What Will Happen If We Do Nothing To Control Trachoma: Health Expectancies for Blinding Trachoma in Southern Sudan

BACKGROUND: Uncontrolled trachoma is a leading cause of blindness. Current global trachoma burden summary measures are presented as disability adjusted life years but have limitations due to inconsistent methods and inadequate population-based data on trachomatous low vision and blindness. We aimed to describe more completely the burden of blinding trachoma in Southern Sudan using health expectancies. METHODOLOGY/PRINCIPAL FINDINGS: Age and gender specific trachomatous trichiasis (TT) prevalence was estimated from 11 districts in Southern Sudan. The distribution of visual acuity (VA) in persons with TT was recorded in one district. Sudan life tables, TT prevalence, and VA were used to calculate Trichiasis Free Life Expectancy (TTFLE) and Trichiasis Life Expectancy (TTLE) using the Sullivan method. TTLE was broken down by VA to derive TTLE with normal vision, TTLE with low vision, and TTLE with blindness. Total life expectancy at birth in 2001 was 54.2 years for males and 58.1 for females. From our Sullivan models, trichiasis life expectancy at the age of 5 years was estimated to be 7.0 (95% confidence interval [CI] = 6.2–7.8) years (12% [95% CI = 11–14] of remaining life) for males and 10.9 (95% CI = 9.9–11.9 ) years (18% [95% CI = 16–20] of remaining life) for females. Trichiasis life expectancy with low vision or blindness was 5.1 (95% CI = 3.9–6.4) years (9% [95% CI = 7–11] of remaining life) and 7.6 (95% CI = 6.0–9.1) years (12% [95% CI = 10–15] of remaining life) for males and females, respectively. Women were predicted to live longer and spend a greater proportion of their lives with disabling trichiasis, low vision, and blindness compared to men. CONCLUSIONS: The study shows the future burden associated with doing nothing to control trachoma in Southern Sudan, that is, a substantial proportion of remaining life expectancy spent with trichiasis and low vision or blindness for both men and women, with a disproportionate burden falling on women.