{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T19:33:34Z","timestamp":1791660814549,"version":"4.3.4"},"reference-count":40,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3_Suppl","license":[{"start":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T00:00:00Z","timestamp":1725321600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Trachomatous scarring has been shown to progress regardless of active ocular <jats:italic>Chlamydia trachomatis<\/jats:italic> infection, indicating that scarring drivers may be unrelated to ongoing transmission. Although scarring prevalence is commonly associated with older age and female sex, less is known about other potential contributors to its development. This study identified and assessed risk factors associated with scarring magnitude in a trachoma-endemic setting, utilizing a five-point photographic scale (S0\u2013S4). During 2017 trachoma surveys of Amhara, Ethiopia, photographers captured left and right conjunctival images of adults (ages 15 years and older) from 10 districts. Subsequently, two graders independently assessed photographs for scarring, with discrepancies adjudicated by an expert grader. Scarring scores for 729 individuals were aggregated from the eye level to the participant level, excluding 17 participants because of poor photograph quality. Among those with scarring, most cases (20.4%) were severe (S4, comprising more than 90% of the tarsal conjunctiva) compared with the prevalence of moderate S3-A\/B (11.2%), S2 (8.3%), and mild S1 (19.2%). The youngest group (ages 15\u201319 years) exhibited all scarring stages. Older participants (60 years and older) experienced a greater burden of severe scarring (S4 prevalence: 32.6%) than their younger (15\u201319 years) counterparts (6.2%). Multivariate ordinal logistic regression models indicated female sex, increasing age, and district-level trachomatous follicular\u2013inflammation prevalence were significant predictors of scarring severity. Trachomatous scarring and its progression to trichiasis, may prove a barrier to meeting WHO timelines for trachoma elimination and will necessitate ongoing surveillance and interventions after elimination thresholds have been met.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0894","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T13:31:58Z","timestamp":1719322318000},"page":"121-126","source":"Crossref","is-referenced-by-count":3,"title":["Severity of Trachomatous Scarring among Adults in Trachoma-Endemic Amhara Region of Ethiopia"],"prefix":"10.4269","volume":"111","author":[{"given":"Jaymie A.","family":"Bromfield","sequence":"first","affiliation":[{"name":"Trachoma Control Program, The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugochi T.","family":"Aguwa","sequence":"additional","affiliation":[{"name":"Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu","family":"Sata","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A.","family":"Jensen","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fetene","family":"Mihretu","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Kelly","family":"Callahan","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila K.","family":"West","sequence":"additional","affiliation":[{"name":"Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meraf A.","family":"Wolle","sequence":"additional","affiliation":[{"name":"Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Nash","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Wkly Epidemiol Rec","first-page":"297","article-title":"Weekly epidemiological record, 2023, vol. 98: 28 [full issue]","volume":"98","year":"2023"},{"key":"b2","series-title":"Invest Ophthalmol Vis Sci","first-page":"592","article-title":"Age, sex, and cohort effects in a longitudinal study of trachomatous scarring","volume":"50","author":"Wolle","year":"2009"},{"key":"b3","series-title":"Ophthalmic Epidemiol","first-page":"137","article-title":"Progression of active trachoma to scarring in a cohort of Tanzanian children","volume":"8","author":"West","year":"2001"},{"key":"b4","series-title":"Ophthalmology","first-page":"243","article-title":"Constant ocular infection with Chlamydia trachomatis predicts risk of scarring in children in Tanzania","volume":"116","author":"Wolle","year":"2009"},{"key":"b5","series-title":"BMC Ophthalmol","first-page":"213","article-title":"The population-based prevalence of trachomatous scarring in a trachoma hyperendemic setting: Results from 152 impact surveys in Amhara, Ethiopia","volume":"21","author":"Astale","year":"2021"},{"key":"b6","series-title":"PLoS Negl Trop Dis","first-page":"e299","article-title":"The burden