Abstract
.Trachoma is the leading infectious cause of blindness, and facial cleanliness is associated with reduced odds of trachomatous inflammation and Chlamydia trachomatis infection, but there is little evidence of how to drive this behavior change at scale. We report the results of a program integrating face washing into a school-based handwashing promotion program in Turkana County, Kenya. Children aged 5–15 years participated in an intervention delivered to schools in two phases, along with a third phase receiving the intervention after the evaluation, which served as a control. The primary outcome was the number of face washing events that took place when handwashing occurred, which was measured by a 3-hour structured observation at all 67 schools, and a total of 3,871 handwashing events were observed. Differences in observed in face washing behavior between each phase and the control schools were calculated using log-binomial regression with clustering at the school level, whereas survey responses on knowledge of trachoma transmission and prevention were compared using χ2 tests adjusted for clustering at the school level. Face washing during handwashing events was higher in schools after 12 months (59.3%) and 20 months (44.2%) than in control schools (18.7%, P < 0.001). Trachoma knowledge was higher in schools evaluated after 12 months (80%) and 20 months (70%) than in control schools (42%, P < 0.001), and knowledge of some of key preventive behaviors was higher in intervention schools. Integrating face washing messages into school-based handwashing promotion programs increased face washing, which may help to prevent trachoma when combined with other interventions.
Highlights
IntroductionBlinding trachoma is a condition of the eye caused by repeated Chlamydia trachomatis infections and is the leading infectious cause of blindness globally.[1]
Trachoma is the leading infectious cause of blindness, and facial cleanliness is associated with reduced odds of trachomatous inflammation and Chlamydia trachomatis infection, but there is little evidence of how to drive this behavior change at scale
Blinding trachoma is a condition of the eye caused by repeated Chlamydia trachomatis infections and is the leading infectious cause of blindness globally.[1]
Summary
Blinding trachoma is a condition of the eye caused by repeated Chlamydia trachomatis infections and is the leading infectious cause of blindness globally.[1]. The WHO called for the elimination of Trachoma as a public health problem through the founding of the Global Alliance for the Elimination of Blinding Trachoma by 2020 (GET2020) strategy in 1993.4 The WHO recommends the “SAFE” strategy for elimination, consisting of surgery, antibiotic treatment, facial cleanliness, and environmental sanitation. Significant progress has been made in reducing the effects of trachoma globally, with the number at risk dropping between 2007 and 2018 from 1.2 billion[5] to 158 million.[6] considerable evidence exists to support the effectiveness of surgery to reverse turned-in eyelashes[7] and mass annual antibiotic treatment,[8] there is less certainty on the impact of environmental sanitation[9] on the proper definition, measurement, or impact of facial cleanliness.[10]
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