Podoconiosis, trachomatous trichiasis and cataract in northern Ethiopia: A comparative cross sectional study
Identifieur interne : 000139 ( Pmc/Checkpoint ); précédent : 000138; suivant : 000140Podoconiosis, trachomatous trichiasis and cataract in northern Ethiopia: A comparative cross sectional study
Auteurs : Helen Burn [Royaume-Uni] ; Sintayehu Aweke [Éthiopie] ; Tariku Wondie [Éthiopie] ; Esmael Habtamu [Éthiopie, Royaume-Uni] ; Kebede Deribe [Royaume-Uni, Éthiopie] ; Saul Rajak [Royaume-Uni] ; Stephen Bremner [Royaume-Uni] ; Gail Davey [Royaume-Uni]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2017.
Abstract
Rural populations in low-income countries commonly suffer from the co-morbidity of neglected tropical diseases (NTDs). Podoconiosis, trachomatous trichiasis (both NTDs) and cataract are common causes of morbidity among subsistence farmers in the highlands of northern Ethiopia. We explored whether podoconiosis was associated with cataract or trachomatous trichiasis (TT) among this population.
A comparative cross-sectional study was conducted in East Gojam region, Amhara, Ethiopia in May 2016. Data were collected from patients previously identified as having podoconiosis and from matched healthy neighbourhood controls. Information on socio-demographic factors, clinical factors and past medical history were collected by an interview-administered questionnaire. Clinical examination involved grading of podoconiosis by examination of both legs, measurement of visual acuity, direct ophthalmoscopy of dilated pupils to grade cataract, and eyelid and corneal examination to grade trachoma. Multiple logistic regression was conducted to estimate independent association and correlates of podoconiosis, TT and cataract.
A total of 700 participants were included in this study; 350 podoconiosis patients and 350 healthy neighbourhood controls. The prevalence of TT was higher among podoconiosis patients than controls (65 (18.6%) vs 43 (12.3%)) with an adjusted odds ratio OR 1.57 (95% CI 1.02–2.40), p = 0.04. There was no significant difference in prevalence of cataract between the two populations with an adjusted OR 0.83 (95% CI 0.55–1.25), p = 0.36. Mean best visual acuity was 0.59 (SD 0.06) in podoconiosis cases compared to 0.44 (SD 0.04) in controls, p<0.001. The proportion of patients classified as blind was higher in podoconiosis cases compared with healthy controls; 5.6% vs 2.0%; adjusted OR 2.63 (1.08–6.39), P = 0.03.
Individuals with podoconiosis have a higher burden of TT and worse visual acuity than their matched healthy neighbourhood controls. Further research into the environmental and biological reasons for this co-morbidity is required. A shared approach to managing these two NTDs within the same population could be beneficial.
Url:
DOI: 10.1371/journal.pntd.0005388
PubMed: 28187129
PubMed Central: 5322969
Affiliations:
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xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton</wicri:regionArea><wicri:noRegion>Brighton</wicri:noRegion></affiliation></author><author><name sortKey="Aweke, Sintayehu" sort="Aweke, Sintayehu" uniqKey="Aweke S" first="Sintayehu" last="Aweke">Sintayehu Aweke</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>The Carter Center, Addis Ababa, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>The Carter Center, Addis Ababa</wicri:regionArea><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation></author><author><name sortKey="Wondie, Tariku" sort="Wondie, Tariku" uniqKey="Wondie T" first="Tariku" last="Wondie">Tariku Wondie</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>The Carter Center, Addis Ababa, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>The Carter Center, Addis Ababa</wicri:regionArea><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation></author><author><name sortKey="Habtamu, Esmael" sort="Habtamu, Esmael" uniqKey="Habtamu E" first="Esmael" last="Habtamu">Esmael Habtamu</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>The Carter Center, Addis Ababa, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>The Carter Center, Addis Ababa</wicri:regionArea><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Deribe, Kebede" sort="Deribe, Kebede" uniqKey="Deribe K" first="Kebede" last="Deribe">Kebede Deribe</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton</wicri:regionArea><wicri:noRegion>Brighton</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>School