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Meraf Amde Wolle, Beatriz Munoz, Harran Mkocha, Sheila K West; Progression of Scarring in a Cohort of Women in Kongwa Tanzania. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4255.
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© ARVO (1962-2015); The Authors (2016-present)
Progression of scarring in trachoma endemic communities has been described, with rates from 9.4% to as high as 28% per year, depending on the assessment algorithm. The continued development of trichiasis in communities that have long eliminated trachoma suggest that scarring must progress even in the relative absence of trachoma in children but the rates of progression are unknown. In a district that had trachoma prevalence of 5.2%, we followed a cohort of women with scarring for 3.5 years to determine the progression to more severe scarring.
A prospective cohort study was conducted over a 3.5-year period from 2013 to 2016 in 48 villages in Kongwa, Tanzania where trachoma at baseline was 5.2% in children. A random sample of 4161 women aged 15 and older was selected based on a complete census. Images of the everted eye lid were taken and graded for presence and severity of scarring, using a published scarring grading scheme. All images were graded twice independently and adjudicated for a final grade. Those who at baseline had scarring grade 2 were eligible for this study (N=226). Data on demographic factors were gathered at baseline and follow-up. Progression rates by age were calculated, and age-adjusted logistic regression and multivariable logistic models were used to look for associations of factors with progression of trachomatous scarring.
The cumulative progression rate of scarring was 33.0%, (95% CI 27.9%, 38.6%), or approximately 9.4% per year. The progression rate did not increase by age . Exposure to cooking fire during the 3.5 year period was not associated with progression. There was no evidence of clustering of progression by community (ICC= 0.05, 95% CI -0.06, 0.17).
Trachomatous scarring continues to progress in the relative absence of trachoma; the rates are similar to those reported previously despite there being a significant reduction in the incidence of trachomatous scarring. Given that progression rates have stayed relatively stable in the absence of trachoma, rates of incident trichiasis may remain the same as well.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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