title: 'A living death': a qualitative assessment of quality of life among women with trichiasis in rural Niger.
abstract: BACKGROUND
  Prior to blindness, trachoma is thought to profoundly affect women's abilities to lead normal lives, but supporting evidence is lacking. To better understand the effects of trichiasis, we asked women to define quality of life, how trichiasis affects this idea and their perceptions of eyelid surgery.
  
  
  METHODS
  Operated and unoperated women were purposively selected for in-depth interviews. These were audio-recorded and transcribed, and codes were identified and applied to the transcripts. Overarching themes, commonalities and differences were identified and matched to quotations.
  
  
  RESULTS
  Twenty-three women were interviewed. Quality of life was defined as health, security, family, social status and religious participation. Trichiasis caused severe pain and loss of health, leading to loss of security. This affected social, economic and religious activities and caused burden on their families. Surgery improved quality of life, even in cases of surgical failure or recurrent disease.
  
  
  CONCLUSIONS
  Trichiasis disables most women, even those reporting fewer or less-severe symptoms. While women in rural Niger often live in extreme poverty, trichiasis exacerbates the situation, making women unable to work and undermining their social status. It adds to family burden, as women lose the ability to meaningfully contribute to the household and require additional family resources for their care.
authors.affiliation: The Carter Center, Atlanta, Georgia, USA Rollins School of Public Health, Emory University, Atlanta, Georgia, USA stephanielpalmer@gmail.com.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Palmer
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Winskell
authors.affiliation: The Carter Center, Atlanta, Georgia, USA Agnes Scott College, Decatur, Georgia, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Patterson
authors.affiliation: Programme Nationale de la Santé Oculaire, Niamey, Niger.
authors.forename: Kadri
authors.initials: K
authors.lastname: Boubacar
authors.affiliation: Ecole Nationale de la Santé Publique, Zinder, Niger.
authors.forename: Fatahou
authors.initials: F
authors.lastname: Ibrahim
authors.affiliation: Ecole Nationale de la Santé Publique, Zinder, Niger.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Namata
authors.affiliation: The Carter Center Niger, Zinder, Niger.
authors.forename: Tahirou
authors.initials: T
authors.lastname: Oungoila
authors.affiliation: The Carter Center Niger, Niamey, Niger.
authors.forename: Mohamed Salissou
authors.initials: MS
authors.lastname: Kané
authors.affiliation: The Carter Center Niger, Zinder, Niger.
authors.forename: Adamou Sabo
authors.initials: AS
authors.lastname: Hassan
authors.affiliation: The Carter Center, Atlanta, Georgia, USA Bill & Melinda Gates Foundation, Seattle, Washington, USA.
authors.forename: Aryc W
authors.initials: AW
authors.lastname: Mosher
authors.affiliation: The Carter Center, Atlanta, Georgia, USA.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hopkins
authors.affiliation: The Carter Center, Atlanta, Georgia, USA The International Trachoma Initiative, Decatur, Georgia, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001766:Blindness; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008875:Middle Aged; D009548:Niger; D036301:Qualitative Research; D011788:Quality of Life; D012424:Rural Population; D058457:Trichiasis / Q000523:psychology*; D014786:Vision Disorders / Q000209:etiology; D055815:Young Adult
keywords: Niger; Quality of life; Trichiasis; Women