Background: Burundi is currently not meeting targets for elimination of trachoma and trichiasis by 2020 (GET2020). The recommended SAFE strategy (Surgery, antibiotics, face washing and environmental improvement) is currently not fully implemented in many areas of Burundi. The existence of associations between face-washing, sanitation and trachoma prevalence remain undocumented. Methods: A convenience sample of 468 individuals from 117 households was drawn from attendees at trachoma clinics set up in four villages. Trachoma status, sex and age were recorded for all household members. Adult household members were surveyed about access to clean water and toilets, and knowledge of trachoma risk factors. Associations between cases of active trachoma per household and environmental risk factors were evaluated using generalised estimating equations. Results: The overall prevalence of active trachoma was 7.1% (95% CI 5.0-9.6%), but 19.5% (95% CI13.7-26.4%) in children under nine years old. 0.9% (95% CI 0.3-2.0) of participants had trichiasis. Access to a sanitary toilet more than halved the odds of active trachoma (OR 0.43, 95% CI 0.25-0.74%), however, participants did not appreciate this association. Conclusion: Access to sanitation was associated with the occurrence of active trachoma. Future research should focus on whether improving knowledge of and access to sanitation might reduce trachoma prevalence. Keywords: Environmental risk factors; trachoma; Gashoho Health District; Burundi.
Trachoma is an infectious disease and it is the leading cause of preventable blindness worldwide. To achieve its elimination, the World Health Organization set a goal of reducing the prevalence in endemic areas to less than $5$ % by 2020, utilizing the SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) strategy. However, in Burundi, trachoma prevalences of greater than $5$ % are still reported in 11 districts and it is hypothesized that this is due to the poor implementation of the environmental improvement factor of the SAFE strategy. In this paper, a model based on an ordinary differential equation, which includes an environmental transmission component, is developed and analysed. The model is calibrated to recent field data and is used to estimate the reductions in trachoma that would have occurred if adequate environmental improvements were implemented in Burundi. Given the assumptions in the model, it is clear that environmental improvement should be considered as a key component of the SAFE strategy and, hence, it is crucial for eliminating trachoma in Burundi.
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