The Epidemiology of Trachoma in Darfur States and Khartoum State, Sudan: Results of 32 Population-Based Prevalence Surveys

Figures & data

Figure 1. States with baseline trachoma mapping, Global Trachoma Mapping Project, Sudan, 2014–2015.

Table 1. Characteristics of sample population, Global Trachoma Mapping Project, Sudan, 2014–2015.

	Age, years	Consented, n (%)	Absent, n (%)	Refused, n (%)	Other^a, n (%)	Total, n
Male	1–9	16,093 (94.5)	919 (5.4)	6 (0.0)	3 (0.0)	17,021
	10–14	3494 (78.3)	969 (21.7)	1 (0.0)	0 (0.0)	4464
	≥15	10,141 (65.0)	5447 (34.9)	14 (0.1)	6 (0.0)	15,608
	All ages	29,728 (80.1)	7335 (19.8)	21 (0.1)	9 (0.0)	37,093
Female	1–9	16,440 (95.8)	699 (4.1)	17 (0.1)	4 (0.0)	17,160
	10–14	4146 (84.5)	753 (15.4)	6 (0.1)	0 (0.0)	4905
	≥15	23,175 (91.2)	2179 (8.6)	53 (0.2)	3 (0.0)	25,410
	All ages	43761 (92.2)	3631 (7.7)	76 (0.2)	7 (0.0)	47,475
Total		73,489 (86.9)	10,966 (13.0)	97 (0.1)	16 (0.0)	84,568

^aSleeping.

Table 2. Trachomatous inflammation – follicular (TF) in children aged 1–9 years, Global Trachoma Mapping Project, Sudan, 2014–2015.

State	Evaluation unit	Examined, n	TF cases, n	Unadjusted TF, (%)	Adjusted^a TF, % (95% CI)
North Darfur	El Fashir	904	186	20.6	18.7 (13.1–26.5)
	Kalmando, Dar El Salam	994	114	11.5	9.3 (6.1–13.5)
	Maleet, El Koma	963	142	14.7	11.4 (6.1–17.9)
	Om Kdadah	1113	14	1.3	1.0 (0.2–1.7)
	Eltwaish Wa El Laayeet	1057	42	4.0	3.1 (0.9–6.0)
	El Malha	837	0	0.0	0.0 (0.0–0.3)
South Darfur	Aid el Forsan	1127	4	0.4	0.4 (0.0–0.8)
	Rehed Al Birdi	1176	41	3.5	2.9 (1.8–3.9)
	Kas	1269	45	3.5	3.0 (1.3–5.4)
	Tolos	954	13	1.4	1.1 (0.4–2.1)
	Nyala City	985	38	3.9	3.7 (1.4–6.4)
	As-salam, Belale	1014	48	4.7	5.2 (2.7–8.5)
	Unitty	904	4	0.4	0.3 (0.0–0.8)
East Darfur	Yaseen, Shiairiya	1009	36	3.6	3.3 (1.5–5.9)
	El diain (East)	1016	16	1.6	1.3 (0.2–2.6)
	El diain - Assalaya, El Firduce	961	14	1.5	1.1 (0.2–2.3)
	Bahr el Arab, Abu Jabra	1058	11	1.0	0.8 (0.0–2.2)
Central Darfur	Zalinji, Azoom	968	115	11.9	11.6 (7.4–17.4)
	Wadi Salih (Garseila)	820	35	4.3	4.0 (2.4–6.4)
	Bondes, Mokjar	889	12	1.3	0.9 (0.4–1.7)
	Nertity	998	31	3.1	2.5 (1.0–3.9)
	Um dokhn	1193	49	4.1	3.7 (1.7–5.7)
West Darfur	El Jinaina	851	98	11.5	8.8 (4.7–14.2)
	Forbranga, Habillah	808	42	5.2	4.8 (3.0–7.2)
	Jabal moon, Sarba, Kolbos	1030	60	5.8	4.8 (2.8–7.1)
	Beda	900	99	11.0	9.9 (6.7–13.4)
	Kreanik	1086	4	0.4	0.4 (0.0–1.2)
Khartoum	Om Bada, Karrary	891	4	0.4	0.6 (0.1–1.4)
	Omdurman	1278	57	4.5	4.3 (2.2–7.3)
	Bahri	1065	5	0.5	0.5 (0.1–1.0)
	Sharg El Neel	1358	20	1.5	1.6 (0.8–2.5)
	Jabal Awliya	1085	7	0.6	0.6 (0.1–1.3)

^aAdjusted for age in single years.

CI, confidence interval.

Figure 2. (a) Prevalence of trachomatous inflammation – follicular (TF) in 1–9-year-olds by evaluation unit in selected Darfur districts, Global Trachoma Mapping Project, Sudan, 2014–2015. (b) Prevalence of trachomatous inflammation – follicular (TF) in 1–9-year-olds by evaluation unit in Khartoum, Global Trachoma Mapping Project, Sudan, 2014–2015.

