Spatial and network mapping of comorbidity with trachoma and visual-impairing NCDs in a pastoralist community in Kenya: implications for SDGs and UHC

Abstract

Background: We explore the spatial distribution of comorbidity with trachoma and potentially visual-impairing non-communicable diseases (NCDs) and their risk factors among Kenyan pastoralists. Methods: Using a cross-sectional study design, we recruited and clinically examined 262 study participants for NCDs (hypertension or diabetes) and trachoma using the World Health Organization grading system. Net- work models estimated interactions and risks linked with trachoma and NCDs while the Poisson point process determined their spatial distribution. Results: Of the 262 participants, 140 (53%) had trachoma, with > 71% of these cases identified among fe- males and those > 60 y of age. A total of 36 trachoma cases co-occurred with hypertension (26%) and diabetes (0.01%). NCDs were frequent among those with recurring trachoma (21%) and trachomatous trichiasis (14.3%). Trachoma and NCDs clustered together in < 1 km distances (R = 0.18, p = 0.02). In network analysis, age was strongly associated with trachoma and NCDs. Trachoma was linked with geographic location while diabetes was linked with water source distances. Education level became the central risk factor. Conclusions: We demonstrate a twin trachoma-NCD burden that is higher among elderly pastoralists in south- ern Kenya. Attenuating adverse population-level visual impairment, including integrating the trachoma SAFE strategy with NCD comprehensive care, amplifies the benefits from economies of scale, accelerating realization of Sustainable Development Goal 3 and universal health coverage in hard-to-reach areas.