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E.S. West, A. Kayengoya, B. Munoz, H. Mkocha, S. West; Risk Factors for Trichiasis Recurrence in a Trachoma Endemic Area . Invest. Ophthalmol. Vis. Sci. 2003;44(13):771.
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Purpose: To determine long-term trichiasis recurrence rates following BTRP surgery and to examine risk factors for trichiasis recurrence. Methods: A cohort of 394 surgical cases living in five districts in central Tanzania was assembled. An in-person questionnaire was administered to each surgical case to determine surgical history and current living conditions. Triciasis recurrence and active trachoma at the time of the study visit were assessed. Detailed characteristics of trichiasis recurrence were recorded. Ocular swabs were collected and tested for C. trachomatis using PCR. All consenting individuals living within the same household as a surgical case also were examined for active trachoma and ocular swabs were collected. District specific trichiasis recurrence rates were calculated. Univariate analyses were performed to examine the relationship between potential risk factors and trichiasis recurrence. Logistic regression models using generalized estimating equations to correct for the correlation between eyes within surgical cases were used to determine adjusted associations between identified risk factors and trichiasis recurrence. Results: 50% of participants had trichiasis in at least one eye at the time of the study visit. The overall trichiasis recurrence rate for post-surgical eyes was 28%. Recurrence rates varied significantly across districts. Trachoma within surgical cases and household members was a significant risk factor for trichiasis recurrence. Residents of Kongwa were 2.3 times more likely to experience recurrence compared to residents of Singida. Left eyes were 44% more likely to have recurrence than right eyes; older indiviudlas were twice as likely to have recurrence as individuals under the age of 45. Results were suggestive of an association between location of recurrence and laterality. Conclusions: Trichiasis recurrence in this population in Tanzania is 50% higher than previously published rates. Active trachoma and surgical factors appear to be important risk factors for recurrence. Vigilant follow up of surgical cases is needed in order to reduce blindness. Community screening for trichiasis may help to identify individuals needing surgery earlier. Post-surgical antibiotic treatment for trachoma may reduce recurrence. Additional research is needed to further clarify the associations found in this study.
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