Associations between Water, Sanitation and Hygiene (WASH) and trachoma clustering at aggregate spatial scales, Amhara, Ethiopia

Abstract

BackgroundTrachoma is the leading infectious cause of blindness globally. The WHO has recommended the SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvements) strategy to eliminate trachoma as a public health problem. The F and E arms of the strategy will likely be important for sustained disease reductions, yet more evidence is needed detailing relationships between hygiene, sanitation and trachoma in areas with differing endemicity. This study addressed whether the regional differences in water, sanitation, and hygiene (WASH) variables were associated with the spatial distribution of trachomatous inflammation-follicular (TF) among children aged 1 to 9 years in the Amhara National Regional State of Ethiopia.MethodsData from 152 multi-stage cluster random trachoma surveys were used to understand the degree of clustering of trachoma on two spatial scales (district and village) in Amhara using a geographical information system and the Getis-Ord Gi* (d) statistic for local clustering. Trained and certified graders examined children for the clinical signs of trachoma using the WHO simplified system. Socio-demographic, community, and geoclimatic factors thought to promote the clustering of the disease were included as covariates in a logistic regression model.ResultsThe mean district prevalence of TF among children aged 1 to 9 years in Amhara was 25.1% (standard deviation = 16.2%). The spatial distribution of TF was found to exhibit global spatial dependency with neighboring evaluation units at both district and village level. Specific clusters of high TF were identified at both the district and the village scale of analysis using weighted estimates of the prevalence of the disease. Increased prevalence of children without nasal and ocular discharge as well as increased prevalence of households with access to a water source within 30 minutes were statistically significantly negatively associated with clusters of high TF prevalence.ConclusionsWater access and facial cleanliness were important factors in the clustering of trachoma within this hyperendemic region. Intensified promotion of structural and behavioral interventions to increase WASH coverage may be necessary to eliminate trachoma as a public health problem in Amhara and perhaps other hyper-endemic settings.

Twelve-Year Longitudinal Trends in Trachoma Prevalence among Children Aged 1–9 Years in Amhara, Ethiopia, 2007–2019

“…Continued improvements in these indicators are needed, as recent evidence has demonstrated that lack of water access and unclean faces were associated with trachoma hot spots within Amhara. 37 As part of F and E interventions in the region, the program has partnered with educators to improve awareness of trachoma and trachoma preventive strategies as part of a region-wide STP. Trachoma programming in schools has been shown to improve health knowledge and facial cleanliness, although gains would likely be the greatest when programs are undertaken alongside improvements in environmental conditions.…”

Knowledge, Attitudes, and Practices about Trachoma in Rural Communities of Tigray Region, Northern Ethiopia: Implications for Prevention and Control

“…Several factors are associated with increased risk of trachoma. ese include lack of water, poor personal hygiene, and environmental sanitation [6][7][8]. Furthermore, poor knowledge [9,10], and unfavorable sociocultural perceptions and poor practices about prevention of trachoma are the main factors in the transmission and sustaining of the infection of trachoma in the communities [11][12][13][14].…”

Fatores de risco associados a ocorrência de tracoma em comunidade assistida pelo programa "Um estudante uma família" da Universidade Lúrio, Moçambique

“…Os programas de saúde devem incluir os membros da comunidade para melhorar os hábitos de lavagem do rosto das crianças e para conscientizar os pais sobre os perigos das partilhas de utensílios pessoais de higiene do rosto. Além disso, um programa regular de educação em saúde nas escolas primárias precisa ser implementado para prevenir as doenças tropicais negligenciadas (28) . O saneamento precário favorece o habitat para o vetor físico Musca sorbens, sobrecarrega o sistema de saúde e agrava a vida na comunidade.…”