EXPOSURE TO CHILDREN AND RISK OF ACTIVE TRACHOMA IN TANZANIAN WOMEN

The authors surveyed the trachoma status of 515 women aged 18-60 years and 527 children aged 1-7 years in the trachoma hyperendemic region o f Kongwa, Tanzania, in 1989 to further describe the importance of expo sure to young children as a risk factor for active trachoma in women. The women were identified as caretakers. who currently cared for child ren aged 1-7 years; noncaretakers, who lived with, but did not care fo r, children aged 1-7; or those without children aged 1-7 in the househ old. The age-adjusted odds ratios for active trachoma seemed to rise w ith greater exposure to young children, from 1.00 for women without su ch children, to 1.63 for noncaretakers and 2.43 for caretakers (trend test, p = 0.08). Among those who lived in households with young childr en, the prevalence of active trachoma in women increased with the tota l number of young children cared for and with the number of infected c hildren cared for. The prevalence of active trachoma was 40% (6 of 15) for caretakers of three or more infected children, compared with 0 (0 of 88) for caretakers with no infected children (p < 0.0001). Caring for infected children also appeared to be associated with signs of chr onic trachoma in caretakers. Noncaretakers who lived with infected chi ldren were not at a significantly increased risk for trachoma compared with noncaretakers who were not exposed to such children (5.4% (three of 56) vs. 5.6% (one of 18); p > 0.4). None of the facial signs obser ved in the children (flies on the face, nasal discharge, etc.) appeare d to increase the odds ratio of active trachoma in caretakers beyond t he increase associated with trachoma alone in the child. These data su pport the hypothesis that active disease in women is associated with d irect caretaking of young children with active disease. Strategies tha t interrupt household transmission may affect the blinding sequelae of trachoma in women.