Abstract
IntroductionTrachoma is a disease that can lead to visual impairment and ultimately blindness. Previous estimates of health losses from trachoma using the Global Burden of Disease methodology have not, however, included the stage prior to visual impairment. We estimated the burden of all stages of trachoma in South Sudan and assessed the uncertainty associated with the severity and duration of stages of trachoma prior to full blindness.MethodsThe prevalence of trachoma with normal vision, low vision and blindness in the Republic of South Sudan has been estimated previously. These estimates were used to model the incidence and duration of the different stages employing DISMOD II. Different assumptions about disability weights and duration were used to estimate the Years Lived with Disability (YLD).ResultsWe have estimated the total burden of trachoma in South Sudan to be between 136,562 and 163,695 YLD and trichiasis with normal vision contributes between 5% and 21% of the total depending on the disability weight applied. Women experience more of this burden than men. The sensitivity of the results to different assumptions about the disability weights is partly dependent upon the assumed duration of the different disease states.InterpretationA better understanding of the natural history of trachoma is critical for a more accurate burden estimate.
Highlights
Trachoma is a disease that can lead to visual impairment and blindness
Employing these modelled durations and the disability weights of 0.245 and 0.068 for trichiasis with low vision and trichiasis with normal vision, respectively, all states of trachoma combined, incident in 1 year, resulted in 174,550 Years Lived with Disability in South Sudan
The inclusion of trichiasis with normal vision contributes 11.73% to total burden experienced by females and is equivalent to 30% of the burden amongst women due to trichiasis with blindness
Summary
Trachoma is a disease that can lead to visual impairment and blindness. Previous estimates of health losses from trachoma using the Global Burden of Disease methodology have not, included the stage prior to visual impairment. Recurrent re-infection by the bacterium can eventually lead to the repositioning of the eyelashes back towards the cornea, a condition known as trichiasis. Without treatment this state eventually begins to impair the individual’s vision and leads to blindness. The burden estimates will be sensitive to the disability weights applied to different health states While this is an issue for all nonfatal conditions, it can be a important issue for conditions that are highly prevalent with lower levels of severity [3]. Uncertainty about disability weights may be most consequential where chronic, low severity conditions exist in large parts of the populations This describes the case of trachoma in South Sudan
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