of trachoma in Ayod County of southern Sudan","volume":"2","author":"King","year":"2008"},{"key":"b7","series-title":"Int J Epidemiol","first-page":"1167","article-title":"Incidence of trichiasis in a cohort of women with and without scarring","volume":"28","author":"Mu\u00f1oz","year":"1999"},{"key":"b8","series-title":"Ophthalmology","first-page":"2219","article-title":"Natural history of trachomatous scarring in the Gambia: Results of a 12-year longitudinal follow-up","volume":"108","author":"Bowman","year":"2001"},{"key":"b9","series-title":"Br J Ophthalmol","first-page":"677","article-title":"Low vision and blindness in adults in Gurage Zone, central Ethiopia","volume":"87","author":"Melese","year":"2003"},{"key":"b10","series-title":"Br J Ophthalmol","first-page":"1406","article-title":"The burden of trachoma in the rural Nile Delta of Egypt: A survey of Menofiya governorate","volume":"85","author":"Ezz al Arab","year":"2001"},{"key":"b11","series-title":"Trop Med Int Health","first-page":"1115","article-title":"Trachoma in Jimma zone, south western Ethiopia","volume":"2","author":"Zerihun","year":"1997"},{"key":"b12","series-title":"Br J Ophthalmol","first-page":"536","article-title":"Trachoma and blindness in the Nile Delta: Current patterns and projections for the future in the rural Egyptian population","volume":"73","author":"Courtright","year":"1989"},{"key":"b13","series-title":"Trans R Soc Trop Med Hyg","first-page":"985","article-title":"The excess burden of trachomatous trichiasis in women: A systematic review and meta-analysis","volume":"103","author":"Cromwell","year":"2009"},{"key":"b14","series-title":"Br J Ophthalmol","first-page":"419","article-title":"Risk factors for incidence of trachomatous scarring in a cohort of women in low endemic district","volume":"102","author":"Karani","year":"2018"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0003763","article-title":"Pathogenesis of progressive scarring trachoma in Ethiopia and Tanzania and its implications for disease control: Two cohort studies","volume":"9","author":"Burton","year":"2015"},{"key":"b16","series-title":"Ophthalmic Epidemiol","first-page":"267","article-title":"The prevalence of trachomatous trichiasis in Oman (Oman Eye Study 2005)","volume":"14","author":"Khandekar","year":"2007"},{"key":"b17","series-title":"PLoS Negl Trop Dis","first-page":"e0008708","article-title":"Incidence and progression of trachomatous scarring in a cohort of children in a formerly hyper-endemic district of Tanzania","volume":"14","author":"Kashaf","year":"2020"},{"key":"b18","series-title":"PLoS Negl Trop Dis","first-page":"e0006085","article-title":"Trachomatous scarring among children in a formerly hyper-endemic district of 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endemic district in Tanzania","volume":"15","author":"Wolle","year":"2021"},{"key":"b23","series-title":"Trans R Soc Trop Med Hyg","first-page":"111","article-title":"Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia","volume":"117","author":"Whitson","year":"2022"},{"key":"b24","series-title":"Am J Trop Med Hyg","first-page":"1278","article-title":"Twelve-year longitudinal trends in trachoma prevalence among children aged 1-9 years in Amhara, Ethiopia, 2007\u20132019","volume":"104","author":"Sata","year":"2021"},{"key":"b25","series-title":"Am J Trop Med Hyg","first-page":"1286","article-title":"Progress to eliminate trachoma as a public health problem in Amhara National Regional State, Ethiopia: Results of 152 population-based surveys","volume":"101","author":"Stewart","year":"2019"},{"key":"b26","series-title":"PLoS One","first-page":"e74570","article-title":"A novel electronic data collection system for large-scale surveys of 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Ophthalmol","first-page":"667","article-title":"A controlled trial of surgery for trachomatous trichiasis of the upper lid","volume":"110","author":"Reacher","year":"1992"},{"key":"b32","series-title":"Br J Ophthalmol","first-page":"1282","article-title":"A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia","volume":"89","author":"Burton","year":"2005"},{"key":"b33","series-title":"Am J Epidemiol","first-page":"366","article-title":"Exposure to children and risk of active trachoma in Tanzanian women","volume":"137","author":"Congdon","year":"1993"},{"key":"b34","series-title":"JAMA Oncol","first-page":"1749","article-title":"Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: A systematic analysis for the Global Burden of Disease Study","volume":"5","year":"2019"},{"key":"b35","series-title":"Epidemiol 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