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Year : 2013  |  Volume : 2  |  Issue : 3  |  Page : 202-206

Risk factors for active trachoma among children aged 1-9 years in Maksegnit town, Gondar Zuria District, Northwest Ethiopia

1 Department of Optometric, College of Medicine and Health Sciences, University of Gonder, Gondar, Ethiopia
2 Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia

Date of Web Publication14-Feb-2014

Correspondence Address:
Haimanot Gebrehiwot Moges
Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2278-0521.127069

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Background: Trachoma is a leading preventable infectious eye disease caused by repeated infection with eye strains of the bacteria Chlamydia trachomatis. Developing countries that have poor environmental sanitation, inadequate water supply, and poor socioeconomic status are highly exposed with the disease. Aims of the study: The aim of the research was to assess the risk factors of active trachoma among children 1-9 years old in Maksegnit town. Settings and Design: Cross-sectional community based study was conducted in April 2012; in Maksegnit town located at Gondar Zuria District, North Gondar, northwest Ethiopia. Materials and Methods: A total of 420 children (age 1-9-years-old) from 420 households were included in the study. All children were examined for trachoma by optometrists and ophthalmic officers using the World Health Organization (WHO) simplified clinical grading system. Interviews and observations were used to assess risk factors. Descriptive statistics was carried out for variables in the study and odds ratio (OR) with 95% confidence interval (CI) were used to assess the association between the potential risk factors and active trachoma. Result: The prevalence of active trachoma was found to be 100 (23.8 %). Unclean face (adjusted odds ratio (AOR) = 4.12; 95% CI = 1.92-8.81), flies on face (AOR = 2.310; 95% CI = 1.32-4.05), and using wood and animal dung as a source of energy for cooking (AOR = 2.190; 95% CI = 1.152-4.163) were independent predictors of active trachoma. Conclusion: Trachoma is still a major public health problem in the study area. Trachoma prevention programs that include smoke-free household energy, fly control, sanitation, and hygiene are recommended to lower the burden of trachoma in Maksegnit town.

Keywords: Active trachoma, children, Maksegnit, prevalence, risk factor

How to cite this article:
Shiferaw D, Moges HG. Risk factors for active trachoma among children aged 1-9 years in Maksegnit town, Gondar Zuria District, Northwest Ethiopia. Saudi J Health Sci 2013;2:202-6

How to cite this URL:
Shiferaw D, Moges HG. Risk factors for active trachoma among children aged 1-9 years in Maksegnit town, Gondar Zuria District, Northwest Ethiopia. Saudi J Health Sci [serial online] 2013 [cited 2021 Dec 8];2:202-6. Available from: https://www.saudijhealthsci.org/text.asp?2013/2/3/202/127069

  Introduction Top

Trachoma is the commonest infectious cause of blindness. Recurrent episodes of infection with serovars A-C of Chlamydia trachomatis cause conjunctival inflammation in children who go on to develop scarring and blindness as adults. [1] Trachoma is an ancient disease and has previously been a significant public health problem in many areas of the world including parts of Europe and North America. Today, however, trachoma is largely found in poor, rural communities in low-income countries, particularly in sub-Saharan Africa in which 150 million people have active infection, over 5 million are blind or have serious visual loss from trachoma and 100 million children are thought to be in need of treatment. [2],[3]

The World Health Organization (WHO) endorses a four-pronged approach to eliminate blinding trachoma by the year 2020 known as SAFE: Surgery for trichiasis, Antibiotic against infection, Facial cleanliness, and Environmental sanitation.- Surgery is the most direct and efficient way to prevent blindness from trachoma. As confirmed by several trails use of antibiotic azithromycin treatment is at least as good as, if not better than, topical tetracycline for the clinical and microbiological cures of active trachoma. There are considerable evidences that persons with clean faces are less likely than others to have active trachoma. Much circumstantial evidence also suggests that environmental improvement reduces the incidence of trachoma. The SAFE strategies have been associated with significant reductions in the prevalence of active disease over the past 20 years, but there remain a large number of people with trichiasis who are at risk of blindness resulting from recurrent childhood infection. [4]

The risk factors for trachoma vary between settings depending on individual and environmental factors as well as climatic conditions which may be important determinants of trachoma transmission. The individual factors include, age, sex, educational level, lifestyle habits such as poor personal hygiene (face washing) cleanliness, poor sanitation, socioeconomic status, household crowding, having cattle, and environmental risk factors include exposure to flies, limited access to clean water, fly density, waste disposal system, presence of garbage with the environment, availability of latrine, and latrines near living quarters. Understanding risk factors is essential in designing appropriate interventions for the 'F' and 'E' components of the SAFE strategy. [5],[6],[7],[8],[9],[10],[11],[12],[13],[14]

This study focused to provide further information on risk factors of active trachoma which remains a big public health problem regardless of the efforts undertaken in the study area.

