Wolle Meraf A, Muñoz Beatriz E, Mgboji Glory, Naufal Fahd, Kashaf Michael Saheb, Mkocha Harran, West Sheila K
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America.
Kongwa Trachoma Project, Kongwa, Tanzania.
PLoS Negl Trop Dis. 2024 Jan 26;18(1):e0011861. doi: 10.1371/journal.pntd.0011861. eCollection 2024 Jan.
Trachoma is a chronic conjunctivitis caused by the bacterium Chlamydia trachomatis. Repeated infections lead to trachomatous conjunctival scarring which can progress to potentially blinding trachomatous trichiasis (TT). In trachoma hyperendemic conditions, women compared to men have an increased risk of scarring and TT, which can progress to blinding corneal opacification. This study determined if there were gender differences in scarring prevalence and severity when trachoma prevalence approaches elimination, in a formerly trachoma hyperendemic region.
METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional prevalence study was conducted amongst adults age 15 years and older in Kongwa district, Tanzania in 2019. 3168 persons over age 15 years agreed to be examined and had at least one eye with a gradable image. Ocular photographs were graded for scarring according to a published four-step severity scale. Overall, about half of all study participants had scarring. However, more females (52.3%) had any scarring compared to males (47.2%), OR = 1.22 (95% CI = 1.05-1.43). For every year increase in age, there was a 6.5% increase in the odds of having more severe scarring (95% CI: 5.8%, 7.2%). Women were more likely than men to have severe scarring, OR 2.36 (95% CI: 1.84-3.02). Residence in a community with TF≥10% was associated with a 1.6-fold increased odds of any scarring.
CONCLUSIONS/SIGNIFICANCE: Overall scarring prevalence and more severe scarring prevalence was higher in females compared to males, even adjusting for age and community TF prevalence. The data suggest that processes occur that lead to women preferentially progressing towards more severe scarring compared to men.
沙眼是一种由沙眼衣原体引起的慢性结膜炎。反复感染会导致沙眼性结膜瘢痕形成，进而可能发展为具有潜在致盲性的沙眼性倒睫（TT）。在沙眼高度流行地区，与男性相比，女性发生瘢痕形成和沙眼性倒睫的风险更高，而沙眼性倒睫可发展为致盲性角膜混浊。本研究确定在一个曾经沙眼高度流行的地区，当沙眼患病率接近消除时，瘢痕形成的患病率和严重程度是否存在性别差异。
方法/主要发现：2019年在坦桑尼亚孔瓜区对15岁及以上成年人进行了一项横断面患病率研究。3168名15岁以上的人同意接受检查，且至少有一只眼睛有可分级图像。根据已发表的四步严重程度量表对眼部照片的瘢痕形成情况进行分级。总体而言，所有研究参与者中约有一半有瘢痕形成。然而，有任何瘢痕形成的女性（52.3%）比男性（47.2%）更多，比值比（OR）=1.22（95%置信区间[CI]=1.05 - 1.43）。年龄每增加一岁，出现更严重瘢痕形成的几率增加6.5%（95%CI：5.8%，7.2%）。女性比男性更有可能出现严重瘢痕形成，OR为2.36（95%CI：1.84 - 3.02）。居住在沙眼滤泡（TF）≥10%的社区与任何瘢痕形成的几率增加1.6倍相关。
结论/意义：即使在调整年龄和社区沙眼滤泡患病率后，女性的总体瘢痕形成患病率和更严重瘢痕形成患病率仍高于男性。数据表明，存在一些过程导致女性比男性更容易发展为更严重的瘢痕形成。
