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 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. The s...
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| Veröffentlicht in: | PLoS neglected tropical diseases 2012-04, Vol.6 (4), p.e1585-e1585 |
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| creator | Edwards, Tansy Smith, Jennifer Sturrock, Hugh J W Kur, Lucia W Sabasio, Anthony Finn, Timothy P Lado, Mounir Haddad, Danny Kolaczinski, Jan H |
| description | Large 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.
The 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.
Trachoma 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. |
| doi_str_mv | 10.1371/journal.pntd.0001585 |
| format | Article |
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The 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.
Trachoma 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.</description><identifier>ISSN: 1935-2735</identifier><identifier>ISSN: 1935-2727</identifier><identifier>EISSN: 1935-2735</identifier><identifier>DOI: 10.1371/journal.pntd.0001585</identifier><identifier>PMID: 22506082</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibiotics ; Care and treatment ; Child ; Child, Preschool ; Demographic aspects ; Diagnosis ; Epidemiologic Methods ; Estimates ; Female ; Humans ; Infant ; Infant, Newborn ; Inflammation ; Intervention ; Male ; Medicine ; Methods ; Middle Aged ; Older people ; Polls & surveys ; Population number ; Poverty ; Prevalence ; Prevalence studies (Epidemiology) ; Risk Factors ; Sudan - epidemiology ; Trachoma ; Trachoma - epidemiology ; Tropical diseases ; Villages ; Young Adult</subject><ispartof>PLoS neglected tropical diseases, 2012-04, Vol.6 (4), p.e1585-e1585</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>2012 Edwards et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Edwards T, Smith J, Sturrock HJW, Kur LW, Sabasio A, et al. (2012) Prevalence of Trachoma in Unity State, South Sudan: Results from a Large-Scale Population-Based Survey and Potential Implications for Further Surveys. PLoS Negl Trop Dis 6(4): e1585. doi:10.1371/journal.pntd.0001585</rights><rights>Edwards et al. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c690t-7e30bfaa81202bc8d5739b43fedf65ca03a495b210959ab8d0208a116be389213</citedby><cites>FETCH-LOGICAL-c690t-7e30bfaa81202bc8d5739b43fedf65ca03a495b210959ab8d0208a116be389213</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323519/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323519/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,729,782,786,866,887,2106,2932,23875,27933,27934,53800,53802</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22506082$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Ngondi, Jeremiah M.</contributor><creatorcontrib>Edwards, Tansy</creatorcontrib><creatorcontrib>Smith, Jennifer</creatorcontrib><creatorcontrib>Sturrock, Hugh J W</creatorcontrib><creatorcontrib>Kur, Lucia W</creatorcontrib><creatorcontrib>Sabasio, Anthony</creatorcontrib><creatorcontrib>Finn, Timothy P</creatorcontrib><creatorcontrib>Lado, Mounir</creatorcontrib><creatorcontrib>Haddad, Danny</creatorcontrib><creatorcontrib>Kolaczinski, Jan H</creatorcontrib><title>Prevalence of trachoma in unity state, South Sudan: results from a large-scale population-based survey and potential implications for further surveys</title><title>PLoS neglected tropical diseases</title><addtitle>PLoS Negl Trop Dis</addtitle><description>Large 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.
The 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.
Trachoma 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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibiotics</subject><subject>Care and treatment</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Demographic aspects</subject><subject>Diagnosis</subject><subject>Epidemiologic Methods</subject><subject>Estimates</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Inflammation</subject><subject>Intervention</subject><subject>Male</subject><subject>Medicine</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Older people</subject><subject>Polls & surveys</subject><subject>Population number</subject><subject>Poverty</subject><subject>Prevalence</subject><subject>Prevalence studies (Epidemiology)</subject><subject>Risk Factors</subject><subject>Sudan - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PLoS neglected tropical diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Edwards, Tansy</au><au>Smith, Jennifer</au><au>Sturrock, Hugh J W</au><au>Kur, Lucia W</au><au>Sabasio, Anthony</au><au>Finn, Timothy P</au><au>Lado, Mounir</au><au>Haddad, Danny</au><au>Kolaczinski, Jan H</au><au>Ngondi, Jeremiah M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence of trachoma in unity state, South Sudan: results from a large-scale population-based survey and potential implications for further surveys</atitle><jtitle>PLoS neglected tropical diseases</jtitle><addtitle>PLoS Negl Trop Dis</addtitle><date>2012-04-01</date><risdate>2012</risdate><volume>6</volume><issue>4</issue><spage>e1585</spage><epage>e1585</epage><pages>e1585-e1585</pages><issn>1935-2735</issn><issn>1935-2727</issn><eissn>1935-2735</eissn><abstract>Large 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.
The 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.
Trachoma 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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22506082</pmid><doi>10.1371/journal.pntd.0001585</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; Public Library of Science (PLoS) Journals Open Access; PubMed Central |
| subjects | Adolescent Adult Aged Aged, 80 and over Antibiotics Care and treatment Child Child, Preschool Demographic aspects Diagnosis Epidemiologic Methods Estimates Female Humans Infant Infant, Newborn Inflammation Intervention Male Medicine Methods Middle Aged Older people Polls & surveys Population number Poverty Prevalence Prevalence studies (Epidemiology) Risk Factors Sudan - epidemiology Trachoma Trachoma - epidemiology Tropical diseases Villages Young Adult |
| title | Prevalence of trachoma in unity state, South Sudan: results from a large-scale population-based survey and potential implications for further surveys |
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