of Public Health, Addis Ababa University, Addis Ababa</wicri:regionArea><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation></author><author><name sortKey="Rajak, Saul" sort="Rajak, Saul" uniqKey="Rajak S" first="Saul" last="Rajak">Saul Rajak</name><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>Sussex Eye Hospital, Brighton, Sussex, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Sussex Eye Hospital, Brighton, Sussex</wicri:regionArea><wicri:noRegion>Sussex</wicri:noRegion></affiliation></author><author><name sortKey="Bremner, Stephen" sort="Bremner, Stephen" uniqKey="Bremner S" first="Stephen" last="Bremner">Stephen Bremner</name><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Brighton and Sussex Medical School, Brighton</wicri:regionArea><wicri:noRegion>Brighton</wicri:noRegion></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton</wicri:regionArea><wicri:noRegion>Brighton</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS Neglected Tropical Diseases</title><idno type="ISSN">1935-2727</idno><idno type="eISSN">1935-2735</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Rural populations in low-income countries commonly suffer from the co-morbidity of neglected tropical diseases (NTDs). Podoconiosis, trachomatous trichiasis (both NTDs) and cataract are common causes of morbidity among subsistence farmers in the highlands of northern Ethiopia. We explored whether podoconiosis was associated with cataract or trachomatous trichiasis (TT) among this population.</p></sec><sec id="sec002"><title>Methods</title><p>A comparative cross-sectional study was conducted in East Gojam region, Amhara, Ethiopia in May 2016. Data were collected from patients previously identified as having podoconiosis and from matched healthy neighbourhood controls. Information on socio-demographic factors, clinical factors and past medical history were collected by an interview-administered questionnaire. Clinical examination involved grading of podoconiosis by examination of both legs, measurement of visual acuity, direct ophthalmoscopy of dilated pupils to grade cataract, and eyelid and corneal examination to grade trachoma. Multiple logistic regression was conducted to estimate independent association and correlates of podoconiosis, TT and cataract.</p></sec><sec id="sec003"><title>Findings</title><p>A total of 700 participants were included in this study; 350 podoconiosis patients and 350 healthy neighbourhood controls. The prevalence of TT was higher among podoconiosis patients than controls (65 (18.6%) vs 43 (12.3%)) with an adjusted odds ratio OR 1.57 (95% CI 1.02–2.40), p = 0.04. There was no significant difference in prevalence of cataract between the two populations with an adjusted OR 0.83 (95% CI 0.55–1.25), p = 0.36. Mean best visual acuity was 0.59 (SD 0.06) in podoconiosis cases compared to 0.44 (SD 0.04) in controls, p<0.001. The proportion of patients classified as blind was higher in podoconiosis cases compared with healthy controls; 5.6% vs 2.0%; adjusted OR 2.63 (1.08–6.39), P = 0.03.</p></sec><sec id="sec004"><title>Conclusions</title><p>Individuals with podoconiosis have a higher burden of TT and worse visual acuity than their matched healthy neighbourhood controls. Further research into the environmental and biological reasons for this co-morbidity is required. A shared approach to managing these two NTDs within the same population could be beneficial.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Hotez, Pj" uniqKey="Hotez P">PJ Hotez</name></author><author><name sortKey="Molyneux, Dh" uniqKey="Molyneux D">DH Molyneux</name></author><author><name sortKey="Fenwick, A" uniqKey="Fenwick A">A Fenwick</name></author><author><name sortKey="Ottesen, E" uniqKey="Ottesen E">E Ottesen</name></author><author><name sortKey="Sachs, Se" uniqKey="Sachs S">SE Sachs</name></author><author><name sortKey="Sachs, Jd" uniqKey="Sachs J">JD Sachs</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Onapa, Aw" uniqKey="Onapa A">AW Onapa</name></author><author><name sortKey="Simonsen, Pe" uniqKey="Simonsen P">PE Simonsen</name></author><author><name sortKey="Pedersen, Em" uniqKey="Pedersen E">EM Pedersen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruiz, L" uniqKey="Ruiz L">L Ruiz</name></author><author><name sortKey="Campo, E" uniqKey="Campo E">E Campo</name></author><author><name sortKey="Corachan, M" uniqKey="Corachan M">M Corachán</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Price, E W" uniqKey="Price E">E.W. