Unimproved water sources and open defecation are associated with active trachoma in children in internally displaced persons camps in the Darfur States of Sudan.

Colin K Macleod,Rebecca Willis,Brian Chu,Anthony W Solomon,Balgesa Elkheir Elshafie,Husam Eldin Sadig,Awad Hassan,Kamal Hashim Binnawi,Naomi Cocks

doi:10.1093/trstmh/trz042

Abstract

PurposeTo estimate the proportion of children with trachomatous inflammation—follicular (TF) and adults with trachomatous trichiasis (TT) in internally displaced persons (IDP) camps in the Darfur States of Sudan and to evaluate associated risk factors.MethodsIDP camps were identified from government census data. We conducted a subanalysis of data collected in these camps during 2014–2015 as part of surveys covering 37 districts of the Darfur States within the Global Trachoma Mapping Project. A random-effects hierarchical model was used to evaluate factors associated with TF in children or TT in adults.ResultsThirty-six IDP camps were represented in the survey data, in which 1926 children aged 1–9 y were examined, of whom 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 aged 1–9 y. Of 2139 individuals examined aged ≥15 y, 16 (0.7%) had TT. TT was strongly independently associated with being older and living alone.ConclusionTrachoma is found at low levels in these camps, but still at levels where intervention is needed. Disease elimination in conflict-related settings presents a unique challenge for the trachoma community, and may require an innovative approach. Understanding how best to undertake trachoma elimination interventions in these areas should be prioritized.

Highlights

We report the trachoma prevalence and between-camp risk factors associated with disease
A total of 36 internally displaced persons (IDPs) camp clusters within 11 districts were identified in 27 surveys in the Darfur States (Table 1, Figure 1)
Because of the method of selection we used, all included data were by definition from IDP camps that were formally recognized by the government of Sudan, and so were not likely to be recent settlements

Summary

Introduction

The United Nations Office for Coordination of Humanitarian Affairs (UNOCHA) estimates that in 2014 more than 59 million people worldwide were displaced from their homes due to conflict or insecurity. Over 38 million of these were internally displaced persons (IDPs) still living within the borders of their own country.2Displaced persons present unique challenges to health systems, having an increased risk of infectious disease, malnutrition related to food and water insecurity, trauma-related psychiatric disorders and maternal mortality. Even where healthcare needs could otherwise be managed, large-scale interventions are made difficult by ongoing risks of violence and the itinerant nature of the population.Trachoma is an eye disease that blinds through recurrent conjunctival infection with the bacterium Chlamydia trachomatis.It is the most common infectious cause of blindness worldwide, affecting the world’s poorest and most vulnerable populations.. The United Nations Office for Coordination of Humanitarian Affairs (UNOCHA) estimates that in 2014 more than 59 million people worldwide were displaced from their homes due to conflict or insecurity.. Over 38 million of these were internally displaced persons (IDPs) still living within the borders of their own country.. Displaced persons present unique challenges to health systems, having an increased risk of infectious disease, malnutrition related to food and water insecurity, trauma-related psychiatric disorders and maternal mortality.. Trachoma is an eye disease that blinds through recurrent conjunctival infection with the bacterium Chlamydia trachomatis. It is the most common infectious cause of blindness worldwide, affecting the world’s poorest and most vulnerable populations.

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Conclusion