Trachoma Prevalence and Associated WASH and Behavioral Risk Among Rural Communities of North Gondar Zone, Ethiopia: A...

Trachoma is a leading infectious cause of preventable blindness and remains a major public health problem in rural Ethiopia, where inadequate water, sanitation, and hygiene (WASH) conditions sustain transmission. This study assessed the prevalence of active trachoma and associated WASH and hygiene-related factors among children aged 1-9 years in rural communities of North Gondar Zone, Ethiopia. A community-based cross-sectional study was conducted among 456 children selected using a multistage sampling technique. Data on sociodemographic characteristics, household WASH conditions, and hygiene practices were collected using structured caregiver interviews and direct observation. Active trachoma was diagnosed using the WHO simplified trachoma grading system (trachomatous inflammation-follicular and/or trachomatous inflammation-intense). Poor face-washing practice was defined as washing the child's face less than twice per day or the presence of ocular or nasal discharge, while good practice was defined as washing the child's face at least twice per day and the absence of ocular or nasal discharge. High fly density was defined as the observation of three or more eye-seeking flies on or around the child's face during household assessment. Binary and multivariable logistic regression analyses were performed, with statistical significance set at p < 0.05. The overall prevalence of active trachoma was 20.6% (95% CI: 16.9%-24.3%). In multivariable analysis, higher odds of active trachoma were observed among children from households using unimproved water sources (AOR = 1.76; 95% CI: 1.01-3.05), households without latrines (AOR = 1.94; 95% CI: 1.15-3.28), children with poor face-washing practices (A O R = 2.63; 95% CI: 1.52-4.55), and children exposed to high fly density (AOR = 2.71; 95% CI: 1.60-4.58). These findings indicate significant associations rather than causal relationships due to the cross-sectional design. The study highlights the continued burden of trachoma in the area and supports strengthening integrated WASH and facial cleanliness interventions under the WHO SAFE strategy.