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosntds</journal-id><journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title></journal-title-group><issn pub-type="ppub">1935-2727</issn><issn pub-type="epub">1935-2735</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28187129</article-id><article-id pub-id-type="pmc">5322969</article-id><article-id pub-id-type="doi">10.1371/journal.pntd.0005388</article-id><article-id pub-id-type="publisher-id">PNTD-D-16-01705</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Parasitic Diseases</subject><subj-group><subject>Elephantiasis</subject><subj-group><subject>Podoconiosis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Tropical Diseases</subject><subj-group><subject>Neglected Tropical Diseases</subject><subj-group><subject>Podoconiosis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Ophthalmology</subject><subj-group><subject>Lens Disorders</subject><subj-group><subject>Cataracts</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Tropical Diseases</subject><subj-group><subject>Neglected Tropical Diseases</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Bacterial Diseases</subject><subj-group><subject>Trachoma</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Ophthalmology</subject><subj-group><subject>Eye Diseases</subject><subj-group><subject>Trachoma</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Tropical Diseases</subject><subj-group><subject>Neglected Tropical Diseases</subject><subj-group><subject>Trachoma</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Geographical Locations</subject><subj-group><subject>Africa</subject><subj-group><subject>Ethiopia</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Ocular System</subject><subj-group><subject>Ocular Anatomy</subject><subj-group><subject>Cornea</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Ocular System</subject><subj-group><subject>Ocular Anatomy</subject><subj-group><subject>Cornea</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Surgical and Invasive Medical Procedures</subject><subj-group><subject>Ophthalmic Procedures</subject><subj-group><subject>Cataract Surgery</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Head</subject><subj-group><subject>Eyes</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Head</subject><subj-group><subject>Eyes</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Ocular System</subject><subj-group><subject>Eyes</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Ocular System</subject><subj-group><subject>Eyes</subject></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Podoconiosis, trachomatous trichiasis and cataract in northern Ethiopia: A comparative cross sectional study</article-title><alt-title alt-title-type="running-head">Podoconiosis, trachomatous trichiasis and cataract in northern Ethiopia</alt-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0002-1469-8169</contrib-id><name><surname>Burn</surname><given-names>Helen</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Aweke</surname><given-names>Sintayehu</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Wondie</surname><given-names>Tariku</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Habtamu</surname><given-names>Esmael</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Deribe</surname><given-names>Kebede</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff004"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rajak</surname><given-names>Saul</given-names></name><xref ref-type="aff" rid="aff003"><sup>3</sup></xref><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bremner</surname><given-names>Stephen</given-names></name><xref ref-type="aff" rid="aff006"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Davey</surname><given-names>Gail</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></aff><aff id="aff002"><label>2</label><addr-line>The Carter Center, Addis Ababa, Ethiopia</addr-line></aff><aff id="aff003"><label>3</label><addr-line>International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom</addr-line></aff><aff id="aff004"><label>4</label><addr-line>School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia</addr-line></aff><aff id="aff005"><label>5</label><addr-line>Sussex Eye Hospital, Brighton, Sussex, United Kingdom</addr-line></aff><aff id="aff006"><label>6</label><addr-line>Brighton and Sussex Medical School, Brighton, United Kingdom</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Budke</surname><given-names>Christine M.