Prevalence and Correlates of Trachomatous Scarring Severity among Adults in the Trachoma Hyper-endemic Amhara Region of Ethiopia Pubblico

Abstract

Background: In hyperendemic communities, conjunctival scarring can be observed in young adults and children due to frequent reinfection. Studies have shown that the prevalence of scarring increases with age, and women are more likely than men to develop severe signs of trachoma and related blindness. This study seeks to explore the factors and clinical features that contribute to various stages of scarring sequelae in an endemic area using a validated four-point severity scale. 

Methods: Left and right eye upper tarsal conjunctiva photographs, demographic information, and WASH indicators were collected in early 2017 as part of trachoma impact surveys in East Amhara, Ethiopia. Two graders assessed scarring severity in individuals aged 15 or older using Wolle et al.'s26 scale (S1-S4). The highest score across conjunctiva was recorded to obtain person-level scarring severity. A third grader provided an adjudicating grade if needed.

Results: Person-level scarring severity data was collected from 97.5% of adults. Scarring sequalae at every severity stage was observed among the youngest age group (15-19 years old). Age had a significant effect when comparing the odds of different scarring severity levels across age groups, with older individuals having higher odds of being in a higher severity level (include stat). Women were found to experience a greater prevalence of scarring at stages of severity compared to men (include stat). Additionally, living in a district with a trachoma follicular (TF) prevalence greater than 10% was significantly associated with an increased odds of scarring by over four-fold. 

Conclusions: The study identified increasing age, female gender, and residing in a district with a TF prevalence greater than 10% as independent correlating factors for increasing conjunctival scarring among adults in the region. These findings suggest that a considerable percentage of the population remains at risk of trichiasis development, and disparities in women and older age groups may be exacerbated by expected progression to come. The prevalence of trachomatous scarring, and its potential for progression to trichiasis, may prove a considerable barrier to achieving the elimination of trachoma as a public health problem. 

Table of Contents

Literature Review ....................................................................................1

Introduction ...........................................................................................1

Environmental Characteristics and Risk Factors of Trachoma .....................2

Prevalence of Trachomatous Scarring in Amhara, Ethiopia .........................3

Other Characteristics and Risk Factors of Conjunctival Scarring .................4

Validity and Reliability of Photographic Grading for Trachoma Diagnosis ....6

Conclusions ............................................................................................8

Introduction ...........................................................................................9

Methods ................................................................................................11

Ethical Considerations ............................................................................11

Study Area .............................................................................................11

Data Collection ......................................................................................12

Photography ..........................................................................................12

Photographic Grading .............................................................................13

Statistical Analysis .................................................................................14

Results ..................................................................................................15

Discussion .............................................................................................19

Key Findings ..........................................................................................19

Interpretation of Findings .......................................................................19

Limitations ............................................................................................24

Recommendations ..................................................................................25

Conclusions ...........................................................................................26

References .............................................................................................26

Appendix ...............................................................................................31

Supplementary Appendix ........................................................................34

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Environmental Health
Parola chiave	Trachoma Trachomatous Scarring Neglected Tropical Diseases
Committee Chair / Thesis Advisor	Scott Nash, Emory University
Committee Members	Jeremy Sarnat, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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