An eye for inequality: how trachoma relates to poverty in Tanzania and Vietnam.
OBJECTIVE
An important challenge for trachoma control strategies is to break the circle of poverty, poor hygiene and poor health by bringing its benefits to the poor. This article aims to assess to what extent trachoma is a disease of the poor, and trachoma services reach the poor in Tanzania and Vietnam.


METHODS
Individual level data on trachoma prevalence (active trachoma and trichiasis) and utilization of trachoma-related services were collected in both countries in 2004. Prevalence data were also available for Vietnam in 2001. We used household level data to construct an asset index as our living standards measure. Next, we related trachoma prevalence and service use to living standards, and used concentration indices to summarize and test the degree of inequality.


RESULTS
Trachoma prevalence was higher among the poorest groups in Tanzania. No such relation could be established in Vietnam where prevalence declined over the period 2001-2004 and particularly so among the least poor. Antibiotics were used more by the poorest in Tanzania and by the less poor in Vietnam. In both countries, there was no unequivocal pattern for the relation between living standards and the use of trachoma services.


CONCLUSIONS
Trachoma is found to be a disease of the poorest in Tanzania, but not in Vietnam. In the latter country there are indications that district characteristics have an important impact on trachoma prevalence. The higher use of antibiotics among the better-off in Vietnam may have contributed to their larger decline in active trachoma prevalence between 2001 and 2004 compared to the poorer segments.
Jansen
Evertjan
E
Institute for Medical Technology Assessment, Erasmus University Medical Centre, Rotterdam, The Netherlands. evertjan@fastmail.fm
Baltussen
Rob M P M
RM
van Doorslaer
Eddy
E
Ngirwamungu
Edith
E
Nguyen
Mai P
MP
Kilima
Peter M
PM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data; D015995:Prevalence; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology; D014141:Trachoma / Q000188:drug therapy* / Q000453:epidemiology*; D014744:Vietnam / Q000453:epidemiology
D000900:Anti-Bacterial Agents