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Texas A&M University College Station, UNITED STATES</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p><list list-type="simple"><list-item><p><bold>Conceptualization:</bold> HB SR GD EH.</p></list-item><list-item><p><bold>Data curation:</bold> TW SA HB.</p></list-item><list-item><p><bold>Formal analysis:</bold> HB EH SR GD SB KD.</p></list-item><list-item><p><bold>Funding acquisition:</bold> HB GD.</p></list-item><list-item><p><bold>Investigation:</bold> HB TW SA.</p></list-item><list-item><p><bold>Methodology:</bold> HB TW SA EH SR.</p></list-item><list-item><p><bold>Project administration:</bold> GD HB.</p></list-item><list-item><p><bold>Resources:</bold> TW SA EH.</p></list-item><list-item><p><bold>Supervision:</bold> GD.</p></list-item><list-item><p><bold>Validation:</bold> HB TW SA.</p></list-item><list-item><p><bold>Visualization:</bold> HB.</p></list-item><list-item><p><bold>Writing – original draft:</bold> HB.</p></list-item><list-item><p><bold>Writing – review & editing:</bold> KD GD EH SR SB HB.</p></list-item></list></p></fn><corresp id="cor001">* E-mail: <email>hburn88@gmail.com</email></corresp></author-notes><pub-date pub-type="epub"><day>10</day><month>2</month><year>2017</year></pub-date><pub-date pub-type="collection"><month>2</month><year>2017</year></pub-date><volume>11</volume><issue>2</issue><elocation-id>e0005388</elocation-id><history><date date-type="received"><day>20</day><month>9</month><year>2016</year></date><date date-type="accepted"><day>4</day><month>2</month><year>2017</year></date></history><permissions><copyright-statement>© 2017 Burn et al</copyright-statement><copyright-year>2017</copyright-year><copyright-holder>Burn et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pntd.0005388.pdf"></self-uri><abstract><sec id="sec001"><title>Background</title><p>Rural populations in low-income countries commonly suffer from the co-morbidity of neglected tropical diseases (NTDs). Podoconiosis, trachomatous trichiasis (both NTDs) and cataract are common causes of morbidity among subsistence farmers in the highlands of northern Ethiopia. We explored whether podoconiosis was associated with cataract or trachomatous trichiasis (TT) among this population.</p></sec><sec id="sec002"><title>Methods</title><p>A comparative cross-sectional study was conducted in East Gojam region, Amhara, Ethiopia in May 2016. Data were collected from patients previously identified as having podoconiosis and from matched healthy neighbourhood controls. Information on socio-demographic factors, clinical factors and past medical history were collected by an interview-administered questionnaire. Clinical examination involved grading of podoconiosis by examination of both legs, measurement of visual acuity, direct ophthalmoscopy of dilated pupils to grade cataract, and eyelid and corneal examination to grade trachoma. Multiple logistic regression was conducted to estimate independent association and correlates of podoconiosis, TT and cataract.</p></sec><sec id="sec003"><title>Findings</title><p>A total of 700 participants were included in this study; 350 podoconiosis patients and 350 healthy neighbourhood controls. The prevalence of TT was higher among podoconiosis patients than controls (65 (18.6%) vs 43 (12.3%)) with an adjusted odds ratio OR 1.57 (95% CI 1.02–2.40), p = 0.04. There was no significant difference in prevalence of cataract between the two populations with an adjusted OR 0.83 (95% CI 0.55–1.25), p = 0.36. Mean best visual acuity was 0.59 (SD 0.06) in podoconiosis cases compared to 0.44 (SD 0.04) in controls, p<0.001. The proportion of patients classified as blind was higher in podoconiosis cases compared with healthy controls; 5.6% vs 2.0%; adjusted OR 2.63 (1.08–6.39), P = 0.03.</p></sec><sec id="sec004"><title>Conclusions</title><p>Individuals with podoconiosis have a higher burden of TT and worse visual acuity than their matched healthy neighbourhood controls. Further research into the environmental and biological reasons for this co-morbidity is required. A shared approach to managing these two NTDs within the same population could be beneficial.