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

• Type of Material: Article
• Authors: Angelia M. Sanders, The Carter Center; Zeinab Abdalla, The Carter Center; Belgesa E. Elshafie, Federal Ministry of Health; Andrew W. Nute, The Carter Center; Elizabeth F. Long, The Carter Center; Nabil Aziz, The Carter Center; Paul Weiss, Emory University; E. Kelly Callahan, The Carter Center; Scott D. Nash, The Carter Center
• Language: English
• Date: 2019-06-01
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Sanders et al.
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pntd.0007491
• Title of Journal or Parent Work: PLoS Neglected Tropical Diseases
• ISSN: 1935-2727
• Volume: 13
• Issue: 6
• Start Page: e0007491
• End Page: e0007491
• Grant/Funding Information: The authors received no external funding for this work.; The study design, data collection and analysis, decision to publish and preparation of the manuscript were made by the program personnel in collaboration with the Sudan Federal Ministry of Health.; This is a routine monitoring activity as part of a national trachoma program technically and financially assisted by The Carter Center in collaboration with the Sudan Federal Ministry of Health, and carried out by program personnel.
• Keywords: Life Sciences & Biomedicine; Tropical Medicine; EPIDEMIOLOGY; Science & Technology; AZITHROMYCIN; Parasitology; Infectious Diseases
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

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 inflamma-tion-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.