Active trachoma and community use of sanitation, Ethiopia.

William E Oswald,Eshetu Sata,Jonathan D King,Christine L Moe,Elizabeth K Callahan,Michael R Kramer,Mulat Zerihun,Birhan Guadie,Paul M Emerson,Tekola Endeshaw,Aisha Ep Stewart,Tesfaye Teferi,Zerihun Tadesse,Demelash Gessese,Dana Flanders,Berhanu Melak,Thomas F Clasen

doi:10.2471/blt.16.177758

Abstract

ObjectiveTo investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1–9 years and community sanitation usage.MethodsBetween 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access.FindingsIn surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28–30) and mean community sanitation usage was 47% (95% CI: 45–48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and ≥ 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57–1.03 and OR: 0.67; 95% CI: 0.48–0.95, respectively).ConclusionIn Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level.

Highlights

It has been estimated that, as a result of trachoma, approximately 1.2 million people are blind and a further 1.7 million have low vision.[1]
Our study shows that increasing the proportion of households in a community with latrines in use may be protective against active trachoma among children aged 1–9 years, independent of whether a child’s household had a latrine in use or better access to water and controlling for potential confounders
There was no clear evidence of multiplicative modification of the effect of community sanitation usage on active trachoma by household latrine use and water access

Summary

Introduction

It has been estimated that, as a result of trachoma, approximately 1.2 million people are blind and a further 1.7 million have low vision.[1] Globally, trachoma remains the leading infectious cause of blindness. In 2009, an estimated 40.6 million people had active trachoma and 8.2 million had trichiasis – i.e. the blinding stage of the disease.[2] About 77% of those living in trachoma-endemic areas of the world are to be found in 29 of the countries in the World Health Organization’s (WHO’s) African Region, and Ethiopia is the country most affected by trachoma worldwide.[3] Trachoma is caused by ocular infection with a bacterium: Chlamydia trachomatis. Inflammation attributable to repeat infections during childhood constitutes the disease’s active stage. Trachoma is predominantly found in resource-poor, rural communities in low-income countries.[4,5] By afflicting some of the most deprived people in the world, it leads to disability, dependency and further poverty.[6]

Methods

Results

Conclusion