Ohidor Stephen, Presley Nicholas A, Sanders Angelia M, Nute Andrew W, Gonzalez Tania A, Bol Yak Yak, Nyibong Albino W, Weiss Paul, Niquette James, Callahan E Kelly, Nash Scott D
The Carter Center - South Sudan, The Carter Center, Juba, Central Equatoria State, South Sudan.
Trachoma Control Program, The Carter Center, Atlanta, Georgia, USA.
Trop Med Int Health. 2025 Mar;30(3):159-169. doi: 10.1111/tmi.14078. Epub 2025 Jan 9.
Trachoma is targeted by the World Health Organization (WHO) for elimination as a public health problem by 2030. Trachoma impact surveys using standardised methodology are recommended to monitor progress towards elimination and to determine eligibility for continued surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) interventions. From 2007 to 2015, four counties of Eastern Equatoria State, South Sudan, received three to five rounds of mass drug administration with antibiotics. A trachoma impact survey in 2015 indicated all four counties had trachomatous-inflammation follicular prevalence among children ages 1-9 years above the WHO elimination threshold (range 17.4%-47.6%). Based on these results, the recommended number of years of SAFE interventions were implemented and the counties were subsequently resurveyed.
Between 2021 and 2023, trachoma impact surveys were conducted in Budi, Kapoeta East, Kapoeta North, and Kapoeta South counties using a two-stage cluster sample design. Trained and certified graders examined participants for trachoma clinical signs using the WHO simplified grading system to estimate county-level prevalence.
A total of 12,570 individuals from 3286 households in 116 survey clusters were examined for trachoma. Prevalence of trachomatous-inflammation follicular among children ages 1-9 years was 5.6% (95% confidence interval [CI]:3.7%-8.3%) in Kapoeta South, 7.4% (CI:5.1%-10.7%) in Budi, 12.3% (CI:7.8%-18.9%) in Kapoeta East, and 18.1% (CI:13.5%-24.0%) in Kapoeta North. Trachomatous inflammation-intense prevalence among children ages 1-9 years ranged from 0.4% (CI:0.2%-1.0%) in Kapoeta East to 2.1% (CI:1.4%-3.2%) in Kapoeta North, and trachomatous trichiasis in individuals ages ≥15 years ranged from 1.0% (CI:0.5%-2.1%) in Kapoeta North to 1.9% (CI:1.3%-2.8%) in Budi.
As no county reached the WHO elimination thresholds of trachomatous-inflammation follicular <5% or trachomatous trichiasis <0.2%, SAFE interventions should continue. Furthermore, these districts are classified as having persistent trachoma, based on trachomatous-inflammation follicular levels remaining >5% after two impact surveys. Compared to results from 2015, the prevalence of trachomatous-inflammation follicular, trachomatous inflammation-intense, and trachomatous trichiasis in all counties decreased, indicating that the Republic of South Sudan Ministry of Health's Trachoma Control Program is advancing towards its elimination goal.
世界卫生组织（WHO）的目标是到2030年消除沙眼这一公共卫生问题。建议采用标准化方法进行沙眼影响调查，以监测消除沙眼的进展情况，并确定是否有资格继续实施手术、抗生素、面部清洁和环境改善（SAFE）干预措施。2007年至2015年期间，南苏丹东赤道州的四个县接受了三到五轮抗生素群体给药。2015年的一项沙眼影响调查表明，所有四个县1至9岁儿童的沙眼滤泡性炎症患病率均高于世界卫生组织的消除阈值（范围为17.4% - 47.6%）。基于这些结果，实施了建议的SAFE干预措施年限，随后对这些县进行了重新调查。
2021年至2023年期间，在布迪、东卡波埃塔、北卡波埃塔和南卡波埃塔县采用两阶段整群抽样设计进行了沙眼影响调查。经过培训和认证的分级人员使用世界卫生组织简化分级系统对参与者进行沙眼临床体征检查，以估计县级患病率。
在116个调查群组的3286户家庭中，共对12570人进行了沙眼检查。南卡波埃塔县1至9岁儿童的沙眼滤泡性炎症患病率为5.6%（95%置信区间[CI]：3.7% - 8.3%），布迪县为7.4%（CI：5.1% - 10.7%），东卡波埃塔县为12.3%（CI：7.8% - 18.9%），北卡波埃塔县为18.1%（CI：13.5% - 24.0%）。1至9岁儿童的沙眼重度炎症患病率在东卡波埃塔县为0.4%（CI：0.2% - 1.0%），在北卡波埃塔县为2.1%（CI：1.4% - 3.2%），≥15岁个体的沙眼倒睫患病率在北卡波埃塔县为1.0%（CI：0.5% - 2.1%），在布迪县为1.9%（CI：1.3% - 2.8%）。
由于没有一个县达到世界卫生组织沙眼滤泡性炎症<5%或沙眼倒睫<0.2%的消除阈值，因此应继续实施SAFE干预措施。此外，根据两次影响调查后沙眼滤泡性炎症水平仍>5%，这些地区被归类为患有持续性沙眼。与2015年的结果相比，所有县的沙眼滤泡性炎症、沙眼重度炎症和沙眼倒睫患病率均有所下降，这表明南苏丹共和国卫生部的沙眼控制计划正在朝着消除目标迈进。
