The prevalence of blinding trachoma in northern states of Sudan.
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ABSTRACT: Background
Despite historical evidence of blinding trachoma, there have been no widespread contemporary surveys of trachoma prevalence in the northern states of Sudan. We aimed to conduct district-level surveys in this vast region in order to map the extent of the problem and estimate the need for trachoma control interventions to eliminate blinding trachoma.Methods and findings
Separate, population based cross-sectional surveys were conducted in 88 localities (districts) in 12 northern states of Sudan between 2006 and 2010. Two-stage cluster random sampling with probability proportional to size was used to select the sample. Trachoma grading was done using the WHO simplified grading system. Key prevalence indicators were trachomatous inflammation-follicular (TF) in children aged 1-9 years and trachomatous trichiasis (TT) in adults aged 15 years and above. The sample comprised 1,260 clusters from which 25,624 households were surveyed. A total of 106,697 participants (81.6% response rate) were examined for trachoma signs. TF prevalence was above 10% in three districts and between 5% and 9% in 11 districts. TT prevalence among adults was above 1% in 20 districts (which included the three districts with TF prevalence >10%). The overall number of people with TT in the population was estimated to be 31,072 (lower and upper bounds = 26,125-36,955).Conclusion
Trachoma mapping is complete in the northern states of Sudan except for the Darfur States. The survey findings will facilitate programme planning and inform deployment of resources for elimination of trachoma from the northern states of Sudan by 2015, in accordance with the Sudan Federal Ministry of Health (FMOH) objectives.
SUBMITTER: Hassan A
PROVIDER: S-EPMC3104955 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe epidemiology of fevers and their management in areas of low malaria transmission in Africa is not well understood. The characteristics of fever, its treatment and association with infection prevalence from a national household sample survey in the northern states of Sudan, an area that represents historically low parasite prevalence, are examined in this study.MethodsIn October-November 2009, a cluster sample cross-sectional household malaria indicator survey was undertaken in the 15 northern states of the Sudan. Data on household assets and individual level information on age, sex, whether the individual had a fever in the last 14 days and on the day of survey, actions taken to treat the fever including diagnostic services and drugs used and their sources were collected. Consenting household members were asked to provide a finger-prick blood sample and examined for malaria parasitaemia using a rapid diagnostic test (RDT). All proportions and odds ratios were weighted and adjusted for clustering.ResultsOf 26,471 respondents 19% (n = 5,299) reported a history of fever within the last two weeks prior to the survey and 8% had fever on the day of the survey. Only 39% (n = 2,035) of individuals with fever in last two weeks took any action, of which 43% (n = 875) were treated with anti-malarials. About 44% (n = 382) of malaria treatments were done using the nationally recommended first-line therapy artesunate+sulphadoxine-pryrimethamine (AS+SP) and 13% (n = 122) with non-recommended chloroquine or SP. Importantly 33.9% (n = 296) of all malaria treatments included artemether monotherapy, which is internationally banned for the treatment of uncomplicated malaria. About 53% of fevers had some form of parasitological diagnosis before treatment. On the day of survey, 21,988 individuals provided a finger-prick blood sample and only 1.8% were found positive for Plasmodium falciparum. Infection prevalence was higher among individuals who had fever in the last two weeks (OR = 3.4; 95%CI = 2.6 - 4.4, p < 0.001) or reported fever on the day of survey (OR = 6.2; 95%CI = 4.4 - 8.7, p < 0.001) compared to those without a history of fever.ConclusionAcross the northern states of the Sudan, the period prevalence of fever is low. The proportion of fevers that are likely to be malaria is very low. Consequently, parasitological diagnosis of all fevers before treatment is an appropriate strategy for malaria case-management. Improved regulation and supervision of health workers is required to increase the use of diagnostics and remove the practice of prescribing artemisinin monotherapy.
