The Burden of Trachoma in South Sudan: Assessing the Health Losses from a Condition of Graded Severity

Abstract

IntroductionTrachoma is a disease that can lead to visual impairment and ultimately blindness. Previous estimates of health losses from trachoma using the Global Burden of Disease methodology have not, however, included the stage prior to visual impairment. We estimated the burden of all stages of trachoma in South Sudan and assessed the uncertainty associated with the severity and duration of stages of trachoma prior to full blindness.MethodsThe prevalence of trachoma with normal vision, low vision and blindness in the Republic of South Sudan has been estimated previously. These estimates were used to model the incidence and duration of the different stages employing DISMOD II. Different assumptions about disability weights and duration were used to estimate the Years Lived with Disability (YLD).ResultsWe have estimated the total burden of trachoma in South Sudan to be between 136,562 and 163,695 YLD and trichiasis with normal vision contributes between 5% and 21% of the total depending on the disability weight applied. Women experience more of this burden than men. The sensitivity of the results to different assumptions about the disability weights is partly dependent upon the assumed duration of the different disease states.InterpretationA better understanding of the natural history of trachoma is critical for a more accurate burden estimate.

The Epidemiology of Trachoma in the Lower Shire Valley of Southern Malawi and Implications for the “SAFE” Strategy

“…The observation that TT was more prevalent in women than men is a finding that is well accepted, possibly this is due to the number of increased recurrent trachoma infections in women resulting from frequent contacts with children [31]. It is important to note that not all cases of trachomatous trichiasis lead to cornea opacities and impaired visual acuity [43] and that some of the cornea opacities seen in the community are not caused by trachoma but may be caused by other cornea infections and concurrent use of traditional medicines for treatment. Moreover the observed cases may be old prevalent cases and may need to be verified.…”

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“…However, in Tanzania, severe infection, repeated infections, and both severe and repeated infection in children under the age of 10 years led to trichiasis within 5 years [12]. While people with untreated trichiasis will ultimately become blind, a study in South Sudan has found that between 5 and 12% of people with trachoma have normal vision with trichiasis [13]. …”

Baseline Prevalence of Trachoma in Refugee Settlements in Uganda: Results of 11 Population-based Surveys

“…Given the high prevalence of trachoma in South Sudan 12 , 31 in particular, it is surprising that the prevalence of TF among the refugee population was so low. This low prevalence has been noted in other settlements serving refugees from South Sudan, for example in Sudan and in Ethiopia.…”