Research Article: The Burden of Trachoma in Ayod County of Southern Sudan

Date Published: September 24, 2008

Publisher: Public Library of Science

Author(s): Jonathan D. King, Jeremiah Ngondi, Gideon Gatpan, Ben Lopidia, Steve Becknell, Paul M. Emerson, Julius Schachter

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.

Partial Text: Trachoma is a disease caused by ocular serovars of the bacterial pathogen Chlamydia trachomatis. Infection with ocular C. trachomatis results in conjunctivitis and clinical signs of active trachoma are distinguished by the presence of follicles on the tarsal conjunctiva and intense inflammation. Repeated infections lead to conjunctival scarring of the upper eye lid which may result in entropion allowing eyelashes to scrape the cornea; a condition referred to as trichiasis. Without corrective lid surgery, lashes continue to abrade the cornea leading to additional infections, ulceration and eventually opacities in the cornea that are irreversible.[1]

Communities in Ayod are in urgent need of interventions to eliminate trachoma as a public health problem. Active trachoma affected nearly every household in this survey and one in three had at least one person with trichiasis. The prevalence of active trachoma in children 1–9 years of age reported in this survey is, to our knowledge, the highest district-wide estimate ever reported in Southern Sudan. Ngondi et al reported TF prevalence in children as high as 77.2% in a separate county within Jonglei State and TF greater than 60% in counties within two other states.[8] In addition, active trachoma in Ayod is among the highest reported globally, comparative to other trachoma hyperendemic settings in Tanzania[28],[29], Ethiopia[22],[30],[31], Kenya[32] and parts of Australia.[33],[34] Including Ayod, surveys in 12 other areas in Southern Sudan have consistently demonstrated the unreasonably high burden of trachoma (Figure 1).



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