title: Trachoma and Relative Poverty: A Case-Control Study.
abstract: 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.
  
  
  RESULTS
  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<0.0001), self-rated wealth (OR, 4.41, 95%CI, 2.75-7.07; p<0.0001) and peer-rated wealth (OR, 8.22, 95% CI, 4.59-14.72; p<0.0001). Cases had less access to latrines (57% v 76.5%, p = <0.0001) and higher person-to-room density (4.0 v 3.31; P = 0.0204) than the controls. Compared to controls, cases were significantly less likely to participate in economically productive activities regardless of visual impairment and other health problems, more likely to report difficulty in performing activities and more likely to receive assistance in performing productive activities.
  
  
  CONCLUSIONS
  This study demonstrated a strong association between trachomatous trichiasis and relative poverty, suggesting a bidirectional causative relationship possibly may exist between poverty and trachoma. Implementation of the full SAFE strategy in the context of general improvements might lead to a virtuous cycle of improving health and wealth. Trachoma is a good proxy of inequality within communities and it could be used to target and evaluate interventions for health and poverty alleviation.
authors.affiliation: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.|The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Esmael
authors.initials: E
authors.lastname: Habtamu
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Tariku
authors.initials: T
authors.lastname: Wondie
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Sintayehu
authors.initials: S
authors.lastname: Aweke
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Zerihun
authors.initials: Z
authors.lastname: Tadesse
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Mulat
authors.initials: M
authors.lastname: Zerihun
authors.affiliation: Amhara Regional Health Bureau, Bahirdar, Ethiopia.
authors.forename: Zebideru
authors.initials: Z
authors.lastname: Zewdie
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America.
authors.forename: Kelly
authors.initials: K
authors.lastname: Callahan
authors.affiliation: International Trachoma Initiative, Atlanta, Georgia, United States of America.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.affiliation: International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kuper
authors.affiliation: Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Bailey
authors.affiliation: Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: David C W
authors.initials: DC
authors.lastname: Mabey
authors.affiliation: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Saul N
authors.initials: SN
authors.lastname: Rajak
authors.affiliation: International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Polack
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.affiliation: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Burton
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012424:Rural Population; D012959:Socioeconomic Factors; D014141:Trachoma / Q000150:complications / Q000453:epidemiology*; D058457:Trichiasis / Q000453:epidemiology*