International Journal of Epidemiology, Vol 28, 1167-1171, Copyright © 1999 by International Epidemiological Association
B Munoz, L Bobo, H Mkocha, M Lynch, YH Hsieh and S West
BACKGROUND: Blindness from trachoma is a significant problem for many
underdeveloped countries. While active trachoma is common in children,
trichiasis, the potentially blinding sequella, develops in adulthood and
affects mainly women. Little is known about factors associated with the
development of trichiasis. METHODS: The 7-year incidence of trichiasis and
its association with ocular chlamydia infection was examined in a cohort of
women from a hyperendemic area. A total of 4,932 women 18 years and older,
living in 11 villages in Central Tanzania, were examined in 1989. A
follow-up examination in 1996 was performed on all women with scars living
in six of the 11 villages and on a random sample of women without scars
from the same villages. Trachoma was graded clinically, chlamydia infection
was ascertained at follow-up using polymerase chain reaction-enzyme
immunoassay (PCR-EIA). RESULTS: A total 523 of the women with scars and 503
of the women without scars were re-examined. Forty-eight of the women with
scars (incidence, 9.2%) and three of the women without scars (0.6%)
developed trichiasis in the 7-year period. Prevalence of chlamydia
infection was significantly higher in the group with scars (11.7% versus
7.1%). Trichiasis cases were more likely to be older, and to have chlamydia
infection at follow-up odds ratio (95% confidence interval) 2.5 (1.1- 5.7).
CONCLUSION: The 7-year incidence rate in the population with scars was
high, over 1% per year. Ocular chlamydia infection was more common in the
group with scars at baseline and was also associated with being a
trichiasis case, suggesting the importance of potentially long- term
chlamydia infection in the progression to trichiasis. Antibiotic
distribution programmes for trachoma control should include women with
scars.
Incidence of trichiasis in a cohort of women with and without scarring [In Process Citation]
Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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