Trachoma and Relative Poverty: A Case-Control Study

Background Trachoma is widely considered a disease of poverty. Although there are many epidemiological studies linking trachoma to factors normally associated with poverty, formal quantitative data linking trachoma to household economic poverty within endemic communities is very limited. Methodology/Principal Findings Two hundred people with trachomatous trichiasis were recruited through community-based screening in Amhara Region, Ethiopia. These were individually matched by age and gender to 200 controls without trichiasis, selected randomly from the same sub-village as the case. Household economic poverty was measured through (a) A broad set of asset-based wealth indicators and relative household economic poverty determined by principal component analysis (PCA, (b) Self-rated wealth, and (c) Peer-rated wealth. Activity participation data were collected using a modified ‘Stylised Activity List’ developed for the World Bank’s Living Standards Measurement Survey. Trichiasis cases were more likely to belong to poorer households by all measures: asset-based analysis (OR = 2.79; 95%CI: 2.06–3.78; p
Author Summary Trachoma has long been considered a disease of poverty. However, there is surprisingly little direct data that formally quantifies the relationship between trachoma and economic poverty, and none that specifically focuses on trichiasis. We compared 200 people with trachomatous trichiasis (TT) to 200 people (controls) without the condition, who were matched on age and sex, living in the same community, in Amhara Region, Ethiopia. We measured household relative poverty using three measures: household assets, self-rated wealth and peer-rated wealth. We also measured activity participation. We found TT case households were poorer by all relative economic measures. We found cases less likely to participate in economically productive activities regardless of visual impairment and other health problems, more likely to report difficulty and need assistance performing activities. The results suggest that the causative relationship between poverty and trachoma could possibly be bidirectional: poor households are more affected by trachoma and trichiasis reduces productivity even prior to development of visual impairment, which may exacerbate poverty. Implementation of the SAFE strategy in the context of general socioeconomic improvements might lead to a virtuous cycle of improving health and wealth. Trachoma could be used as proxy of inequality and to target and evaluate interventions for health and poverty alleviation.