- Socio-demographic and household characteristics:
The study included 125 patients with trachoma from two eye care hospitals; 80 patients (60.4%) were from Makah eye complex and 45 patients (35.2%) were from Abdelfadeel-Almaz hospital. There were 68 patients (54.4%) females and 57 males (45.6%) males. The majority of the participants (78.4%) were aged more than 50 years. Most of the respondents (61.6%) were resident in Khartoum state, and (16.8%) were from Gezira state. Most of the respondents (81.6%) were not having an infected person in the family (Table 1).
Regarding drinking water, most of the respondents 98 (78.4%) had a pipe inside the house, 8 % (10) had a pipe outside the house as a source of water supply. More than half (59.2%) of the respondents have animals and 52.2% of them have them inside their houses. The majority of the respondents (74.2%) were having pit latrines as a type of toilet, whereas 2.4% were not having toilets at all. Most of the respondents (68.8%) were washing their faces 2-5 times per day, and 4.8% never wash their faces. Regarding hands washing, the majority (54.4%) were washing their hands 2-5 times per day (Table 2).
- Clinical stages of Trachoma:
All patients were examined on slit lamp by the ophthalmologist and the clinical signs of trachoma were graded in accordance with WHO Trachoma Grading System. Most of the respondents (56%) were found to have trachoma follicles (TF) and 40.8% of them were having trachomatus trichiasis (TT) (Table 3).
Table 1: Socio-demographic characteristics of the study population attending two eye care hospitals in Khartoum state, March 2015. (n=125)
Variable
|
No.
|
Percent %
|
Hospital
|
Makkah eye complex
|
80
|
60.4%
|
AbdelfadeelAlmaz
|
45
|
35.2%
|
Gender
|
Male
|
57
|
45.6%
|
Female
|
68
|
54.4%
|
Age
|
Less than 15 years
|
1
|
0.8%
|
15-29 years old
|
7
|
5.6%
|
30-49 years old
|
19
|
15.2%
|
More than 50 years
|
98
|
78.4%
|
Residence
|
Khartoum state
|
77
|
61.6%
|
Gezira state
|
21
|
16.8%
|
Infected person in the family
|
Present
|
102
|
81.6%
|
Absent
|
23
|
18.4%
|
Level of education
|
Illiterate
|
66
|
52.8%
|
Khalwa
|
22
|
17.6%
|
Primary school
|
17
|
13.6%
|
Secondary school
|
11
|
8.8%
|
University graduate
|
8
|
6.4%
|
Post graduate
|
1
|
0.8%
|
Monthly income
|
Less than 1000 SDG
|
36
|
28.8%
|
1000-2000 SDG
|
9
|
7.2%
|
More than 2000 SDG
|
3
|
2.4%
|
Unemployed
|
76
|
60.8%
|
Table 2: Environmental factors and personal hygiene among patients with trachoma attending two eye care hospitals in Khartoum state, March 2015. (n=125)
Variable
|
No.
|
Percent %
|
Drinking water source
|
House pipe
External pipe
Wells
Rivers
|
89
1
6
2
|
78.4
0.8
4.8
1.6
|
Place of Animals breeding (if present)
|
Inside the house
Inside the residential block
|
66
10
|
86.8
13.2
|
Type of toilets
|
Flush toilets
Pit Latrine
No toilet
|
29
92
4
|
23.4
74.2
2.4
|
Face washing per day
|
Once
2-5 times
More than 5 times
Never
|
8
86
25
6
|
6.4
68.8
20
4.8
|
Hands washing per day
|
Once
2-5 times
More than 5 times
Never
|
4
68
52
1
|
3.2
54.4
41.6
0.8
|
Table 3: clinical stages of trachoma among patients with trachoma attending two eye care hospitals in Khartoum state, March 2015
Clinical stage
|
No.
|
Percent %
|
Trachoma Follicles (TF)
Trachoma Scarring (TS)
Trachoma Trichiasis (TT)
Corneal Opacification (CO)
|
70
2
51
2
|
56.0
1.60
40.8
1.60
|
- Characteristics of the studies included in the review:
Our search retrieved records for 93 published articles. Abstract and full texts of the potentially relevant studies were retrieved for screening and studies lacking insufficient data about the outcomes of interest were subsequently omitted. Lastly, a total of nine epidemiological studies published from 2007 to 2020 which met the eligibility criteria were included [9-17]. Main features and summery of the data from the included studies are shown in (Table 4).
Low socioeconomic status and poor personal and environmental hygiene were the common reported socio-demographic and household characteristics among patients with trachoma in all studies. Particular areas in Sudan exhibited higher burden of Trachoma, where prevalence of trachoma was above the WHO thresholds, specifically Gadarif state and all of five Darfur states. The presence of one million South-Sudanese refugees in displacement camps in White Nile state coming from a trachoma hyper-endemic country could impact the progress towards trachoma elimination [14].
