Comparison of Face Washing and Face Wiping Methods for Trachoma Control: A Pilot Study

Czerniewska, Alexandra; Versteeg, Aalbertus; Shafi, Oumer; Dumessa, Gebeyehu; Aga, Muluadam Abraham; Macleod, David; Sarah, Virginia; Dodson, Sarity; Negussu, Nebiyu; Sori, Birhanu Kenate; Kirumba, Michael; Biran, Adam; Cairncross, Sandy; Burton, Matthew J.; Greenland, Katie

doi:10.4269/ajtmh.19-0726

Cited by 9 publications

(10 citation statements)

References 9 publications

(13 reference statements)

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“…By the end of the study, face-washing with soap had become much more common in the intervention clusters than the control clusters, an encouraging sign since soap has been found to play a key role in clearing ocular discharge and ocular chlamydia. 28 Practise of the main hygiene message – face-washing with soap twice a day – was also more common in intervention clusters, although this practice was reported by only 26–43% of participants by month 36. These results, while affirming the challenges inherent in behavioural interventions, nonetheless point to positive changes in face-washing during the study period.…”

Section: Discussionmentioning

confidence: 98%

Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Aragie¹,

Tadesse²,

Dagnew³

et al. 2021

Bull World Health Org

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Section: Discussionmentioning

confidence: 98%

Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Aragie¹,

Tadesse²,

Dagnew³

et al. 2021

Bull World Health Org

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“…The target for facial cleanliness is having a clean face, at any time of day [ 26 , 27 ]. The facial cleanliness indicators used in this study indicate that this was not achieved, and highlight the importance of continued face washing throughout the day.…”

Section: Discussionmentioning

confidence: 99%

“…The facial cleanliness indicators used in this study indicate that this was not achieved, and highlight the importance of continued face washing throughout the day. In a pilot study comparing face washing and wiping methods, Czerniewska et al [ 27 ] observed that the impact of washing with soap was sustained for four hours for ocular discharge, and was limited and not sustained for nasal discharge. Similarly, King et al [ 8 ] observed that by four hours post-face washing, the presence of ocular and nasal discharge was no longer able to predict whether the face had been washed or not.…”

Section: Discussionmentioning

confidence: 99%

“…This could have affected the proportion of children with unclean face indicators, with others reporting higher proportions in children examined in clinics compared with at home [ 9 ]. A more robust methodology would involve measuring facial cleanliness indicators on the same child at different time-points over the course of a day to provide longitudinal data [ 8 , 27 ], but these would need to be coupled with data on face washing practices. Our face washing data were obtained from household head responses to a questionnaire; this is prone to responder bias, likely over-estimating WASH access and use, and perhaps a better reflection of respondents’ awareness of the WASH activities that should be being practised, without this knowledge having been translated into sustained behaviour change [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Facial cleanliness indicators by time of day: results of a cross-sectional trachoma prevalence survey in Senegal

et al. 2020

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Background The World Health Organization-recommended strategy for trachoma elimination as a public health problem is known by the acronym “SAFE”, where “F” stands for facial cleanliness to reduce transmission of ocular Chlamydia trachomatis infection. Accurately and reliably measuring facial cleanliness is problematic. Various indicators for measuring an unclean face exist, however, the accuracy and reliability of these indicators is questionable and their relationship to face washing practices is poorly described. Methods Clean face indicator (ocular or nasal discharge, flies on the face, and dirt on the face), trachoma clinical sign, and ocular C. trachomatis infection data were collected for 1613 children aged 0–9 years in 12 Senegalese villages as part of a cross-sectional trachoma prevalence study. Time of examination was recorded to the nearest half hour. A risk factor questionnaire containing Water, Sanitation and Hygiene (WASH) questions was administered to heads of compounds (households that shared a common doorway) and households (those who shared a common cooking pot). Results WASH access and use were high, with 1457/1613 (90.3%) children living in households with access to a primary water source within 30 min. Despite it being reported that 1610/1613 (99.8%) children had their face washed at awakening, > 75% (37/47) of children had at least one unclean face indicator at the first examination time-slot of the day. The proportion of children with facial cleanliness indicators differed depending on the time the child was examined. Dirt on the face was more common, and ocular discharge less common, in children examined after 11:00 h than in children examined at 10:30 h and 11:00 h. Conclusions Given the high reported WASH access and use, the proportion of children with an unclean face indicator should have been low at the beginning of the day. This was not observed, explained either by: the facial indicators not being reliable measures of face washing; eye discharge, nose discharge or dirt rapidly re-accumulated after face washing in children in this population at the time of fieldwork; and/or responder bias to the risk factor questionnaire. A high proportion of children had unclean face indicators throughout the day, with certain indicators varying by time of day. A reliable, standardised, practical measure of face washing is needed, that reflects hygiene behaviour rather than environmental or cultural factors.

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“…Studies have demonstrated the trachoma-protective effect of keeping children's faces free of ocular and nasal secretions [6][7][8][9][10][11][12][13][14]. Washing faces as often as needed is apparently a crucial way to keep faces clean; current educational programs focus on the importance of face-washing [15][16][17][18][19][20][21]. However, further work to evaluate additional factors that influence facial cleanliness is needed.…”

Section: Introductionmentioning

confidence: 99%

Environmental factors and hygiene behaviors associated with facial cleanliness and trachoma in Kongwa, Tanzania

et al. 2021

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Background Having a clean face is protective against trachoma. In the past, long distances to water were associated with unclean faces and increased trachoma. Other environmental factors have not been extensively explored. We need improved clarity on the environmental factors associated with facial cleanliness and trachoma prevalence, especially when the disease burden is low. Methodology/Principle findings A cross-sectional survey focusing on household environments was conducted in all 92 villages in Kongwa, Tanzania, in a random selection of 1798 households. Children aged 0–5 years in these households were examined for facial cleanliness. In each of the 50 randomly-selected villages, 50 children aged 1–9 years were randomly selected and examined for trachoma. In a multivariate model adjusting for child age, we found that children were more likely to have clean faces if the house had a clean yard (OR 1.62, 95% CI 1.37–1.91), an improved latrine (OR 1.11, 95% CI 1.01–1.22), and greater water storage capacity (OR 1.02, 95% CI 1.00–1.04), and if there were clothes washed and drying around the house (OR 1.30, 95% CI 1.09–1.54). However, measures of crowding, wealth, time spent on obtaining water, or the availability of piped water was not associated with clean faces. Using a cleanliness index (clean yard, improved latrine, washing clothes, ≥1 child in the household having a clean face), the community prevalence of trachoma decreased with an increase in the average value of the index (OR 2.28, 95% CI 1.17–4.80). Conclusions/Significance Access to water is no longer a significant limiting factor in children’s facial cleanliness in Kongwa. Instead, water storage capacity and the way that water is utilized are more important in facial cleanliness. A household cleanliness index with a holistic measure of household environment is associated with reduced community prevalence of trachoma.

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Comparison of Face Washing and Face Wiping Methods for Trachoma Control: A Pilot Study

Cited by 9 publications

References 9 publications

Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Facial cleanliness indicators by time of day: results of a cross-sectional trachoma prevalence survey in Senegal

Environmental factors and hygiene behaviors associated with facial cleanliness and trachoma in Kongwa, Tanzania

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