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We aimed to investigate prevalence of potential risk factors, and associations between risk factors and active trachoma in southern Sudan. Surveys were undertaken in ten sites and children aged 19 years examined for trachoma. Risk factors were assessed through interviews and observations. Using ordinal logistic regression, associations between severity of active trachoma and risk factors were explored. Trachomatous inflammation-intense (TI) was considered more severe than trachomatous inflammation-follicular (TF). A total of 7,418 children were included in the analysis. Risk factors and prevalences were unclean face, 52.3%; face washed less than twice daily, 50.8%; water collection > 30 minutes, 38.1%; absence of latrines, 95.4%; garbage disposal within 20 m, 74.4%; cattle ownership, 69.2%; and flies, 83.3%. After adjusting for age and sex, unclean face, less frequent face washing, cattle ownership, and increasing fly density were found to be independently associated with severity of active trachoma. Our study suggests that facial hygiene and environmental sanitation are priority trachoma-control interventions in southern Sudan.
Received January 3, 2007. Accepted for publication March 27, 2007.
Acknowledgments: We thank the following organizations who were instrumental in facilitating the surveys: The Carter Center, Sudan Peoples Liberation Movement Secretariat of Health, Sudan Relief and Rehabilitation Commission in all study sites; Christian Mission Aid and Southern Sudan Operation Mercy in Mankien; Adventist Development and Relief Association in Kiech Kuon and Kimotong; Association of Christian Relief Organizations Serving Sudan in Paluer, MEDAIR in Padak; Sudan Medical Care in Paluer, Kongor, Boma, and Narus; and ZOA Refugee Care in Katigiri and Tali.
Financial support: Surveys were funded by Lions Clubs International Foundation (all study sites) and Dark and Light Blind Care (Mankien).
* Address correspondence to Paul Emerson, The Carter Center, One Copenhill, 453 Freedom Parkway, Atlanta, GA 30307. E-mail: paul.emerson{at}emory.edu
Authors addresses: Jeremiah Ngondi, Mark Reacher, Carol Brayne, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Robinson Way, Cambridge, CB2 2SR, United Kingdom, Telephone: +44-1223-763829, Fax: +44-1223-330330, E-mails: jn250{at}cam.ac.uk, mark.reacher{at}hpa.org.uk, and carol.brayne{at}medschl.cam.ac.uk. Fiona Matthews, MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge, CB2 2SR, United Kingdom, Telephone: +44-1223-330391, Fax: +44-1223-330388, E-mail: fiona.matthews{at}mrc-bsu.cam.ac.uk. Alice Onsarigo, Family Health International, P.O. Box 38835-00623, Nairobi, Kenya, Telephone: +254-20-271-3913, Fax: +254-20-272-6130, E-mail: alionza{at}yahoo.com. Ibrahim Matende, Lighthouse for Christ Eye Centre, P.O. Box 81465-80100, Mombasa, Kenya, Telephone: +254-41-222-6179, Fax: +254-41-222-0018, E-mail: ibu_matende{at}wananchi.com. Samson Baba, Ministry of Health, Government of Southern Sudan, Juba, Southern Sudan, Telephone: +254-722-364 982, Fax: +254-20-3874 924, E-mail: samson_baba{at}yahoo.co.uk. James Zin-geser, World Health Organization, Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark, Telephone: +45-39-17-1258, Fax: +45-39-17-1863, E-mail: jzi{at}euro.who.int. Paul Em-erson, The Carter Center, One Copenhill, 453 Freedom Parkway, Atlanta, GA 30307, Telephone: +1 (404) 420-3854, Fax: +1 (404) 874-5515, E-mail: paul.emerson{at}emory.edu.
Reprint requests: Paul Emerson, The Carter Center, One Copenhill, 453 Freedom Parkway, Atlanta, GA 30307, Telephone: +1 (404) 420-3854, Fax: +1 (404) 874-5515, E-mail: paul.emerson{at}emory.edu.
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