Household, community and district clustering of trachoma, and the protective effects of latrines in 11 health districts in Guinea Pubblico
Bressler, Jonathan (2015)
Abstract
Background: Trachoma--a disease caused by an entirely preventable bacterial infection--has made 1.2 million people alive today irreversibly blind. An international coalition of partners has taken on the goal of eliminating preventable blindness due to trachoma from the world by 2020. For the past fifteen years, the World Health Organization (WHO) has recommended the SAFE strategy to achieve this ambitious goal. Progress in sanitation under the "environmental change" element of this strategy has been slow, and the role that household waste facilities play in preventing this disease is unclear. During baseline mapping of trachoma in 11 health districts in Guinea in 2012 and 2013, concurrent household surveys were conducted to assess water and sanitation factors in all households surveyed for trachoma. We conducted a robust secondary analysis of these data in an effort to quantify on a large scale the impact that latrines have on trachoma.
Methods: Using mixed-effects logistic and linear models, we assessed the impact of latrine use and latrine cleanliness on active trachoma in 1-9 year old children, and the impact of community-wide latrine coverage on trachoma prevalence.
Principal Findings: 4,767 households with 22,954 children between 1 and 9 years of age were surveyed in all 11 health districts. After adjusting for clustering and other factors, we found that children in households with clean, well-maintained latrines were almost two-thirds as likely to have TF or TI as children without latrines or with poorly maintained latrines (POR 0.69, 95%CI 0.60 - 0.80). However, children in households that merely used latrines, regardless of latrine cleanliness, did not show a statistically significant difference in TF or TI from those in households with no latrine. Furthermore, community-wide increases in both latrine use and latrine cleanliness were significantly associated with community TF/TI prevalence below 5%, indicating that latrines are highly associated with maintaining trachoma burden below potentially blinding levels.
Conclusion: Latrine cleanliness is extremely important to reduction of the burden of trachoma, and merely owning and using a latrine is not necessarily protective. High latrine coverage will be necessary to bringing trachoma prevalence below blinding levels, and keeping it low post-elimination.
Table of Contents
Introduction…………………………………………………………….1
Methods……………………………………………………………….…4
Results……………………………………………………………….….10
Discussion……………………………………………………………...15
References……………………………………………………………...22
Tables………………………………………………………..…………..26
Appendix A………….…………………………………….……………30
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