Prevalence of Trachoma in Unity State, South Sudan: Results from a Large-Scale Population-Based Survey and Potential Implications for Further Surveys

Large parts of South Sudan are thought to be trachoma endemic but baseline data, required to initiate interventions, are few. District-by-district surveys, currently recommended by the World Health Organization (WHO), are often not financially or logistically viable. We therefore adapted existing WHO guidelines and combined eight counties (equivalent to districts) of Unity State into one survey area, randomly sampling 40 villages using a population-based survey design. This decision was based on a trachoma risk map and a trachoma rapid assessment, both identifying the state as likely to be highly endemic. The survey confirmed trachoma as being hyperendemic throughout Unity State, meaning that large-scale intervention should be initiated now. Simulation studies were conducted to determine the likely outcome if fewer (n = 20) or more (n = 60) villages had been sampled, confirming that precision decreased or increased, respectively. Importantly, simulation results also showed that all three sample sizes would have led to the same conclusion, namely the need for large-scale intervention. This finding suggests that district-by-district surveys may not be required for areas where trachoma is suspected to be highly prevalent but that are lacking baseline data; instead districts may be combined into a larger survey area

What Will Happen If We Do Nothing To Control Trachoma: Health Expectancies for Blinding Trachoma in Southern Sudan

Summary measures of population health attempt to express disease burden in terms of a common “currency” and are useful in establishing public health priorities. Disability adjusted life years (DALYs), a health gap measure, have previously been used to estimate burden due to trachoma; however, their methods and results have limitations. This study demonstrates the application of the health expectancies to estimate burden due to trachoma. The study illustrates the future burden associated with doing nothing to control trachoma in Southern Sudan: a substantial proportion of remaining life expectancy spent with trichiasis and low vision or blindness for both men and women, with a disproportionate burden falling on women. The results presented are intuitively meaningful for policy makers and a non-technical audience and compare favourably with other indicators such as mortality and incidence rates or DALYs, which are not generally easily understood. Unless action is taken by further delivery of trachoma control interventions, then populations in Southern Sudan can expect to spend a substantial proportion of their life with low vision or blindness due to trachoma

Associations between Active Trachoma and Community Intervention with Antibiotics, Facial Cleanliness, and Environmental Improvement (A,F,E)

Trachoma is an infectious disease that is cased by a bacterium, Chlamydia trachomatis, and is the leading cause of preventable blindness estimated to be responsible for 3.6% of blindness globally. The World Health Organization (WHO) recommends a strategy for trachoma control known as SAFE—surgery, antibiotics, facial cleanliness, and environmental improvement. Regular evaluations of trachoma control activities are advocated for by the WHO for decision making, programme planning, and the rational use of programme resources. We undertook a survey to evaluate the effectiveness of the SAFE strategy following three years of interventions in four districts in Southern Sudan. In this paper, we aimed to find out the relationship between the antibiotics, facial cleanliness, and environmental improvement (A,F,E) and active trachoma signs. Our study revealed that prevalence of active trachoma was less in children who had received treatment with azithromycin, had clean faces, had faces washed more frequently, and used latrines compared to children who had not received these interventions. The study findings are important since they make the case for implementing the A,F,E interventions together

Poverty and poor education are key determinants of high household food insecurity among populations adjoining forest concessions in the Congo Basin