In attempts to eliminate trachoma, Sudan National Trachoma Control Program (NTCP) adopted the WHO-SAFE strategy; (Surgery for Trichiasis; Antibiotic therapy through mass distribution; Facial cleanliness promotion through health education; and Environmental improvement with sanitation) [17]. Recently, NTCP piloted a TT case-finding approach in some localities to identify patients and provide surgical services free of charge [17]. However, conflicts and security concerns in several endemic areas of Sudan limits the ability of NTCP to reach trachoma elimination in Sudan [11].
Table 4: Descriptive summary of the studies included in the review:
Study
|
Year
|
Study setting
|
Main findings
|
Rushood et al [9]
|
2007
|
Total coverage survey for of all governmental primary schools children in Khartoum State.
|
- Out of 671,119 children screened, 288 children had active trachoma: 86.5% of them were from Ummbada locality, where poverty is widespread.
|
Islam et al.
[10]
|
2009
|
Local population of Nyala city, South Darfur state, in the free medical camps established by Pakistani Field Hospital.
|
- Out of 4326 individuals examined during the medical camps, 378 (8.73%) had clinical signs of trachoma.
- 45.5% of patients were less than 20 years of age.
- Most of patients had poor personal hygiene and low socioeconomic status with lack of basic facilities such as proper house, clean water and covered latrines.
- TF and TI were observed in 81.34% and 50.37% of patients respectively.
- TT and CO was observed in 19.1% and 14.5% of patients, respectively.
|
Hassan et al [11]
|
2010
|
Large population based cross-sectional survey conducted in 88 localities across northern states of Sudan
|
- Out of 106,697 participants examined, 31,072 patients had TT.
- Higher prevalence of TF (more than 10%) in three districts: two in Blue Nile State (Geissan and Kurmuk); and one in Gederaf State (El Galabat East).
- Higher prevalence of TT (above the WHO threshold for community based intervention of 1%) in 20 districts.
- Prevalence of TT increased significantly with age and females compared to males.
- Factors associated with presence of a child with trachoma: Increasing household size, household head with no formal education, livestock in compound, and pit latrine
|
Elshafie et al [12]
|
2016
|
Cross sectional, community-based survey covering Khartoum State and all accessible districts in the five Darfur States
|
- 73,489 residents examined in 908 villages. The highest prevalence of TF in children was found in El Fashir district, North Darfur state (18.7%).
- Five districts (El Fashir, Zalinji, Azoom, Maleet, and El Koma) had TF prevalence above the WHO threshold (10%) for mass treatment with azithromycin, together with facial cleanliness and environmental improvement interventions.
- TF in children was independently associated with younger age, unimproved sanitation in the household, having ≥ 5 children in the household, and living in internally displaced persons camps.
|
Alkhidir et al [13]
|
2017
|
Population-based prevalence study of Trachoma among children in Tabldiya village, Gadarif State
|
- 11.0% of the 900 participants had active trachoma; 3.96 % of them had TF, and none had TI.
- The prevalence of Chlamydia trachomatis in whole children in the village was 1.4%
|
Sanders et al [14]
|
2019
|
Cross-sectional, multi-stage, cluster-random surveys in refugee camps in two localities (Al Salam and Al Jabalain) White Nile State
|
- Prevalence of TF in children was 15.7% in Al Salam and 10.6% in Al Jabalain.
- Prevalence of TT in those 15 years above was 2.9% in Al Salam and 5.0% in Al Jabalain.
- Participants in these two refugee camps reported coming from four states in South Sudan (Upper Nile, Unity, Jonglei, and Western Bahr el Ghazal states).
|
Macleod et al [15]
|
2019
|
Secondary analysis of data from 27 cross-sectional population-based trachoma prevalence surveys carried out in the internally displaced persons camps in the five Darfur States
|
- Out of 1926 children examined, 38 (8%) had TF. Poor sanitation, younger age and living in a household that purchased water from a vendor were associated with TF in children.
- Out of 2139 adults examined, 16 (0.7%) had TT. TT was strongly independently associated with being older and living alone.
|
Sanders et al [16]
|
2019
|
Population-based Trachoma prevalence surveys in seven localities across five states of Sudan (Gadarif, Red Sea, Sinnar, Blue Nile, and South Kordofan).
|
- Out of 22,548 individuals included, prevalence of TT was (0.4% to 6.4%) in children less than 9 years, and was (0.1% to 4.4 %) in those aged 15 years and older.
|
Sanders et al [17]
|
2020
|
Piloting a TT patient case-searching approach in Gadarif state
|
- Out of 66,526 residents examined, local case finders suspected that 491 residents had TT. Of them, 369 were confirmed for TT and needed surgical intervention.
- TT case-finding approach provides an example of an effective method for identifying TT patients
|