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Xinyi Chen, Beatriz Munoz, Meraf Wolle, Harran Mkocha, Sheila K West; Trachoma and facial cleanliness are associated with environmental factors and hygiene behaviors in Tanzania. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2624.
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Facial cleanliness and environmental improvement are parts of the SAFE strategy to eliminate trachoma, but the impact of environmental factors on children’s facial cleanliness and trachoma have not been extensively explored, especially when disease burden is low. We performed a cross-sectional clinical study to identify environmental factors affecting children’s facial cleanliness and trachoma in Kongwa, Tanzania, where the overall prevalence of trachoma was 7% but varied between villages.
A standardized survey was carried out to observe characteristics of household environment and hygiene behaviors in a random selection of 1,798 households in 92 villages. Children aged 0-5 in these households were examined for facial cleanliness. In 50 randomly-selected villages, children aged 1-9 were randomly selected and examined for trachoma.
Time spent on obtaining water was generally short and not correlated with clean faces. In a multivariate model adjusting for child age and household wealth, children were more likely to have clean faces if the yard was clean, if the household had an improved latrine, if the household had greater water storage capacity, and if there were clothes drying around the house. Based on our findings, we constructed a cleanliness index which was a summary score of the following markers: clean yard, washing clothes, improved latrine, ≥ 1 child in the household having clean faces. When the community prevalence of trachoma was <5%, more than 50% of household in the community had a score of 2 or higher. If the trachoma prevalence was more than 10%, less than 50% of households had a score of 2 or higher. An ordinal logistic regression predicting category of trachoma prevalence (0-5%, 5-9.9%, ≥10%) found that a 0.5 unit increase in the community average clean index score was associated with a 2.3 increase in the odds of dropping trachoma prevalence by one category.
A household cleanliness index that increases with increasing number of cleanliness factors was significantly correlated with decreased community prevalence of trachoma, suggesting that a multi-pronged approach to improve household cleanliness is valuable for trachoma elimination.
This is a 2021 ARVO Annual Meeting abstract.
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