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

Kur, Lucia W.; Picon, Diana; Adibo, Obec; Robinson, Emily; Sabasio, Anthony; Edwards, Tansy; Ndyaba, Aggrey; Rumunu, John; Lewis, Karinya; Lado, Mounir; Kolaczinski, Jan

doi:10.1371/journal.pntd.0000492

Cited by 7 publications

(9 citation statements)

References 15 publications

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“…These findings indicate that trachoma constitutes a major problem to public health in Southern Sudan [27] . However, not all of Southern Sudan is equally at risk, as indicated by recent surveys that identified areas where trachoma is not endemic [28] . Generating a better understanding of the geographical distribution of trachoma is therefore important so that the limited available resources can be better targeted.…”

Section: Introductionmentioning

confidence: 99%

Targeting Trachoma Control through Risk Mapping: The Example of Southern Sudan

Clements

Kur

Gatpan³

et al. 2010

PLoS Negl Trop Dis

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BackgroundTrachoma is a major cause of blindness in Southern Sudan. Its distribution has only been partially established and many communities in need of intervention have therefore not been identified or targeted. The present study aimed to develop a tool to improve targeting of survey and control activities.Methods/Principal FindingsA national trachoma risk map was developed using Bayesian geostatistics models, incorporating trachoma prevalence data from 112 geo-referenced communities surveyed between 2001 and 2009. Logistic regression models were developed using active trachoma (trachomatous inflammation follicular and/or trachomatous inflammation intense) in 6345 children aged 1–9 years as the outcome, and incorporating fixed effects for age, long-term average rainfall (interpolated from weather station data) and land cover (i.e. vegetation type, derived from satellite remote sensing), as well as geostatistical random effects describing spatial clustering of trachoma. The model predicted the west of the country to be at no or low trachoma risk. Trachoma clusters in the central, northern and eastern areas had a radius of 8 km after accounting for the fixed effects.ConclusionIn Southern Sudan, large-scale spatial variation in the risk of active trachoma infection is associated with aridity. Spatial prediction has identified likely high-risk areas to be prioritized for more data collection, potentially to be followed by intervention.

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Section: Introductionmentioning

confidence: 99%

Targeting Trachoma Control through Risk Mapping: The Example of Southern Sudan

Clements

Kur

Gatpan³

et al. 2010

PLoS Negl Trop Dis

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“…Trachoma surveys have also been undertaken in a number of areas in the country [6]–[8]. For LF, schistosomiasis and STH, by contrast, systematic prevalence data are not available, with previous studies in Southern Sudan having been few and limited in scale [9]–[11].…”

Section: Introductionmentioning

confidence: 99%

“…In Southern Sudan, up until now, the distribution of onchocerciasis has been comprehensively mapped by the Ministry of Health, Government of Southern Sudan (MoH-GoSS) with assistance from the African Program for Onchocerciasis Control [5] . Trachoma surveys have also been undertaken in a number of areas in the country [6] – [8] . For LF, schistosomiasis and STH, by contrast, systematic prevalence data are not available, with previous studies in Southern Sudan having been few and limited in scale [9] – [11] .…”

Section: Introductionmentioning

confidence: 99%

Integrated Mapping of Neglected Tropical Diseases: Epidemiological Findings and Control Implications for Northern Bahr-el-Ghazal State, Southern Sudan