Table 3. Trachomatous trichiasis (TT) in those ≥15 years, Global Trachoma Mapping Project, Sudan, 2014–2015.

State	Evaluation unit	Examined, n	TT cases, n	Unadjusted TT, %	Adjusted^a TT, % (95% CI)
North Darfur	El Fashir	943	18	1.9	0.8 (0.4–1.3)
	Kalmando, Dar El Salam	1033	11	1.1	0.6 (0.1–1.4)
	Maleet, El Koma	931	4	0.4	0.2 (0.0–0.5)
	Om Kdadah	1074	3	0.3	0.2 (0.0–0.4)
	Eltwaish Wa El Laayeet	1056	1	0.1	0.0 (0.0–0.1)
	El Malha	768	1	0.1	0.0 (0.0–0.1)
South Darfur	Aid el Forsan	1068	1	0.1	0.0 (0.0–0.1)
	Rehed Al Birdi	928	15	1.6	0.5 (0.2–0.8)
	Kas	1066	14	1.3	0.5 (0.1–1.2)
	Tolos	1019	7	0.7	0.3 (0.1–0.6)
	Nyala City	1162	9	0.8	0.3 (0.1–0.6)
	As-salam, Belale	997	0	0.0	0.0 (0.0–0.2)
	Unitty	1062	4	0.4	0.2 (0.0–0.3)
East Darfur	Yaseen, Shiairiya	887	6	0.7	0.2 (0.1–0.4)
	El diain (East)	852	2	0.2	0.0 (0.0–0.1)
	El diain - Assalaya, El Firduce	927	4	0.4	0.2 (0.0–0.4)
	Bahr el Arab, Abu Jabra	876	1	0.1	0.0 (0.0–0.1)
Central Darfur	Zalinji, Azoom	992	17	1.7	0.7 (0.3–1.2)
	Wadi Salih (Garseila)	927	33	3.6	1.0 (0.5–1.6)
	Bondes, Mokjar	868	17	2.0	0.4 (0.2–0.6)
	Nertity	826	19	2.3	0.6 (0.3–0.9)
	Um dokhn	918	18	2.0	0.5 (0.2–0.9)
West Darfur	EL Jinaina	828	19	2.3	0.5 (0.3–0.9)
	Forbranga, Habillah	808	35	4.3	1.2 (0.8–1.7)
	Jabal moon, Sarba, Kolbos	1161	22	1.9	0.5 (0.2–0.9)
	Beda	828	31	3.7	1.0 (0.6–1.4)
	Kreanik	897	10	1.1	0.5 (0.1–0.9)
Khartoum	Om Bada, Karrary	1396	1	0.1	0.1 (0.0–0.2)
	Omdurman	1517	1	0.1	0.0 (0.0–0.1)
	Bahri	1475	2	0.1	0.1 (0.0–0.3)
	Sharg El Neel	1469	3	0.2	0.1 (0.0–0.3)
	Jabal Awliya	1782	1	0.1	0.0 (0.0–0.1)

^aAdjusted for sex and age in 5-year age bands.

CI, confidence interval.

Figure 3. (a) Prevalence of trachomatous trichiasis (TT) in ≥15-year-olds by evaluation unit in selected Darfur districts, Global Trachoma Mapping Project, Sudan, 2014–2015. (b) Prevalence of trachomatous trichiasis (TT) in ≥15-year-olds by evaluation unit in Khartoum, Global Trachoma Mapping Project, Sudan, 2014–2015.

Table 4. Univariable association with the outcome trachomatous inflammation – follicular (TF) in children aged 1–9 years, Global Trachoma Mapping Project, Sudan, 2014–2015.

Variable		Examined, n	TF, %	OR (95% CI)^a
Age, years	<5	15,718	5.6	1.9 (1.7–2.2)
	5–9	16,815	3.1	1 (reference)
Sex	Male	16,093	4.5	1 (reference)
	Female	16,440	4.1	0.9 (0.8–1.0)
Number in household	<8	28,030	4.4	1 (reference)
	≥8	4503	3.7	0.9 (0.6–1.1)
Number aged 1–9 years in household	<5	29,275	4.3	1 (reference)
	≥5	3258	4.9	1.2 (1.0–1.5)
Use of unimproved sanitation	Yes	26,931	4.7	1.5 (1.2–2.0)
	No	5602	2.5	1 (reference)
Open defecation	Yes	12,698	4.6	1.3 (1.0–1.6)
	No	19,835	4.1	1 (reference)
Surface water (river, lake, etc) source of drinking water	No	31,387	4.4	1 (reference)
	Yes	1146	2.6	0.7 (0.3–1.7)
Time to nearest source of drinking water, minutes	<30	21,414	4.0	1 (reference)
	≥30	11,119	5.0	0.8 (0.6–1.1)
Surface water (river, lake, etc.) source of water for washing	Yes	1122	2.9	1.0 (0.4–2.3)
	No	31,411	4.4	1 (reference)
Time to nearest source of water for washing, minutes	All washing done at source	179	0.6	0.3 (0.0–2.3)
	≤30	22,040	3.9	1 (reference)
	>30	10,314	5.3	0.9 (0.6–1.2)
Maximum temperature annually, °C	≥40	6955	1.9	0.4 (0.2–0.5)
	<40	25,578	5.0	1 (reference)
Annual rainfall, mm	<500	19,816	4.6	1.2 (0.8–1.8)
	≥500	12,717	3.9	1 (reference)
Household located in an internally displaced persons camp	Yes	1823	7.6	2.8 (1.3–5.6)
	No	30,710	4.1	1 (reference)

^aBolding denotes significant values.

