Trichiasis and disability in a trachoma-endemic area of Tanzania

Objective: To measure limitations in the daily activities of village life associated with having trichiasis for individuals with and without visual acuity loss. Methods: Men and women 40 years and older in 6 randomly chosen rural villages in the Kongwa district of Tanzania had visual acuity measured and were examined by an ophthalmologist. Subjects indicated the degree of difficulty with daily activities of village life and whether the difficulty was related, in any way, to vision. Limitations were scored using an indicator of "any difficulty" and using a 4-point scale ranging from "no difficulty" to "unable to do." Scores of individuals with and without trichiasis were compared separately for men and women. Results: Among men, trichiasis was associated with excess functional limitation only for those with visual acuity loss (adjusted difference in proportion of tasks [AD] compared with men with neither trichiasis nor visual impairment, 0.35; 95% confidence interval [CI], 0.23-0.47). For women, trichiasis alone was limiting (AD, 0.15; 95% CI, 0.08-0.22) similarly to visual acuity loss alone (AD, 0.09; 95% CI 0.06-0.13), and the combination led to greater limitations (AD, 0.32; 95% CI, 0.26-0.39). Conclusion: The burden of trichiasis is likely greater than previously estimated, especially in women for whom trichiasis alone was disabling.