Piloting a trachomatous trichiasis patient case-searching approach in two localities of Sudan.

BACKGROUND: Approximately 1.9 million people have become blind or visually impaired from trachoma, the leading cause of infectious blindness. Trachoma prevalence surveys conducted in Sudan have shown that thousands of Sudanese suffer from the advanced stages of the disease, trachomatous trichiasis (TT), and warrant sight-saving surgery. Sudan's National Trachoma Control Program (NTCP) provides free TT surgery; however, given that many TT patients live in remote areas with limited access to health services, identifying patients and providing eye care services has proved challenging. For this reason, the Sudan NTCP piloted a systematic TT case-finding approach to identify patients. METHODS: In Gedarif state, 11 villages in Baladyat el Gedarif locality and 21 villages in West Galabat locality were included in a TT case-searching activity from September to November 2018. TT case finders were selected from the villages where the activity took place and were trained by ophthalmic medical assistants to identify possible patients. RESULTS: Of 66 626 villagers examined, 491 were identified as having TT by TT case finders. Of those, 369 were confirmed as true cases by the TT surgeons, a 75.2% (369/491) success rate. CONCLUSIONS: The TT case-finding approach provides an example of an effective method for identifying TT patients and should be expanded to other parts of the country known to be endemic for trachoma.

Progress toward Elimination of Trachoma as a Public Health Problem in Seven Localities in the Republic of Sudan: Results from Population-Based Surveys.

Trachoma is the leading cause of infectious blindness in the world. After baseline surveys demonstrated that Sudan was endemic for trachoma, the Sudan Federal Ministry of Health (FMOH) Trachoma Control Program conducted trachoma prevention and treatment interventions in endemic localities. The Sudan FMOH conducted population-based trachoma prevalence surveys between September 2016 and April 2017 in seven localities across five states of Sudan to document current trachoma prevalence estimates and measure water, sanitation, and hygiene (WASH) indicators. Children aged 1-9 years were examined for five clinical signs of trachoma, and participants of all ages were examined for trachomatous trichiasis (TT). A household questionnaire was administered to gather demographic and WASH-related information. The prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years ranged from 0.4% (95% CI: 0.1-1.1%) to 6.4% (95% CI: 3.3-11.9%). Trachomatous trichiasis in those aged 15 years and older ranged from 0.1% (95% CI: 0.0-0.6%) to a high of 4.4% (95% CI: 2.1-9.1%). Of seven localities surveyed, four localities had achieved the elimination threshold of less than 5% TF in children aged 1-9 years. Six localities still required interventions to achieve less than 0.2% TT in those aged 15 years and older. The presence of latrine ranged from a low of 10.8% (95% CI: 5.2-21.1%) to 88.4% (CI: 81.5-93.0%) and clean face among children ranged between 69.5% (95% CI: 63.5-75.0%) and 87.5% (95% CI: 81.2-91.9%). These results demonstrate that Sudan is within reach of eliminating trachoma as a public health problem.

Prevalence of trachoma within refugee camps serving South Sudanese refugees in White Nile State, Sudan: Results from population-based surveys.

BACKGROUND: The 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 FINDINGS: Cross-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/ SIGNIFICANCE: Sudan 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.