Abstract:
Trachoma is an eye infection caused by Chlamydia trachomatis, which may result
into eye disease after repeated re-infections. It remains the principal cause of
preventable blindness and the second leading cause of blindness globally. Its
prevalence is disproportionately high in children and women in poor rural
communities. This descriptive cross-sectional study sought to determine the risk
factors associated with active trachoma among children aged 1-9 years. The study
utilized both quantitative and qualitative methods for data collection and was carried
out at Ol Donyo Nyokie, Kajiado County. Sequential sampling procedure was used
to select study participants. A total of 345 guardians together with their children were
sampled. Systematic sampling was used to select 345 households. In households with
more than one child, one among them was selected using simple random sampling.
Physical examination of the children’s eyes was done while their respective
guardians participated in the questionnaire survey. In addition an observation
checklist was used to access the environment and children faces. Two Focus group
discussions were also conducted among guardians of children aged between 1-5
years and another one among guardians of children aged between 6-9 years.
Additionally, one Key Informant interview was conducted among healthcare
providers to confirm and clarify any pending or new issues described in the
structured questionnaires and FGDs. Data was analyzed using SPSS Version 23. The
overall prevalence of active trachoma was found to be 15.7%. Stratified by age and
sex, the younger age group (1-5) years had a 2.13-likelihood of getting active
trachoma (χ2 (1) =5.93, p< 0.017; AOR=2.13 [95%: CI=1.15-3.96] compared to the
children aged 6-9 years. There was however no significant difference in the
prevalence of trachoma between males and females. The findings of this study
indicate that guardians and children in Ol Donyo Nyokie are at considerable risk of
trachoma infection due to the behavioral practices and attitudes. In the final logistic
regression model; the frequency of face washing was (P<0.001), child’s dirty face
(P<0.005), time taken to a water source >30 mins (P<0.006), guardian’s level of
education (P<0.017), age of child (P<0.021), monthly income (P<0.029), lack of a pit
latrine (P<0.039), open defecation (P<0.054) and lack of a pit latrine utilization
(P<0.055) were identified as predictors of active trachoma. In the Focus Group
Discussion, about three quarters (74%) of the guardians were aware of trachoma.
Majority of guardians (89%) indicated that water was a major challenge in the area
without which trachoma could not be eliminated. A significantly high percentage
(85%) of respondents had to walk for longer distances in order to access water.
Majority of households (77%) lacked pit latrines; utilization was poor for the
households that had latrines. From the Key Informant Interview most of the
healthcare providers confirmed that water, lack of formal education and poverty were
the major problems facing the community in the study area. Results therefore
indicated that active trachoma is still a major public health concern in the study area.
Health education and promotion activities for awareness creation with an aim of
changing cultural perceptions and practices that contribute to trachoma transmission
need to be emphasized. The community also needs to be encouraged to build and
utilize latrines for human waste disposal and the County Government of Kajiado
should consider drilling water points to promote proper hygiene practices that will
help control trachoma transmission and bring down the prevalence levels below the
WHO threshold of (<10 % prevalence).