Trachoma Rapid Assessments in Unity and Northern Bahr-el-Ghazal States, Southern Sudan

Robinson, Emily; Kur, Lucia W.; Ndyaba, Aggrey; Lado, Mounir; Shafi, Juma; Kabare, Emmanuel; McClelland, R. Scott; Kolaczinski, Jan

doi:10.1371/journal.pone.0013138

Cited by 7 publications

(10 citation statements)

References 29 publications

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“…The trachoma community experimented over several years with alternative methods for providing evidence to start programmatic implementation, however, neither have been routinely adopted [ 21 ]. TRAs are designed to provide biased prevalence estimates, as they prioritize finding trachoma where it exists [ 22 , 23 ]. In most cases, these TRAs were used to determine areas where a PBPS should be implemented.…”

Section: Methodsmentioning

confidence: 99%

Mass Drug Administration for Trachoma: How Long Is Not Long Enough?

et al. 2015

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BackgroundBlinding trachoma is targeted for elimination by 2020 using the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements). Annual mass drug administration (MDA) with azithromycin is a cornerstone of this strategy. If baseline prevalence of clinical signs of trachomatous inflammation – follicular among 1-9 year-olds (TF1-9) is ≥10% but <30%, the World Health Organization guidelines are for at least 3 annual MDAs; if ≥30%, 5. We assessed the likelihood of achieving the global elimination target of TF1-9 <5% at 3 and 5 year evaluations using program reports.Methodology/Principal FindingsWe used the International Trachoma Initiative’s prevalence and treatment database. Of 283 cross-sectional survey pairs with baseline and follow-up data, MDA was conducted in 170 districts. Linear and logistic regression modeling was applied to these to investigate the effect of MDA on baseline prevalence. Reduction to <5% was less likely, though not impossible, at higher baseline TF1-9 prevalences. Increased number of annual MDAs, as well as no skipped MDAs, were significant predictors of reduced TF1-9 at follow-up. The probability of achieving the <5% target was <50% for areas with ≥30% TF1-9 prevalence at baseline, even with 7 or more continuous annual MDAs.ConclusionsNumber of annual MDAs alone appears insufficient to predict program progress; more information on the effects of baseline prevalence, coverage, and underlying environmental and hygienic conditions is needed. Programs should not skip MDAs, and at prevalences >30%, 7 or more annual MDAs may be required to achieve the target. There are five years left before the 2020 deadline to eliminate blinding trachoma. Low endemic settings are poised to succeed in their elimination goals. However, newly-identified high prevalence districts warrant immediate inclusion in the global program. Intensified application of the SAFE strategy is needed in order to guarantee blinding trachoma elimination by 2020.

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Section: Methodsmentioning

confidence: 99%

Mass Drug Administration for Trachoma: How Long Is Not Long Enough?

et al. 2015

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“…2) Based on financial and logistical considerations, it was decided to survey a total of 40 sites across the state, whereas the national protocol suggests that 20 sites should be surveyed per county. The rationale for using a larger study area and population in the present PBPS was that Unity State had already been indicated as highly trachoma endemic [14] , [15] , [16] . Survey modification as described above was therefore agreed among partners in South Sudan and with the International Trachoma Initiative to ensure that baseline data to target SAFE interventions could be generated quickly and efficiently without compromising its quality.…”

Section: Methodsmentioning

confidence: 99%

“…Trachoma rapid assessments (TRA) were therefore conducted during 2009 to establish whether there was evidence of ongoing trachoma transmission in two of the suspected trachoma endemic states west of the Nile; Northern Bahr-el-Ghazal and Unity State. The latter was identified as being trachoma endemic throughout, with more than 10% of children aged 1–9 years in all of the thirteen surveyed villages showing signs of TF [16] .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Trachoma in Unity State, South Sudan: Results from a Large-Scale Population-Based Survey and Potential Implications for Further Surveys

