Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries,PLOS Neglected Tropical Diseases

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Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries
PLOS Neglected Tropical Diseases ( IF 3.4 ) Pub Date : 2018-01-22 , DOI: 10.1371/journal.pntd.0006110
Joshua V Garn ₁ , Sophie Boisson ₂ , Rebecca Willis ₃ , Ana Bakhtiari ₃ , Tawfik Al-Khatib ₄ , Khaled Amer ₅ , Wilfrid Batcho ₆ , Paul Courtright ₇ , Michael Dejene ₈ , Andre Goepogui ₉ , Khumbo Kalua ₁₀ , Biruck Kebede ₁₁ , Colin K Macleod ₁₂ , Kouakou IIunga Marie Madeleine ₁₃ , Mariamo Saide Abdala Mbofana ₁₄ , Caleb Mpyet _{7,

15,

16} , Jean Ndjemba ₁₇ , Nicholas Olobio ₁₈ , Alexandre L Pavluck ₃ , Oliver Sokana ₁₉ , Khamphoua Southisombath ₂₀ , Fasihah Taleo ₂₁ , Anthony W Solomon _{22,

23} , Matthew C Freeman ₁

Affiliation

Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland.
International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, United States of America.
Department of Ophthalmology, Sana'a University, Sana'a, Yemen.
Department of Ophthalmology, Ministry of Health, Cairo, Egypt.
Programme National de Lutte contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Bénin.
Division of Ophthalmology, Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa.
Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia.
Ministère de la Santé, Programme Oncho-Cécité-MTN, Conakry, République de Guinée.
Department of Ophthalmology, Blantyre Institute for Community Ophthalmology, College of Medicine, Blantyre, Malawi, Malawi.
Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.
Sightsavers, Haywards Heath, United Kingdom.
Programme National de la Santé Oculaire et de la Lutte contre l'Onchocercose, Abidjan, Côte-d'Ivoire.
Programa Nacional de Oftalmologia, Maputo, Mocambique.
Department of Ophthalmology, University of Jos, Jos, Nigeria.
Sightsavers, Kaduna, Nigeria.
Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Republique Democratique du Congo.
Department of Public Health, Federal Ministry of Health, Abuja, Nigeria.
Eye Department, Ministry of Health and Medical Services, Honiara, Solomon Islands.
National Ophthalmology Center, Ministry of Health, Vientiane, Lao People's Democratic Republic.
World Health Organization, Port Vila, Vanuatu.
Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.

Background

Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds.

Methods and findings

We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1–9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation—follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83–0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75–0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR_80–90% = 0.87; 95%CI: 0.73–1.02; PR_90–100% = 0.76; 95%CI: 0.67–0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62–0.97)—that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage.

Conclusions

Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem.

中文翻译：

与活动性沙眼相关的卫生和供水覆盖阈值：对 13 个国家的横截面数据进行建模

背景

面部清洁和卫生被认为可以减少沙眼传播，但之前没有关于社区级畜群保护阈值的数据。我们描述了活动性沙眼、获得改善的卫生设施以及为洗脸而获得改善的水源之间的关联，目的是估计社区水平或群体保护阈值。

方法和结果

我们使用了来自 13 个国家 354,990 个家庭的 884,850 名 1-9 岁儿童的整群抽样全球沙眼测绘项目数据。我们采用多变量混合效应修正泊松回归模型来评估水和卫生设施覆盖率与沙眼滤泡性炎症 (TF) 之间的关系。我们观察到，在家庭层面获得改善卫生设施的家庭中，TF 患病率较低（患病率，PR = 0.87；95%CI：0.83–0.91），并且在家庭层面获得改善的住宅/院子洗涤水源（PR = 0.81；95%CI：0.75–0.88）。在控制家庭用水和厕所使用情况的情况下，我们发现了社区一级为生活在卫生设施覆盖率高的社区的儿童提供预防 TF 保护的证据（PR _80–90% = 0.87；95%CI：0.73–1.02；PR _{90–100 %} = 0.76；95%CI：0.67–0.85）。社区卫生覆盖率超过 80% 与针对 TF 的群体保护相关（PR = 0.77；95%CI：0.62–0.97），即家庭缺乏个人卫生设施但居住在卫生覆盖率高的社区的个人的 TF 较低。对于社区级水覆盖率，没有明显的阈值，尽管我们观察到几个较高十分位的社区水覆盖率的 TF 较低。