title: The epidemiology of trachoma in Eastern Equatoria and Upper Nile States, southern Sudan.
abstract: OBJECTIVE
  Limited surveys and anecdotal data indicate that trachoma is endemic in the states of Eastern Equatoria and Upper Nile in southern Sudan. However, its magnitude and geographical distribution are largely unknown. We conducted surveys to ascertain the prevalence and geographical distribution of trachoma, and to identify targets for control interventions.
  
  
  METHODS
  Population-based cross-sectional surveys were conducted in nine sites in southern Sudan between September 2001 and June 2004. Two-stage random cluster sampling with probability proportional to size was used to select the sample. Trachoma grading was done using the WHO simplified grading system.
  
  
  RESULTS
  A total of 17 016 persons were examined, a response rate of 86.1% of the enumerated population. Prevalence of signs of active trachoma in children aged 1-9 years was: TF=53.7% (95% confidence interval (CI)=52.1-55.3); TI=42.7% (95% CI=41.2-44.2); TF and/or TI=64.1% (95% CI=62.5-65.5). Prevalence of trichiasis (TT) in children aged less than 15 years was 1.2% (95% CI=0.9-1.4), while TT prevalence in persons aged 15 years and above was 9.2% (95% CI=8.6-9.9). Women were more likely to have trichiasis compared to men (odds ratio (OR)=1.57; 95% CI=1.34-1.84). Tentative extrapolation to the states of Eastern Equatoria and Upper Nile estimates that there is a backlog of 178,250 (lower and upper bounds=156,027-205,995) persons requiring surgery and the entire population, estimated to be over 3.9 million, is in need of the SAFE strategy to control blinding trachoma.
  
  
  CONCLUSIONS
  Trachoma is a public health problem in all nine of the study sites surveyed. The unusually high prevalence of active trachoma and TT in children points to the severity of the problem. There is urgent need to implement trachoma control interventions in trachoma endemic regions of southern Sudan.
authors.affiliation: Institute of Public Health, University of Cambridge, Cambridge, England.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Ngondi
authors.forename: Alice
authors.initials: A
authors.lastname: Onsarigo
authors.forename: Liknaw
authors.initials: L
authors.lastname: Adamu
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Matende
authors.forename: Samson
authors.initials: S
authors.lastname: Baba
authors.forename: Mark
authors.initials: M
authors.lastname: Reacher
authors.forename: Paul
authors.initials: P
authors.lastname: Emerson
authors.forename: James
authors.initials: J
authors.lastname: Zingeser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001766:Blindness / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003906:Developing Countries; D004534:Egypt / Q000453:epidemiology; D004781:Environmental Exposure / Q000706:statistics & numerical data; D005141:Eyelid Diseases / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011634:Public Health; D013397:Sudan / Q000453:epidemiology; D014141:Trachoma / Q000453:epidemiology* / Q000517:prevention & control