The prevalence and risk factors of active trachoma in Laikipia County, Kenya 2018

Abstract

Background: There are an estimated 1.8 million people infected with Trachoma globally, with most being in Africa due to poor water supply and poor sanitation. In Kenya, there are 7 million people living within endemic regions, and 85,000 people at risk of contracting the disease. World Health Organization (WHO) defines prevalence of active trachoma or trachoma inflammation follicular (TF) as a public health problem when the prevalence is ≥ 5% in children 1-9 years of age and has targeted to eliminate it by 2020 using the SAFE strategy. Following a baseline study conducted in Laikipia in 2007 that identified an overall TF prevalence of 9.5% with some hotspots Sub- location like Ngarendare (70.0%), Mumonyot & Ruguta (46.7%) and Kurikuri (30.0%). The study sought to estimate the prevalence and risk factors associated with Active Trachoma in Laikipia after implementation of the SAFE strategy intervention from 2007. Methods: The study was a cross-sectional community-based study that sort to estimate the prevalence of active trachoma (TF) among children aged 1-9years and the associated risk factors. The participants were randomly selected from 30 households from each of the randomly selected 30 villages within each of the three evaluation units. Using Cochran’s formula and a non-response rate of 10%, we calculated a minimum sample size of 1,000 aged 1-9 years from each evaluation unit. TF was defined as presence of five or more follicles in the upper tarsal conjunctiva and using x2.5 magnifying loupes under ample lighting, eyes were examined for signs of TF. A standardized questionnaire assessing the risk factors was administered to the household head and water and sanitation facilities observation checklist filled. Descriptive statistics analysis was done and bivariate and multivariate analysis undertaken using Odds ratio as measure of association and chi-square for statistical significance. Factors with p value <0.05 were considered statistically significant. Results: A total of three thousand one hundred and ninety-three (3,193) aged 1-9 years were selected to participate in the study. Among all examined participants 1,625 (50.9%) were male. TF prevalence among the examined aged 1-9 years was estimated at 2.5% (n-112[95%CI 0.87- 4.8]) of whom 62 (55.4%) were male. Laikipia North EU accounted for 63(56.3%) of all the participants with TF signs. The TF signs among age 1-9 year were associated with lack of having a defecation amenities (aOR=5.64, 95%CI 3.55 – 8.95%, aOR=5.64, 95%CI 3.55 – 8.95%, P value <0.001), getting drinking water more than one hour away (aOR=3.31, 95% CI 2.27 – 4.83%, P value <0.001). Conclusion: In all evaluation units, TF prevalence were below the WHO elimination threshold as a public health problem. Poor access to clean safe water and defecation amenities were associated with presence of active trachoma. Recommendation: There is need to scale up community sensitization on facial cleaning, use of clean water improved sanitation and hygiene measures at the community level. As well as the county sustaining the gains made through the implementation of SAFE strategy with the hope of elimination of trachoma.