Risk Factors for Trichiasis in Women in Kongwa, Tanzania: A Case-Control Study

Ophthalmologists analyzed data on 205 women with ingrowing eyelashes caused by trachomatous scarring (trichiasis) with data on 410 age- and village-matched controls to determine risk factors for trichiasis in trachoma hyperendemic areas where women face a greater risk of trichiasis than do men. All women lived in the Kongwa subdistrict of Dodoma Region Tanzania. Cases were 3.6 times more likely to have a mother who also had trichiasis. Family history of fathers or other relatives was not associated with trichiasis however. Cases tended to have never married (odds ratio [OR] = 3.7) suggesting that in a society that expects marriage women with trichiasis were socially and economically marginalized. Mothers with trichiasis were more apt to experience at least 5 deaths of children than controls (OR = 2.6). The researchers assumed that a factor common to both trichiasis and increased child deaths (e.g. socioeconomic status) accounted for this association. Controls were more likely to have attended adult education classes than cases (OR = 2.2) yet attendance at primary school was not a predictor for trichiasis. Women who had slept in a room with a cooking fire during their reproductive years were more prone to trichiasis than women who did during childhood or as current practice (OR -1.8) indicating a more profound pathogenic response (scarring) to infection with Chlamydia trachomatis during pregnancy. Living in a wood/earth (i.e. traditional) home during childbearing years was also a significant predictor of trichiasis (OR = 2.1). These findings suggest that improving living conditions educational opportunities and socioeconomic status during the childbearing years would reduce the risk for trichiasis and blindness.