OR, odds ratio.; CI, confidence interval.

Table 5. Univariable association with the outcome trachomatous trichiasis (TT) in those aged ≥15 years, Global Trachoma Mapping Project, Sudan, 2014–2015.

Variable			Examined, n	TT, %	OR (95% CI)^a
Age, years	15–24		9983	0.1	1 (reference)
	25–34		8308	0.2	1.7 (0.7–4.0)
	35–44		5954	0.4	4.6 (2.1–9.8)
	45–54		3587	0.6	7.3 (3.4–15.9)
	55–64		2366	2.8	33.8 (15.7–63.9)
	65+		3118	6.3	83.2 (37.7–144.2)
Sex	Male		10,141	0.6	1 (reference)
	Female		23,175	1.2	2.0 (1.5–2.7)
Number in household	<8		29,755	1.1	1 (reference)
	≥8		3561	0.5	0.5 (0.3–0.8)
Number aged 1–9 years in household	<5		32,126	1.0	1 (reference)
	≥5		1190	0.3	0.3 (0.1–0.9)
Use of unimproved sanitation	Yes		6522	1.1	2.0 (1.3–2.0)
	No		26,794	0.6	1 (reference)
Open defecation	Yes		11,916	1.4	1.8 (1.4–2.4)
	No		21,400	0.8	1 (reference)
Surface water (river, lake, etc) source of drinking water	Yes		1109	2.0	2.1 (1.0–4.0)
	No		32,207	1.0	1 (reference)
Time to nearest source of drinking water	<30 minutes		22,678	1.0	1 (reference)
	≥30 minutes		10638	1.0	1.0 (0.7–1.3)
Surface water (river, lake, etc) source of water for washing	Yes		1078	2.0	2.1 (1.0–4.6)
	No		32,238	1.0	1 (reference)
Time to nearest source of water for washing	All washing at source		198	0.0
	≤30 minutes		23,223	1.0	1 (reference)
	>30 minutes		9895	1.0	1.0 (0.7–1.4)
Maximum annual temperature, °C	≥40		8968	0.1	0.1 (0.0–0.2)
	<40		24,348	1.3	1 (reference)
Annual rainfall, mm	<500		21,638	0.5	0.3 (0.2–0.4)
	≥500		11,678	1.8	1 (reference)
Household located in an internally displaced persons camp	Yes		1692	1.0	1.0 (0.4–2.1)
	No		31,624	1.0	1 (reference)

^aBolding denotes significant values.

OR, odds ratio; CI, confidence interval.

Table 6. Multilevel multivariable association with the outcome trachomatous inflammation – follicular in children aged 1–9 years, Global Trachoma Mapping Project, Sudan, 2014–2015.

Variable	OR	p-value^a
Age <5 years	1.8	<0.0001
Household unimproved sanitation	1.5	0.003
Maximum temperature at cluster >40°C annually	0.4	<0.0001
Household located in an internally displaced persons camp	2.6	0.006
≥5 children aged 1–9 years in the household	1.2	0.03

^aLikelihood ratio test for inclusion/exclusion in final model.

OR, odds ratio.

Table 7. Multilevel multivariable association with the outcome trachomatous trichiasis in adults aged ≥15 years, Global Trachoma Mapping Project, Sudan, 2014–2015.

Variable	OR	p-value^a
Age, years		<0.0001 (χ^Citation2 trend)
15–24	1 (reference)
25–34	1.6
35–44	4.9
45–54	8.5
55–64	35.8
65+	83.8
Female sex	3.0	<0.0001
Maximum annual temperature ≥40°C	0.2	<0.0001
Desert area (annual rainfall <500 mm)	0.4	<0.0001

^aLikelihood ratio test for inclusion/exclusion in final model.

OR, odds ratio.

Figure 4. Age-specific prevalence of trachomatous inflammation – follicular (TF) in 1–9-year-olds in 32 evaluation units (EUs) (upper panel). In 27 EUs, Darfur States only (lower, left); and in 5 EUs, Khartoum State only (lower, right), Global Trachoma Mapping Project, Sudan, 2014–2015.

Figure 5. Age- and sex-specific prevalence of trachomatous trichiasis (TT) in ≥15-year-olds in 32 evaluation units of Darfur and Khartoum states, Global Trachoma Mapping Project, Sudan, 2014–2015.

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