Blinding Trachoma in Postconflict Southern Sudan

Ngondi, Jeremiah; Ole-Sempele, Francis; Onsarigo, Alice; Matende, Ibrahim; Baba, Samson; Reacher, Mark; Matthews, Fiona E.; Brayne, Carol; Emerson, Paul M.

doi:10.1371/journal.pmed.0030478

Cited by 42 publications

(41 citation statements)

References 8 publications

(9 reference statements)

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“…The proportion of blindness due to trachoma by far exceeds what has been observed in other countries where trachoma is endemic: Mali (12.1%) [29], Kenya(18.7%) [25], Ethiopia (20.6%) [27], and Tanzania (26%) [24]. In Mankien, trachomatous trichiasis (TT) has been documented in children as young as 4 y, overall (all ages) TT prevalence was 9.6%, and prevalence of bilateral trachomatous corneal opacity was 3.1% [30]. Nontrachomatous corneal opacity accounted for a fifth of blindness and a tenth of all forms of visual impairment.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Causes of Blindness and Low Vision in Southern Sudan

Ngondi

Ole-Sempele²,

Onsarigo³

et al. 2006

PLoS Med

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BackgroundBlindness and low vision are thought to be common in southern Sudan. However, the magnitude and geographical distribution are largely unknown. We aimed to estimate the prevalence of blindness and low vision, identify the main causes of blindness and low vision, and estimate targets for blindness prevention programs in Mankien payam (district), southern Sudan.Methods and FindingsA cross-sectional survey of the population aged 5 y and above was conducted in May 2005 using a two-stage cluster random sampling with probability proportional to size. The Snellen E chart was used to test visual acuity, and participants also underwent basic eye examination. Vision status was defined using World Health Organization categories of visual impairment based on presenting visual acuity (VA). A total of 2,954 persons were enumerated and 2,499 (84.6%) examined. Prevalence of blindness (presenting VA of less than 3/60 in the better eye) was 4.1% (95% confidence interval [CI], 3.4–4.8); prevalence of low vision (presenting VA of at least 3/60 but less than 18/60 in the better eye) was 7.7% (95% CI, 6.7–8.7); whereas prevalence of monocular visual impairment (presenting VA of at least 18/60 in better eye and VA of less than 18/60 in other eye) was 4.4% (95% CI, 3.6–5.3). The main causes of blindness were considered to be cataract (41.2%) and trachoma (35.3%), whereas low vision was mainly caused by trachoma (58.1%) and cataract (29.3%). It is estimated that in Mankien payam 1,154 persons aged 5 y and above (lower and upper bounds = 782–1,799) are blind, and 2,291 persons (lower and upper bounds = 1,820–2,898) have low vision.ConclusionsBlindness is a serious public health problem in Mankien, and there is urgent need to implement comprehensive blindness prevention programs. Further surveys are essential to confirm these tragic findings and estimate prevalence of blindness and low vision in the entire region of southern Sudan in order to facilitate planning of VISION 2020 objectives.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Causes of Blindness and Low Vision in Southern Sudan

Ngondi

Ole-Sempele²,

Onsarigo³

et al. 2006

PLoS Med

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“…Few surveys have been conducted in postconflict areas in Africa. A recent survey from southern Sudan estimated that the prevalence of blindness in the total population was 4.1% [5], although there are some concerns about the methods used in this survey [6]. Another survey conducted in 1998 in a rural area of the Democratic Republic of Congo estimated that only 0.5% of surveyed people over 10 y of age were blind in both eyes [16], is relatively similar to the estimates of blindness obtained for Western Province of Rwanda.…”

Section: Discussionmentioning

confidence: 99%

“…Recent surveys, however, have reported a lower than expected prevalence of blindness [2–4], which may reflect a real decline in blindness or may result from improvements in survey quality. In contrast, a recent survey carried out in a postconflict area in Southern Sudan reported a prevalence of blindness of 4.1%, more than four times as high as expected for Africa as a whole [5]. There were methodological problems with this survey [6], but there are few other surveys available for postconflict areas to allow comparison.…”

Section: Introductionmentioning

confidence: 99%

Rapid Assessment of Avoidable Blindness in Western Rwanda: Blindness in a Postconflict Setting

Mathenge

Nkurikiye²,

Limburg

et al. 2007

PLoS Med

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BackgroundThe World Health Organization estimates that there were 37 million blind people in 2002 and that the prevalence of blindness was 9% among adults in Africa aged 50 years or older. Recent surveys indicate that this figure may be overestimated, while a survey from southern Sudan suggested that postconflict areas are particularly vulnerable to blindness. The aim of this study was to conduct a Rapid Assessment for Avoidable Blindness to estimate the magnitude and causes of visual impairment in people aged ≥ 50 y in the postconflict area of the Western Province of Rwanda, which includes one-quarter of the population of Rwanda.Methods and FindingsClusters of 50 people aged ≥ 50 y were selected through probability proportionate to size sampling. Households within clusters were selected through compact segment sampling. Visual acuity (VA) was measured with a tumbling “E” chart, and those with VA below 6/18 in either eye were examined by an ophthalmologist. The teams examined 2,206 people (response rate 98.0%). The unadjusted prevalence of bilateral blindness was 1.8% (95% confidence interval [CI] 1.2%–2.4%), 1.3% (0.8%–1.7%) for severe visual impairment, and 5.3% (4.2%–6.4%) for visual impairment. Most bilateral blindness (65%) was due to cataract. Overall, the vast majority of cases of blindness (80.0%), severe visual impairment (67.9%), and visual impairment (87.2%) were avoidable (i.e.. due to cataract, refractive error, aphakia, trachoma, or corneal scar). The cataract surgical coverage was moderate; 47% of people with bilateral cataract blindness (VA < 3/60) had undergone surgery. Of the 29 eyes that had undergone cataract surgery, nine (31%) had a best-corrected poor outcome (i.e., VA < 6/60). Extrapolating these estimates to Rwanda's Western Province, among the people aged 50 years or above 2,565 are expected to be blind, 1,824 to have severe visual impairment, and 8,055 to have visual impairment.ConclusionsThe prevalence of blindness and visual impairment in this postconflict area in the Western Province of Rwanda was far lower than expected. Most of the cases of blindness and visual impairment remain avoidable, however, suggesting that the implementation of an effective eye care service could reduce the prevalence further.

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“…We thank the authors [1,2] for the two perspectives on our articles [3,4]. Our study estimated the prevalence of blindness in Mankien at 4%, which Kuper and Gilbert describe as being “beyond the range” of the studies reviewed by Pascolini et al [5].…”

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confidence: 95%