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Rabia Karani, Meraf Wolle, Harran Mkocha, Beatriz Munoz, Sheila West; Risk Factors for Incidence of Trachomatous Scarring in a Cohort of Women in Kongwa, Tanzania. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4794.
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© ARVO (1962-2015); The Authors (2016-present)
Trachoma, the leading infectious cause of blindness, disproportionately affects women, who have higher rates of trachomatous scarring (TS) and trichiasis (TT). The reasons for this increased risk for TS and TT in women remain unclear. This prospective cohort study sought to determine risk factors associated with the incidence of trachomatous scarring in a cohort of women in Kongwa, Tanzania.
Baseline data for the presence of TS and risk factors was collected from a random sample of 4161 women age 15 years and older in the Kongwa district of Tanzania. Questionnaire data was collected on age, exposure to indoor cooking fires, education level, distance from the home to water, and ownership of a bicycle. Images of the upper eyelids were taken and graded for the presence of severity of scarring using our previously published four-step severity scale (Wolle, IOVS, 2009). Three years after baseline, a follow-up survey was carried out in the same villages, excluding two villages that refused to participate. During the follow-up survey, images were taken and graded using the same methods. Incident scarring was defined as development of moderate to severe scarring in those with none or minimal scarring at baseline. Fisher Exact Test and X2 analysis were used to compare differences between groups, and logistic regression analyses were used to adjust for age.
We followed up 2538 women (61%), with most lost to follow-up due to travel or moving out of the village. Preliminary analysis of the data showed a 6.5% incidence (2.17% incidence/year) of moderate to severe scarring. Incidence of scarring increased significantly with age (p = .0001). Decreased incidence of scarring was observed in those with markers of higher socioeconomic status: any education in the head of the household (OR = 0.411, CI = 0.183-0.926) or ownership of a bicycle (OR = 0.242, CI = 0.089-0.656).
In these formerly endemic communities, the yearly incidence rate of scarring in women is low, and associated with markers of lower socioeconomic status.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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