Sturrock

Picon²,

Sabasio³

et al. 2009

PLoS Negl Trop Dis

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BackgroundThere are few detailed data on the geographic distribution of most neglected tropical diseases (NTDs) in post-conflict Southern Sudan. To guide intervention by the recently established national programme for integrated NTD control, we conducted an integrated prevalence survey for schistosomiasis, soil-transmitted helminth (STH) infection, lymphatic filariasis (LF), and loiasis in Northern Bahr-el-Ghazal State. Our aim was to establish which communities require mass drug administration (MDA) with preventive chemotherapy (PCT), rather than to provide precise estimates of infection prevalence.Methods and FindingsThe integrated survey design used anecdotal reports of LF and proximity to water bodies (for schistosomiasis) to guide selection of survey sites. In total, 86 communities were surveyed for schistosomiasis and STH; 43 of these were also surveyed for LF and loiasis. From these, 4834 urine samples were tested for blood in urine using Hemastix reagent strips, 4438 stool samples were analyzed using the Kato-Katz technique, and 5254 blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests (ICT). 4461 individuals were interviewed regarding a history of ‘eye worm’ (a proxy measure for loiasis) and 31 village chiefs were interviewed regarding the presence of clinical manifestations of LF in their community. At the village level, prevalence of Schistosoma haematobium and S. mansoni ranged from 0 to 65.6% and from 0 to 9.3%, respectively. The main STH species was hookworm, ranging from 0 to 70% by village. Infection with LF and loiasis was extremely rare, with only four individuals testing positive or reporting symptoms, respectively. Questionnaire data on clinical signs of LF did not provide a reliable indication of endemicity. MDA intervention thresholds recommended by the World Health Organization were only exceeded for urinary schistosomiasis and hookworm in a few, yet distinct, communities.ConclusionThis was the first attempt to use an integrated survey design for this group of infections and to generate detailed results to guide their control over a large area of Southern Sudan. The approach proved practical, but could be further simplified to reduce field work and costs. The results show that only a few areas need to be targeted with MDA of PCT, thus confirming the importance of detailed mapping for cost-effective control.

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“…Previous baseline and impact surveys showed that the prevalence of trachoma varied throughout the country, with low levels of trachoma detected in Western Equatoria [ 5 ], Northern Bahr-el-Ghazal [ 6 ], and Central [ 18 ] states. Hyper endemic levels of trachoma were detected in the Greater Upper Nile region of Jonglei, Upper Nile, and Unity states [ 3 , 7 ], and Eastern Equatoria state [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Burden of trachoma in five counties of Eastern Equatoria state, South Sudan: Results from population-based surveys

et al. 2017

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BackgroundIn order to decrease the prevalence of trachoma within the country, the Republic of South Sudan has implemented components of the SAFE strategy in various counties since 2001. Five counties in Eastern Equatoria state were surveyed in order to monitor progress of programmatic interventions and determine if additional rounds of Mass Drug Administration with azithromycin were needed.Methodology/ Principal findingsFive counties (Budi, Lafon, Kapoeta East, Kapoeta South and Kapoeta North) were surveyed from April to October 2015. A cross-sectional, multi-stage, cluster-random sampling was used. All present, consenting residents of selected households were examined for all clinical signs of trachoma using the World Health Organization (WHO) simplified grading system. 14,462 individuals from 3,446 households were surveyed. The prevalence of trachomatous inflammation-follicular (TF) in children ages one to nine years ranged from 17.4% (95% Confidence Interval (CI): 11.4%, 25.6%) in Budi county to 47.6%, (95% CI: 42.3%, 53.0%) in Kapoeta East county. Trachomatous trichiasis (TT) was also highly prevalent in those 15 years and older, ranging between 2.6% (95% CI: 1.6%, 4.0%) in Kapoeta South to 3.9% (95% CI: 2.4%, 6.1%) in Lafon. The presence of water and sanitation were low in all five counties, including two counties which had a complete absence of latrines in all surveyed clusters.Conclusions/ SignificanceTo our knowledge, these were the first trachoma surveys conducted in the Republic of South Sudan since their independence in 2011. The results show that despite years of interventions, four of the five surveyed counties require a minimum of five additional years of SAFE strategy implementation, with the fifth requiring at minimum three more years.

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

Cited by 7 publications

References 15 publications

Targeting Trachoma Control through Risk Mapping: The Example of Southern Sudan

Targeting Trachoma Control through Risk Mapping: The Example of Southern Sudan

Integrated Mapping of Neglected Tropical Diseases: Epidemiological Findings and Control Implications for Northern Bahr-el-Ghazal State, Southern Sudan

Burden of trachoma in five counties of Eastern Equatoria state, South Sudan: Results from population-based surveys

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