| S-EPMC3115918 | biostudies-literature
Project description:BackgroundTrachoma is a neglected eye disease and an important cause of preventable corneal blindness. In endemic areas, initial infection can occur in early childhood and following a recurrent episodes, it progresses to scarring and visual impairment. Trachoma disappeared from high income countries through enhancements of hygiene and sanitation but the disease is still a challenge in developing countries. In Ethiopia, data indicate that Amhara is the region with the highest prevalence of active trachoma. The aim of this study was to assess the prevalence and associations of active trachoma among rural preschool children in Wadla district, Amhara region, Ethiopia.MethodsIn this study, 596 children were screened for signs of active trachoma by using cluster-sampling technique. Following pre-testing of the survey instrument in a different district, questions about socio-demographic status were delivered for heads of households. Integrated eye care workers, previously trained to undertake trachoma screening for one month, performed eye examination. The logistic regression model was used to look for associations of active trachoma.ResultsThe prevalence of active trachoma among rural preschool children in Wadla district was 22%. Low economic status (adjusted odds ratio [AOR]3.8 (95%CI 1.3-11.4), being 37-48 months old (4.2;1.5-12.0), living in a house with thatched roof (4.4;1.4-13.6), presence of flies in a home (4.6;2.1-9.9), once-weekly face-washing frequency (8.6;2.5-29.3), having a face that had not been washed for longer than a week (10.6;2.9-37.7), and not using soap (4.5;1.8-11.3) had association to active trachoma.ConclusionThe prevalence of active trachoma among rural pre-school children in Wadla district was high. This indicates that Trachoma is still a public health problem in the district. This high prevalence calls for further interventions to prevent future trachomatis blindness.
| S-EPMC7449018 | biostudies-literature
Project description:BackgroundThe world is witnessing mass displacement of populations which could impact global efforts to eliminate neglected tropical diseases such as trachoma. On the African continent, South Sudan has experienced high levels of population displacement. Population based baseline trachoma surveys were conducted among refugee camps in two Sudanese localities hosting South Sudanese refugee populations to determine whether the SAFE strategy was warranted.Methodology/principal findingsCross-sectional, multi-stage, cluster-random surveys were conducted within refugee camps in each of two Sudanese localities, Al Salam and Al Jabalain. For survey sampling, multiple camps within each locality were combined to form the sampling frame for that locality. Household water, sanitation and hygiene indicators were assessed, and trachoma signs were graded by trained and certified graders. The prevalence of trachomatous inflammation-follicular (TF) in children aged one to nine years was 15.7% (95%CI: 12.1-20.2) in Al Salam and 10.6% (95%CI: 7.9-14.0) in Al Jabalain. The prevalence of trachomatous trichiasis (TT) in those 15 years above was 2.9% (95%CI: 1.8-4.8) in Al Salam and 5.0% (95%CI: 3.8-6.6) in Al Jabalain. The presence of water and sanitation was high in both survey units.Conclusion/ significanceSudan has made progress in reducing the prevalence of trachoma within the country; however, the presence of over one million refugees from a neighboring trachoma hyper-endemic country could impact this progress. These surveys were the first step in addressing this important issue. The results demonstrate that at least three years of mass drug administration with azithromycin and tetracycline is needed in addition to the provision of TT surgical services. Additionally, it highlights that non-endemic or formerly endemic localities may have to adopt new strategies to provide services for refugee populations originating from hyper-endemic regions to ensure elimination of trachoma as a public health problem for all populations.
