Trichiasis and disability in a trachoma-endemic area of Tanzania

Objective: To measure limitations in the daily activities of village life a ssociated with having trichiasis for individuals with and without visual ac uity loss. Methods: Men and women 40 years and older in 6 randomly chosen rural villag es in the Kongwa district of Tanzania had visual acuity measured and were e xamined by an ophthalmologist. Subjects indicated the degree of difficulty with daily activities of village life and whether the difficulty was relate d, in any way, to vision. Limitations were scored using an indicator of "an y difficulty" and using a 4-point scale ranging from "no difficulty" to "un able to do." Scores of individuals with and without trichiasis were compare d separately for men and women. Results: Among men, trichiasis was associated with excess functional limita tion only for those with visual acuity loss (adjusted difference in proport ion of tasks [AD] compared with men with neither trichiasis nor visual impa irment, 0.35; 95% confidence interval [CI], 0.23-0.47). For women, trichias is alone was limiting (AD, 0.15; 95% Cl, 0.08-0.22) similarly to visual acu ity loss alone (AD, 0.09; 95% CI 0.06-0.13), and the combination led to gre ater limitations (AD, 0.32; 95% CI, 0.26-0.39). Conclusion: The burden of trichiasis is likely greater than previously esti mated, especially in women for whom trichiasis alone was disabling.