring sequelae are more common and occur at a younger age [30], [31]. There is good evidence that the immune response to Ct is partly determined by host genetic variations, with several studies from different populations having identified genetic polymorphisms related to immune system function that are associated with trachomatous scarring.…”

Trachoma in Western Equatoria State, Southern Sudan: Implications for National Control

“…In fact, in all other sites previously surveyed throughout Southern Sudan, prevalence of active trachoma exceeded the 10% intervention threshold by up to eight times [8]–[11]. Present findings thus provide an important contribution to our understanding of trachoma epidemiology in Southern Sudan, showing that the disease is not highly endemic throughout the country and that prevalence can vary considerably between adjacent counties.…”

“…This rate was somewhat less than that reported by other investigators, who examined 85%–90% of registered household occupants during surveys in other parts of Southern Sudan [10],[11],[28]. The main reason for non-response was that individuals were not present at the time of the survey; unfortunately it was not possible to follow these up due to the difficult operating conditions.…”