| S-EPMC6592575 | biostudies-literature
Project description:BackgroundTrachoma is thought to be common over large parts of Southern Sudan. However, many areas of the country, particularly west of the Nile, have not yet been surveyed. The aim of this study was to confirm whether trachoma extends into Western Equatoria State from neighboring Central Equatoria, where trachoma is highly prevalent, and whether intervention with the SAFE strategy is required.Methods and findingsPopulation-based cross-sectional surveys were conducted using a two-stage cluster random sampling method to select the study population. Subjects were examined for trachoma by experienced graders using the World Health Organization (WHO) simplified grading scheme. Two counties thought to be most likely to have trachoma were surveyed, Maridi and Mundri. In Maridi, prevalence of one of the signs of active trachoma (trachomatous inflammation-follicular (TF)) in children aged 1-9 years was 0.4% (95% confidence interval (CI), 0.0%-0.8%), while no children showing the other possible sign, trachomatous inflammation-intense (TI), were identified. No trachomatous trichiasis (TT) was found in those aged under 15, and prevalence was 0.1% (95% CI, 0.0%-0.4%) in those aged 15 years and above. In Mundri, active trachoma was also limited to signs of TF, with a prevalence of 4.1% (95% CI, 1.4%-6.9%) in children aged 1-9 years. Again, no TT was found in those aged under 15, and prevalence in those aged 15 years and above was 0.3% (95% CI, 0.0%-0.8%).ConclusionTrachoma prevalence in the east of Western Equatoria State is below the WHO recommended intervention threshold for mass drug administration of antibiotic treatment in all villages. However, the prevalence of TF and TT in some villages, particularly in Mundri County, is sufficiently high to warrant targeted interventions at the community level. These results demonstrate that trachoma is not a major public health problem throughout Southern Sudan. Further studies will be required to determine trachoma prevalence in other areas, particularly west of the Nile, but there are presently no resources to survey each county. Studies should thus be targeted to areas where collection of new data would be most informative.
| S-EPMC2710503 | biostudies-literature
Project description: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.
| S-EPMC3323519 | biostudies-literature
Project description:BackgroundHypertension and diabetes mellitus (DM), are highly prevalent worldwide health non-communicable diseases, and are associated with chronic complications. The co-existence of both conditions accelerates the related complications and increases morbidities and mortalities. A cross-sectional study was conducted in Nahr an Nil State (River Nile State) in Sudan between May and August 2018 to identify the prevalence of hypertension and risk factors among patients with DM in that region.ResultsThe median (interquartile) age of the 1,973 enrolled patients was 58.0 (50.0‒65.0) years, and 818 (45.6%) were males. The median (interquartile) duration of diabetes was 5.0 (3.0‒9.0) years. Of the 1,973 enrolled participants, 21.7%, 1.3%, 37.1%, and 39.9% were normal weight, underweight, overweight, and obese, respectively. Of 1,973 854 (47.6%) patients also had hypertension. Logistic regression analyses showed that elderly patients (adjusted odds ratio [AOR] = 1.03, 95%; confidence interval [CI] = 1.02‒1.04), males (AOR = 2.96, 95%; CI = 2.15‒4.07), employed patients (AOR = 1.92, 95%; CI = 1.38‒2.70), obese patients (AOR = 1.59, 95%; CI = 1.21‒2.08), and patients with diabetic foot (DF) (AOR = 2.45, 95%; CI = 1.72‒3.47) were at higher risk for hypertension. Conversely, patients with Type 2 DM (T2DM) (AOR = 0.63, 95%; CI = 0.50‒0.80) were at lower risk for hypertension. There was no significant association between overweight, uncontrolled DM, and hypertension.ConclusionThis study showed a high prevalence of hypertension among patients with DM. Notably, older age, male gender, employment, duration of DM, DF, underweight, and obesity were significant predictors of hypertension among patients with DM.
