title: Trachoma in Western Equatoria State, Southern Sudan: implications for national control.
abstract: BACKGROUND
  Trachoma is thought to be common over large parts of Southern Sudan. However, many areas of the country, particularly west of the Nile, have not yet been surveyed. The aim of this study was to confirm whether trachoma extends into Western Equatoria State from neighboring Central Equatoria, where trachoma is highly prevalent, and whether intervention with the SAFE strategy is required.
  
  
  RESULTS
  Population-based cross-sectional surveys were conducted using a two-stage cluster random sampling method to select the study population. Subjects were examined for trachoma by experienced graders using the World Health Organization (WHO) simplified grading scheme. Two counties thought to be most likely to have trachoma were surveyed, Maridi and Mundri. In Maridi, prevalence of one of the signs of active trachoma (trachomatous inflammation-follicular (TF)) in children aged 1-9 years was 0.4% (95% confidence interval (CI), 0.0%-0.8%), while no children showing the other possible sign, trachomatous inflammation-intense (TI), were identified. No trachomatous trichiasis (TT) was found in those aged under 15, and prevalence was 0.1% (95% CI, 0.0%-0.4%) in those aged 15 years and above. In Mundri, active trachoma was also limited to signs of TF, with a prevalence of 4.1% (95% CI, 1.4%-6.9%) in children aged 1-9 years. Again, no TT was found in those aged under 15, and prevalence in those aged 15 years and above was 0.3% (95% CI, 0.0%-0.8%).
  
  
  CONCLUSIONS
  Trachoma prevalence in the east of Western Equatoria State is below the WHO recommended intervention threshold for mass drug administration of antibiotic treatment in all villages. However, the prevalence of TF and TT in some villages, particularly in Mundri County, is sufficiently high to warrant targeted interventions at the community level. These results demonstrate that trachoma is not a major public health problem throughout Southern Sudan. Further studies will be required to determine trachoma prevalence in other areas, particularly west of the Nile, but there are presently no resources to survey each county. Studies should thus be targeted to areas where collection of new data would be most informative.
authors.affiliation: Ministry of Health, Government of Southern Sudan, Juba, Southern Sudan.
authors.forename: Lucia W
authors.initials: LW
authors.lastname: Kur
authors.forename: Diana
authors.initials: D
authors.lastname: Picon
authors.forename: Obec
authors.initials: O
authors.lastname: Adibo
authors.forename: Emily
authors.initials: E
authors.lastname: Robinson
authors.forename: Anthony
authors.initials: A
authors.lastname: Sabasio
authors.forename: Tansy
authors.initials: T
authors.lastname: Edwards
authors.forename: Aggrey
authors.initials: A
authors.lastname: Ndyaba
authors.forename: John
authors.initials: J
authors.lastname: Rumunu
authors.forename: Karinya
authors.initials: K
authors.lastname: Lewis
authors.forename: Mounir
authors.initials: M
authors.lastname: Lado
authors.forename: Jan
authors.initials: J
authors.lastname: Kolaczinski
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D005843:Geography; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D011897:Random Allocation; D013397:Sudan / Q000453:epidemiology; D014141:Trachoma / Q000453:epidemiology* / Q000517:prevention & control*