  Materials and Methods Top

A community based cross-sectional study design was implemented to determine the prevalence and risk factors of active trachoma in Maksegnit town, located 40 km to south of Gondar town, it is one of the towns found in Gondar Zuria district clustered into seven ketenas. There were 11,444 people, of whom 5,544 were males and 5,900 females within 3,580 houses. [15] Of the total population 3,305 were children aged 1-9-years-old. There are one health center, one vocational training center, one preparatory school, one high school, one primary school, and one kindergarten school in the town.

Children whose age was between 1 and 9 years were the source population among them children lived from randomly selected houses were the study population. Children who were unable to undergo physical examination for trachoma evaluation due to serious sickness during the study period were excluded in the study. The sample size was determined by using the single population proportion formula taking the level of significance (α) = 5% (with confidence level of 95%), Marginal error (w) = 5%, P = 0.539 (prevalence of active trachoma among children aged 1-9-years-old in Ankober). [14] A Z-value of 1.96 was used at 95% confidence interval (CI) and w of 5% (where n = sample size, P = proportion, w = marginal error). Design effect of 1 was used as the household in the town are more or less similar in many characteristics such as household income, hygienic condition, access to safe and adequate water, and knowledge of disease associated with unhygienic conditions that showed no clustering in the study area.

After adding 10% for non-response/participation rate, the final sample size was 421 children.

Households were selected using systematic random sampling technique (k = 8, where k was calculated by dividing the source population (3,305-children aged 1-9 years in Maksegnit town) by the calculated sample size (421) which is 3305/421 = 8; and a lottery method was used to select a child in houses which had more than one children aged 1-9-years-old. If there was no child/children in the selected house a child in the next house was selected.

Active trachoma was the dependent variable of the study and it was operationally defined as "the presence of at least five or more follicles in the upper tarsal conjunctiva and/or pronounced inflammatory thickening of the tarsal conjunctiva that obscures more than half of the normal deep tarsal vessels". [3]

The independent variables included in the study were household income, educational level of mother, educational level of father, sex of child, age of child, cattle ownership. Personal variables such as: Face washing habit, frequency of washing, use of soap to wash face, and facial cleanness were considered in the study. In addition; environmental variables: Water availability, latrine availability, number of fly, waste disposal site, household crowding, distance to water source, and amount of water fetched per day were considered in the study. For a possible observation and data collection the following terms are operationally defined as follows:

Unclean face: If nasal and/or ocular discharge presented prior to screening for signs of active trachoma after brief inspection of child face. [4]

Number of flies: Presence of flies on children's faces and around the doorways for about half a minute during the examination time which was graded as none (0 flies), few (1-4 flies), or many (≥5 flies). [1] Flies on the face: Was coded 'yes' if a fly landed anywhere on the child's face within half minute during the examination for active trachoma. [16]

The study period was from March to April 2012. Before conducting the study, ethical clearance was obtained from the Institutional Ethical Review Board of Institute of Public Health, University of Gondar and supporting letters were obtained from the administrator of Maksegnit town. Though people were not either exposed to unnecessary risk or inflict harm; an oral consent of each participant was taken after explaining the purpose of the study. Consent from children was also obtained before evaluation for active trachoma.

Data was collected with a pretested structured questionnaire prepared using and depending on literature review and identified variables. Data clean-up and cross-checking was done and entered using software's EPI INFO 2002 and exported to Statistical Package for Social Sciences (SPSS) version 16 for analysis. The descriptive statistic and logistic regression were carried out to compute the different proportion and relevant associations.

  Results Top

A total of 420 children whose age was 1-9 years from 420 households were included in the study. The overall participation rate was 99.8%. One child, whose families were unwilling for trachoma evaluation, was not included. Two hundred and nine (49.8%) of the children were male and two hundred and eleven (50.2%) were female.

The prevalence of active trachoma among children aged 1-9 years in the study area was found to be 23.8%.

In this study the factors associated with active trachoma were: Fly density, flies on face, age of child, facial cleanness, time spent to fetch water, distance of water from home, and the type of energy source for fire fuel.

The bivariate logistic regression analysis showed that the risk of active trachoma was more than three and half times in children from household with fly density of greater or equal to five than those in house with no fly (odds ratio (OR) =3.588; 95% CI =1.209-10.469, P < 0.05).

Children with unclean faces were over six times more likely to have active trachoma than children with clean faces (OR =6.776; 95% CI =3.714-12.280, P < 0.0001) [Table 1].
Table 1: Shows bivariate and multivariate logistic regression on factors associated with active trachoma in Maksegnit town, April 2012

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The multivariate analysis showed that children with flies on their face were over two times more likely to have active trachoma than those children without flies on their face (adjusted odds ratio (AOR) =2.310; CI =1.32-4.05, P < 0.05). It was also observed that children with unclean faces were four times more likely to have active trachoma than children with clean faces (AOR =4.12; CI =1.92-8.81, P < 0.0001) and children from household using animal dung and wood as energy source of cooking were two times more likely to have active trachoma than those children from households using wood as a source of energy (AOR =2.190; CI =1.152-4.163, P < 0.05) [Table 1].