| S-EPMC8037914 | biostudies-literature
Project description:BackgroundBased on previous studies, historical records and risk factors, trachoma was suspected to be endemic in 31 health districts (HDs) in Guinea. To facilitate planning for the elimination of trachoma as a public health problem, national trachoma surveys were conducted between 2011 and 2016 to determine the prevalence of trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT) in all 31 endemic HDs.Methodology/principal findingsA total of 27 cross-sectional surveys were conducted, each using two-stage cluster sampling (one survey in 2011 covered five HDs). Children aged 1-9 years and adults aged ?15 years were examined for TF and TT, respectively, using the World Health Organization (WHO) simplified grading system. Indicators of household access to water, sanitation and hygiene (WASH) were also collected. A total of 100,051 people from 13,725 households of 556 clusters were examined, of whom 44,899 were male and 55,152 were female. 44,209 children aged 1-9-years and 48,745 adults aged ?15 years were examined. The adjusted prevalence of TF varied between 1.0% (95%CI: 0.6-1.5%) to 41.8% (95%CI: 39.4-44.2%), while the adjusted prevalence of TT ranged from 0.0% (95%CI: 0.0-0.2%) to 2.8% (95%CI: 2.3-3.5%) in the 27 surveys. In all, 18 HDs had a TF prevalence ?5% in children aged 1-9 years and 21 HDs had a TT prevalence ?0.2% in adults aged ?15 years. There were an estimated 32,737 (95% CI: 19,986-57,811) individuals with TT living in surveyed HDs at the time of surveys.Conclusions/significanceTrachoma is a public health problem in Guinea. 18 HDs required intervention with at least one round of mass drug administration and an estimated 32,737 persons required TT surgery in the country. The results provided clear evidence for Guinea to plan for national trachoma elimination.
| S-EPMC6013237 | biostudies-literature
Project description:BackgroundAs the World Health Organization seeks to eliminate trachoma by 2020, countries are beginning to control the transmission of trachomatous inflammation-follicular (TF) and discontinue mass drug administration (MDA) with oral azithromycin. We evaluated the effect of MDA discontinuation on TF1-9 prevalence at the district level.MethodsWe extracted from the available data districts with an impact survey at the end of their program cycle that initiated discontinuation of MDA (TF1-9 prevalence <5%), followed by a surveillance survey conducted to determine whether TF1-9 prevalence remained below the 5% threshold, warranting discontinuation of MDA. Two independent analyses were performed, 1 regression based and 1 simulation based, that assessed the change in TF1-9 from the impact survey to the surveillance survey.ResultsOf the 220 districts included, TF1-9 prevalence increased to >5% from impact to surveillance survey in 9% of districts. Regression analysis indicated that impact survey TF1-9 prevalence was a significant predictor of surveillance survey TF1-9 prevalence. The proportion of simulations with >5% TF1-9 prevalence in the surveillance survey was 2%, assuming the survey was conducted 4 years after MDA.ConclusionAn increase in TF1-9 prevalence may represent disease resurgence but could also be due to measurement error. Improved diagnostic tests are crucial to elimination of TF1-9 as a public health problem.
| S-EPMC7289551 | biostudies-literature
Project description: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.
| S-EPMC5484542 | biostudies-literature
Project description:BackgroundTrachoma is widely distributed in sub-Saharan Africa and is mainly associated with poor water accessibility. However, these associations have never been demonstrated in some of the communities, especially in northern Tanzania. To cover that gap, the present case control study was conducted to assess the association of water related factors, general hygiene and active trachoma among preschool and school age children in Hai district, northern Tanzania.ResultsFamilies reported to use > 60 litres of water per day were less likely to have active disease (OR= 0.4, 95% CI: 0.1 - 0.3; P<0.001) compared to households collecting ? 60 litres. The risk of having trachoma increased with increase in distance to the water point (OR= 6.5, 95% CI; 1.8 - 16.7; P= 0.003). Households members who reported to use < 2 liters of water for face washing were more likely to be trachomatous (OR= 5.12, 95% CI: 1.87-14.6, P = 0.001). Increased number of preschool children in the household was also associated with increased risk of active trachoma by 2.46 folds.ConclusionsImproving water supply near the households and providing public health education focusing on improving households socio-economic status and individual hygiene especially in pre-school children in part will help to reduce the prevalence of the disease. In addition, integrating public health education with other interventions such as medical interventions remains important.
| S-EPMC3710161 | biostudies-literature