Trachoma control using water, sanitation, and hygiene
Authors: Hugh R Taylor
Journal: The Lancet Global Health (2022)

It was most interesting to read the Article by Solomon Aragie and colleagues1Aragie S Wittberg DM Tadesse W et al.Water, sanitation, and hygiene for control of trachoma in Ethiopia (WUHA): a two-arm, parallel-group, cluster-randomised trial.Lancet Glob Health. 2022; 10: e87-e95Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar and the accompanying Comment by Robert Ntozini2Ntozini R Trachoma control using water, sanitation, and hygiene.Lancet Glob Health. 2022; 10: e10-e11Summary Full Text Full Text PDF PubMed Google Scholar (January, 2022) on the role of a water, sanitation, and hygiene (WASH) intervention on the possible recrudescence of trachoma after the cessation of mass antibiotic distribution with azithromycin. Of course, a WASH approach should cover the F, facial cleanliness, and the E, environmental improvement, components of the SAFE strategy to eliminate blinding trachoma. The mass antibiotic distribution provides the A component, and trichiasis surgery the S. Aragie and colleagues found that implementing WASH did not change the return of chlamydial infection after stopping mass antibiotic distribution from that seen in control villages. WASH interventions should reduce the frequent transmission of infected ocular secretions and, thus, repeated episodes of reinfection, by keeping children's faces clean. The study unfortunately overlooked, or did not report, the prevalence of facial cleanliness in children in either the study or control villages. Without this information it is not possible to assess whether a WASH intervention might or might not reduce the rate of recrudescence of trachoma. Additionally, a programme addressing the F and E components should be run concurrently with mass antibiotic distribution as part of the full SAFE strategy, and not be kept to the end once mass antibiotic distribution is stopped. The only way to stop trachoma is to stop the frequent episodes of reinfection. I declare no competing interests. Trachoma control using water, sanitation, and hygiene – Authors' replyObservational studies have found an association between trachoma and indicators of water, sanitation, and hygiene (WASH). Clean faces, use of soap, reduced distance to water, and access to a latrine have all been found to be associated with reduced prevalence of trachoma and ocular Chlamydia trachomatis infection.1 These observational studies served as the motivation for the WASH Upgrades for Health in Amhara (WUHA) trial,2 a cluster-randomised trial designed to assess the effect of a comprehensive community-based WASH intervention on ocular chlamydia. Full-Text PDF Open AccessWater, sanitation, and hygiene for control of trachoma in Ethiopia (WUHA): a two-arm, parallel-group, cluster-randomised trialAn integrated WASH intervention addressing the F and E components of the SAFE strategy did not prevent an increase in prevalence of ocular chlamydia following cessation of antibiotics in an area with hyperendemic trachoma. The impact of WASH in the presence of annual mass azithromycin distributions is currently being studied in a follow-up trial of the 40 study clusters. Continued antibiotic distributions will probably be important in areas with persistent trachoma. Full-Text PDF Open AccessTrachoma control using water, sanitation, and hygieneTrachoma remains a neglected tropical disease, causing blindness or visual impairment in 1·9 million people and it is responsible for 1·4% of all blindness, worldwide.1 It affects communities living in poor, rural areas in low-income countries where access to water, sanitation, and hygiene (WASH) is scarce.1–3 Sub-Saharan Africa is the most affected region, where trachoma is hyperendemic in some regions.2,4 The SAFE strategy —which has been mandated by WHO for the elimination of trachoma—outlines measures to manage the disease and has been implemented in trachoma endemic countries since 1998. Full-Text PDF Open Access