  Discussion Top

The study showed that trachoma affected a large segment of the children population in Maksegnit town. It was much more in magnitude than findings of earlier studies carried out in 2005 in Brazil, Guatemala, and Mexico where the prevalence of the inflammatory and follicular phase of the disease in children under 10-years-old was 4.5, 1.9, and 1.9%, respectively. [17] This difference may be due to the changes in the epidemiology of trachoma [1] due to the different efforts done to control it [18] and it might also be due to genetic difference for trachoma susceptibility. [19] This result, however, was less in magnitude than other studies done in African countries like studies carried out in Nigeria (in 2009; n = 639, 35.7%), Niger (in 2007; n = 651, 43%; aged 1-5 years), and Sudan (in 2007; n = 7,418, 64.5%). [5],[16],[19],[20],[21],[22] The difference in prevalence between this study and the results of these studies done may be explained by the difference in setting. This study also showed a less prevalence of active trachoma than other studies done in Amhara and Tigray regions of Ethiopia. [5],[6] This reduction in magnitude of active trachoma in the study area may be due to the mass azithromycin distribution that is carried out yearly in a 2 week campaign against trachoma in the study area.

This study showed flies on face was a significant risk factor for active trachoma in which children with flies on their face are more than twice to have active trachoma than those children whose face is without fly (AOR =2.310; CI =1.32-4.05, P < 0.05). Similar result was also obtained in studies carried out in Nigeria (2009) where a child with flies on face was four times more likely to have active trachoma than those children without flies.

The risk factor of flies on face for active trachoma was also reported from studies in Tanzania (2006) and Gambia (2010), Sudan and in Amhara region of Ethiopia in 2007. [10],[13],[16],[22] This result was also consistent with a study done by Golovaty et al., in Ankober, Ethiopia in 2009. [14] Where the risk of active trachoma in children with flies on their face was four time than those children without flies on their face which is twice more than the result in this study.

This result is in line with the general truth that flies are the vectors that transmit the infectious agent from person to person. [1]

The study also showed that using animal dung and wood as fire fuel increases the risk of active trachoma in children aged 1-9 years by more than two than those who uses wood as an energy source (AOR =2.190; CI =1.152,4.163, P < 0.05). This result was also reported in a study done in Tigray region. [22] The association of active trachoma with animal dung and wood as a risk factor is probably due to the indirect effect of the smoke which resulted from the use of animal dung and wood as fire fuel. This is probably because the smoke from the wood and animal dung facilitates the occurrence of tearing and discharges from children's eyes (as they are likely to be with their mother when food is cooked) which attracts flies to their faces. This will facilitate the transmission of the causative agent from flies to children's' eyes. [6],[11],[14]

The above risk factors for active trachoma mentioned are much related to poor livelihood of Maksegnit Town dwellers. It is known that trachoma is an endemic among poor communities characterized by low access to adequate water and sanitation services, overcrowded living conditions, and limited access to healthcare services. [23]

The long run implication of the study, high prevalence of active trachoma among children, indicated the future young population in Maksegnit Town will be predominantly exposed to blindness unless immediate measures and strategies are implemented to mitigate the problem. Further connotation of the study indicate that negligence of the problem will exacerbate poverty by limiting children for accessing education and prevent young individuals from being able to work [23] or care for themselves or their families.

The SAFE strategy should be implemented further in the study area by giving a focus on the risk factors studied. The SAFE strategies are mainly connected to economic welfare of the society; [24] the more economic development a society showed there appear welfare throughout the community. More specifically the economic development will enhance accessibility of adequate water and sanitation services, better infrastructural, and living conditions including usage of clean energy and educational opportunities. Hence, to reduce and further eliminate trachoma from a community of poor environmental settings, a much coordinated work on implementing the SAFE strategy in particular and enhancing the overall living conditions of the community will be crucial.

  Conclusion Top

The prevalence of active trachoma was high in the study area which indicates that active trachoma is still a major public health concern among children aged 1-9 years in the study area. Source of energy for cooking food, number of flies, and unclean face were factors associated with active trachoma.

All the stakeholders in the study area should work on trachoma prevention by designing and implementing community-based health prevention taking an emphasis on personal hygiene, improving source of energy for households, environmental sanitation, and hygiene for avoiding density of flies.

  Acknowledgment Top

This study was financially supported by the University of Gondar and ORBIS International Ethiopia.

  References Top

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