</p></sec></abstract><abstract abstract-type="summary"><title>Author summary</title><p>Podoconiosis is an NTD causing chronic leg swelling in subsistence farming communities in the tropics. There is no research on the association between podoconiosis and two common causes of blindness and visual impairment; trachomatous trichiasis (TT) and cataract. TT is the blinding consequence of conjunctival scarring in trachoma, the leading infectious cause of blindness globally. Cataract is an age-related disease of the lens and remains the leading cause of visual impairment worldwide. Both podoconiosis and TT are NTDs endemic to Ethiopia and promote poverty through many factors such as disability, reduced economic productivity and stigma. This comparative cross-sectional study explored the association between podoconiosis and these two eye diseases. We found that podoconiosis patients were burdened with higher levels of blindness and low vision, had higher prevalence of TT and more severe cataract than their matched neighbourhood controls. These findings can help to direct an integrated approach to managing these two NTDs (podoconiosis and TT) and trigger further research in to the wider context of the double burden of eye disease and NTDs.</p></abstract><funding-group><award-group id="award001"><funding-source><institution>The Association of Physicians</institution></funding-source><award-id>Links with Developing Countries</award-id><principal-award-recipient>Helen Alexandra Burn</principal-award-recipient></award-group><award-group id="award002"><funding-source><institution>Wellcome Trust Intermediate Fellowship in Public Health and Tropical Medicine</institution></funding-source><award-id>201900/Z 16/Z</award-id><principal-award-recipient><name><surname>Deribe</surname><given-names>Kebede</given-names></name></principal-award-recipient></award-group><funding-statement>This work was funded by The Association of Physicians Great Britain and Ireland; Links With Developing Countries Grant, <ext-link ext-link-type="uri" xlink:href="https://theassociationofphysicians.org.uk/index.php/links-with-developing-countries">https://theassociationofphysicians.org.uk/index.php/links-with-developing-countries</ext-link>. KD is funded by Wellcome Trust Intermediate Fellowship in Public Health and Tropical Medicine [grant number 201900/Z 16/Z]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><fig-count count="0"></fig-count><table-count count="5"></table-count><page-count count="14"></page-count></counts><custom-meta-group><custom-meta><meta-name>PLOS Publication Stage</meta-name><meta-value>vor-update-to-uncorrected-proof</meta-value></custom-meta><custom-meta><meta-name>Publication Update</meta-name><meta-value>2017-02-23</meta-value></custom-meta><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>All relevant data are within the Supporting Information files.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>All relevant data are within the Supporting Information files.</p></notes></front></pmc><affiliations><list><country><li>Royaume-Uni</li><li>Éthiopie</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Burn, Helen" sort="Burn, Helen" uniqKey="Burn H" first="Helen" last="Burn">Helen Burn</name></noRegion><name sortKey="Bremner, Stephen" sort="Bremner, Stephen" uniqKey="Bremner S" first="Stephen" last="Bremner">Stephen Bremner</name><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><name sortKey="Deribe, Kebede" sort="Deribe, Kebede" uniqKey="Deribe K" first="Kebede" last="Deribe">Kebede Deribe</name><name sortKey="Habtamu, Esmael" sort="Habtamu, Esmael" uniqKey="Habtamu E" first="Esmael" last="Habtamu">Esmael Habtamu</name><name sortKey="Rajak, Saul" sort="Rajak, Saul" uniqKey="Rajak S" first="Saul" last="Rajak">Saul Rajak</name><name sortKey="Rajak, Saul" sort="Rajak, Saul" uniqKey="Rajak S" first="Saul" last="Rajak">Saul Rajak</name></country><country name="Éthiopie"><noRegion><name sortKey="Aweke, Sintayehu" sort="Aweke, Sintayehu" uniqKey="Aweke S" first="Sintayehu" last="Aweke">Sintayehu Aweke</name></noRegion><name sortKey="Deribe, Kebede" sort="Deribe, Kebede" uniqKey="Deribe K" first="Kebede" last="Deribe">Kebede Deribe</name><name sortKey="Habtamu, Esmael" sort="Habtamu, Esmael" uniqKey="Habtamu E" first="Esmael" last="Habtamu">Esmael Habtamu</name><name sortKey="Wondie, Tariku" sort="Wondie, Tariku" uniqKey="Wondie T" first="Tariku" last="Wondie">Tariku Wondie</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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