Jansen Evertjan, Baltussen Rob M P M, van Doorslaer Eddy, Ngirwamungu Edith, Nguyen Mai P, Kilima Peter M
Institute for Medical Technology Assessment, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Ophthalmic Epidemiol. 2007 Sep-Oct;14(5):278-87. doi: 10.1080/09286580701299403.
An important challenge for trachoma control strategies is to break the circle of poverty, poor hygiene and poor health by bringing its benefits to the poor. This article aims to assess to what extent trachoma is a disease of the poor, and trachoma services reach the poor in Tanzania and Vietnam.
Individual level data on trachoma prevalence (active trachoma and trichiasis) and utilization of trachoma-related services were collected in both countries in 2004. Prevalence data were also available for Vietnam in 2001. We used household level data to construct an asset index as our living standards measure. Next, we related trachoma prevalence and service use to living standards, and used concentration indices to summarize and test the degree of inequality.
Trachoma prevalence was higher among the poorest groups in Tanzania. No such relation could be established in Vietnam where prevalence declined over the period 2001-2004 and particularly so among the least poor. Antibiotics were used more by the poorest in Tanzania and by the less poor in Vietnam. In both countries, there was no unequivocal pattern for the relation between living standards and the use of trachoma services.
Trachoma is found to be a disease of the poorest in Tanzania, but not in Vietnam. In the latter country there are indications that district characteristics have an important impact on trachoma prevalence. The higher use of antibiotics among the better-off in Vietnam may have contributed to their larger decline in active trachoma prevalence between 2001 and 2004 compared to the poorer segments.
沙眼控制策略面临的一项重大挑战是通过让贫困人口受益来打破贫困、卫生条件差和健康状况不佳的恶性循环。本文旨在评估沙眼在多大程度上是贫困人口的疾病，以及坦桑尼亚和越南的沙眼服务覆盖贫困人口的情况。
2004年在两国收集了关于沙眼患病率（活动性沙眼和倒睫）以及沙眼相关服务利用情况的个体层面数据。越南在2001年也有患病率数据。我们使用家庭层面数据构建了一个资产指数作为生活水平衡量指标。接下来，我们将沙眼患病率和服务利用情况与生活水平相关联，并使用集中指数来总结和检验不平等程度。
在坦桑尼亚，最贫困群体中的沙眼患病率较高。在越南则无法建立这样的关系，该国在2001 - 2004年期间患病率下降，尤其是在最不贫困的人群中下降更为明显。在坦桑尼亚，最贫困者使用抗生素更多；在越南，较不贫困者使用抗生素更多。在两国，生活水平与沙眼服务利用之间的关系都没有明确的模式。
研究发现，沙眼在坦桑尼亚是最贫困人口的疾病，但在越南并非如此。在越南，有迹象表明地区特征对沙眼患病率有重要影响。与较贫困人群相比，越南较富裕人群中抗生素使用量较高，这可能导致他们在2001年至2004年期间活动性沙眼患病率下降幅度更大。
