Abstract
BackgroundTrachomatous scarring (TS) results from repeated infection with the bacterium Chlamydia trachomatis. Pronounced scarring is an underlying cause of trachomatous trichiasis (TT) that can lead to blindness. Since the condition is irreversible, TS in adults has been considered a marker of past exposure to trachoma infection. The aim of this report was to estimate the population-based prevalence of TS within Amhara, Ethiopia, a region with a historically high burden of trachoma.MethodsDistrict-level multi-stage cluster surveys were conducted in all districts between 2010 and 2015 to monitor the impact of approximately 5 years of trachoma interventions. Approximately 40 households were sampled per cluster and all participants ages ≥ 1 year were graded for the 5 World Health Organization simplified signs. Before each survey round, trachoma graders participated in a 7-day training and reliability exam that included cases of TS. TS prevalence estimates were weighted to account for sampling design and adjusted for age and sex using post-stratification weighting.ResultsAcross the 152 districts in Amhara, 208,510 individuals ages 1 year and older were examined for the signs of trachoma. Region-wide, the prevalence of TS was 8.2 %, (95 % Confidence Interval [CI]: 7.7–8.6 %), and the prevalence among individuals ages 15 years and older (n = 110,137) was 12.6 % (95 % CI: 12.0–13.3 %). District-level TS prevalence among individuals ages 15 years and older ranged from 0.9 to 36.9 % and was moderately correlated with district prevalence of TT (r = 0.31; P < 0.001). The prevalence of TS increased with age, reaching 22.4 % among those ages 56 to 60 years and 24.2 % among those ages 61 to 65 years. Among children ages 1 to 15 years TS prevalence was 2.2 % (95 % CI: 1.8–2.8 %), increased with age (P < 0.001), and 5 % of individuals with TS also had trachomatous inflammation-intense (TI).ConclusionsThese results suggest that Amhara has had a long history of trachoma exposure and that a large population remains at risk for developing TT. It is promising, however, that children, many born after interventions began, have low levels of TS compared to other known trachoma-hyperendemic areas.
Highlights
Trachomatous scarring (TS) results from repeated infection with the bacterium Chlamydia trachomatis
Astale et al BMC Ophthalmology (2021) 21:213 (Continued from previous page). These results suggest that Amhara has had a long history of trachoma exposure and that a large population remains at risk for developing trachomatous trichiasis (TT)
That children, many born after interventions began, have low levels of TS compared to other known trachoma-hyperendemic areas
Summary
Trachomatous scarring (TS) results from repeated infection with the bacterium Chlamydia trachomatis. Pronounced scarring is an underlying cause of trachomatous trichiasis (TT) that can lead to blindness. Repeated infection and the associated conjunctival inflammation throughout childhood can initiate a scarring process. Scarring is thought to be an irreversible process and could be considered a marker for cumulative exposure to C. trachomatis infection and associated inflammation [3,4,5,6,7]. Severe enough scarring can cause entropion of the eyelid followed by trachomatous trichiasis (TT), corneal opacity, and eventual blindness. Prior evidence has demonstrated that conjunctival scarring may still develop and progress over time, even after the prevalence of clinical signs of active trachoma such as TF and trachomatous-inflammation intense (TI) has declined [9,10,11]. The progression of trachomatous scarring (TS) and subsequent development of TT over time will likely pose a challenge for trachoma elimination and post-elimination surveillance efforts
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