Background: The trees and non-timber forest products (NTFPs) of the Congo Basin play a key role in alleviating food insecurity among millions of people around the world. Although many studies have been conducted both nationally and regionally on issues of food insecurity in the Congo Basin, little is known on the effects of timber exploitation on household food insecurity statues of forest dependent communities in this region. This study focused on the determination of the principal indicators of household food security status of populations living around six selected forest concessions in the Congo Basin. Method: We randomly surveyed 724 households in thirty-four communities living in six popular forest concessions around the Congo Basin. Food consumption pattern data was collected using a validated food-frequency questionnaire in 2012. Household Food Insecurity Access Prevalence (HFIAP) was assessed using the HFIAP indicator and households were categorized into four levels of household food insecurity status as follows: Food secure (HFIAS = 0); mildly food insecure (HFIAS 1–8); moderately food insecure (HFIAS 9–13); and severely food insecure (HFIAS 14–27). Results: The majority of the households interviewed were headed by women (73.1 %, 76.6 %, and 58.6 % for Cameroon, DRC and Gabon respectively), most of them married (84.6 %, 100 %, 57.6 % for Cameroon, DRC and Gabon respectively) with an average age range of 30–49 years. Most of the household members were engaged in farming and/or illegal logging as the main revenue generating activities. Results of global household food insecurity categorized 63.8 % of households in Cameroon as fully food secure and 36 % as food insecure. In the DRC (92.9 %) and Gabon (92.7 %), almost all the survey households were categorized as either moderately or severely food insecure; clearly elucidating the existence of severe insufficiency in the quantity and quality of food meant for human nutrition in these areas. The means of household food insecurity scores for the DRC (17.40 ± 4.15) and Gabon (14.9 ± 5.87) were significantly higher when compared to the average score for Cameroon ((7.55 ± 6.62) at p < 0.0001. This literally means that many of the households especially in DRC and Gabon face enormous difficulties in obtaining an adequate dietary energy supply. Gender (female), educational level (illiterate), and age (young) were positively correlated to food insecurity levels. Conclusion: Our results revealed that, despite the potential contribution of the Congo Basin forests, through enhancing access to different forms of quality foods such as bush meat, wild foods, and medicine, not forgetting the provision of agricultural land, local construction material, and income generation resources, the prevalence of food insecurity among the population adjoining forest concessions in the region is severe. This prevalence is alarming around forest concessions of the DRC and Gabon and in one concession of Cameroon. Given that poverty and poor education were positively correlated to household food insecurity, they were considered the paramount determinants of household food insecurity in this region

Incremental Cost of Conducting Population-Based Prevalence Surveys for a Neglected Tropical Disease: The Example of Trachoma in 8 National Programs

The costs of conducting population-based prevalence surveys for neglected tropical diseases such as trachoma are often cited as a reason that program managers do not conduct baseline or impact assessments when guidelines suggest they are warranted. The authors conducted a review of actual costs incurred during the implementation of 165 district level surveys in 8 national trachoma control programs to identify the median and mean costs per district and per cluster. In addition, the costs of the principal activities that are the most expensive were measured. The data show that field work is the most expensive activity for a prevalence survey, with personnel (per diems, allowances and accommodation) and transport costs driving the total cost of the survey. These findings can be used by program managers to budget for population-based prevalence surveys that are recommended for baseline and evaluation surveys, and periodic uptake surveys for neglected tropical diseases such as trachoma

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

Trachoma is an infectious disease that is endemic to the Republic of South Sudan. In the absence of appropriate treatment recurrent re-infection in an individual will lead to progressively severe states of trachoma, eventually leading to the loss of visual acuity and finally blindness. Here we distinguish between three separate states of disease: trachoma with normal vision, trachoma with low vision and trachoma with blindness. The first of these states, trachoma with normal vision, is the least severe and the impact of this state on a population has not been well investigated. Trachoma, even before any loss of vision, comes with a great deal of pain and social consequences, and thus disability. In this study we employ data from South Sudan and estimate the burden caused by trachoma with normal vision for the first time. In doing so, we also reveal the extent of the gaps in our knowledge surrounding the natural history of trachoma and highlight areas of research that require urgent attention

Risk Factors for Ocular Chlamydia after Three Mass Azithromycin Distributions

Trachoma, which is the leading infectious cause of blindness worldwide, is caused by repeated ocular infection with Chlamydia trachomatis. Treatment for trachoma includes mass azithromycin treatments to the entire community. The World Health Organization recommends at least 3 rounds of annual mass antibiotic distributions in areas with trachoma, with further mass treatments based on the prevalence of trachoma. However, there are other options for communities that have received several rounds of treatment. For example, programs could continue antibiotic treatments only in those households most likely to have infected individuals. In this study, we performed trachoma monitoring on children from 12 Ethiopian communities one year after a third mass azithromycin treatment, and conducted a household survey at the same time. We found that children were more likely to be infected with ocular chlamydia if they had ocular inflammatory signs or ocular discharge, or if they had missed the preceding antibiotic treatment, had an infected sibling, or came from a larger community. These risk factors suggest that after mass azithromycin treatments, trachoma programs could consider continuing antibiotic distributions to households that have missed prior antibiotic distributions, in households with children who have the clinical signs of trachoma, and in larger communities