et al. 2012

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BackgroundLarge parts of South Sudan are thought to be trachoma-endemic but baseline data are limited. This study aimed to estimate prevalence for planning trachoma interventions in Unity State, to identify risk factors and to investigate the effect of different sampling approaches on study conclusions.Methods and FindingsThe survey area was defined as one domain of eight counties in Unity State. Across the area, 40 clusters (villages) were randomly selected proportional to the county population size in a population-based prevalence survey. The simplified grading scheme was used to classify clinical signs of trachoma. The unadjusted prevalence of trachoma inflammation-follicular (TF) in children aged 1–9 years was 70.5% (95% CI: 68.6–72.3). After adjusting for age, sex, county and clustering of cases at household and village level the prevalence was 71.0% (95% CI: 69.9–72.1). The prevalence of trachomatous trichiasis (TT) in adults was 15.1% (95% CI: 13.4–17.0) and 13.5% (95% CI: 12.0–15.1) before and after adjustment, respectively. We estimate that 700,000 people (the entire population of Unity State) require antibiotic treatment and approximately 54,178 people require TT surgery. Risk factor analyses confirmed child-level associations with TF and highlighted that older adults living in poverty are at higher risk of TT. Conditional simulations, testing the alternatives of sampling 20 or 60 villages over the same area, indicated that sampling of only 20 villages would have provided an acceptable level of precision for state-level prevalence estimation to inform intervention decisions in this hyperendemic setting.ConclusionTrachoma poses an enormous burden on the population of Unity State. Comprehensive control is urgently required to avoid preventable blindness and should be initiated across the state now. In other parts of South Sudan suspected to be highly trachoma endemic, counties should be combined into larger survey areas to generate the baseline data required to initiate interventions.

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“…13,14 A study in 2012 found 99 cases of trachomatous trichiasis (19.2%) from only 515 people examined in a refugee camp in Fugnido, Gambella, 15 and the 2005–2006 National Survey of Blindness, Low Vision and Trachoma estimated a regional prevalence of active trachoma (TF and/or TI) in Gambella of 19.1% in those aged 1–9 years. 16 …”

Section: Introductionmentioning

confidence: 99%

Prevalence of Trachoma in Gambella Region, Ethiopia: Results of Three Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project

Abashawl

Macleod

Riang

et al. 2016

Ophthalmic Epidemiology

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Purpose: In Ethiopia, trachoma is a major public health problem, accounting for 11.5% of all cases of blindness. In Gambella, one of the country’s most remote regions, the 2005–2006 National Survey of Blindness, Low Vision and Trachoma estimated a region-level prevalence of active trachoma of 19.1% in those aged 1–9 years. Detailed district or sub-regional level estimates are required to implement interventions. Methods: Population-based prevalence surveys were carried out following a 2-stage cluster random sampling methodology and Global Trachoma Mapping Project protocols. As the 13 districts (woredas) in Gambella had relatively small populations, they were grouped together to form three evaluation units (EUs) of about 100,000 persons each, and all subsequent survey planning and sampling was carried out at EU-level. Results: Altogether, 558 cases of TF (17.2%) were identified in 3238 children aged 1–9 years across the three EUs. The adjusted TF prevalences in 1–9-year-olds for the three EUs were 11.5%, 12.5% and 19.3%; 14.4% for Gambella overall. A total of 142 cases of trichiasis (3.8%) were identified among 3781 adults aged 15 years or older, with age- and sex-adjusted EU-level trichiasis prevalences in adults being 0.8%, 1.3% and 2.4%; 1.5% overall. Conclusion: The high prevalences of TF and trichiasis throughout Gambella indicate a need for rapid scaling up of the World Health Organization SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement) to help meet the 2020 target of global elimination of trachoma as a public health problem.

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Trachoma Rapid Assessments in Unity and Northern Bahr-el-Ghazal States, Southern Sudan

Cited by 7 publications

References 29 publications

Mass Drug Administration for Trachoma: How Long Is Not Long Enough?

Mass Drug Administration for Trachoma: How Long Is Not Long Enough?

Prevalence of Trachoma in Unity State, South Sudan: Results from a Large-Scale Population-Based Survey and Potential Implications for Further Surveys

Prevalence of Trachoma in Gambella Region, Ethiopia: Results of Three Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project

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