03036nas a2200313   4500000000100000008004100001653001200042100001400054700001300068700001200081700001400093700001400107700001300121700001500134700001400149700001200163700001300175700001200188700001200200700001300212700001300225700001300238245005700251856007900308300001300387490000600400520230200406022001402708       2015                            d10aPoverty1 aHabtamu E1 aWondie T1 aAweke S1 aTadesse Z1 aZerihun M1 aZewdie Z1 aCallahan K1 aEmerson P1 aKuper H1 aBailey R1 aMabey D1 aRajak S1 aPolack S1 aWeiss HA1 aBurton M00aTrachoma and relative poverty: A case-control study.  uhttp://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004228   ae00042280 v93 a<p><strong>BACKGROUND: </strong>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.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>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&lt;0.0001), self-rated wealth (OR, 4.41, 95%CI, 2.75-7.07; p&lt;0.0001) and peer-rated wealth (OR, 8.22, 95% CI, 4.59-14.72; p&lt;0.0001). Cases had less access to latrines (57% v 76.5%, p = &lt;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.</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>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.</p>
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