Facial cleanliness, environmental factors and the burden of trachoma in a pastoral conflict area of Tiaty East Baringo County, Kenya

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Abstract Trachoma remains the leading infectious cause of preventable blindness globally, disproportionately affecting marginalized and impoverished communities. Despite global and national efforts guided by the World Health Organization’s (WHO) SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement), the latter two components remain under-implemented. In Kenya, trachoma remains endemic in 13 of 47 counties, including Baringo. A cross-sectional study was conducted in Tiaty East Sub-County, a trachoma Sub-Evaluation Unit in Baringo, to determine the burden of trachoma and assess facial cleanliness and environmental conditions. Using a structured questionnaire and observation checklist, data were collected from 178 randomly selected households. A total of 279 children aged 1–9 years were examined for trachomatous inflammation–follicular (TF). The overall TF prevalence was 5.02%, slightly above the WHO elimination threshold of <5%. Facial cleanliness was sub-optimal with 91.8% of children having visibly unclean faces. Latrine coverage was low (21.3%), and 99.1% of those without latrines practiced open defecation. Most households (61.8%) sourced water from a dam, with 80.9% requiring more than 30 minutes to fetch water. Handwashing stations were absent in 94% of households. Multivariable analysis revealed caregiver age and awareness of poor hygiene as a risk factor for trachoma and were also significantly associated with TF. The persistence of TF and poor F&E indicators highlight critical gaps in trachoma control in the Sub-Evaluation Unit. Strengthening implementation of the F&E components of the SAFE strategy is essential to achieving trachoma elimination in this setting. Author summary Trachoma is an eye disease that can cause blindness if not controlled. Kenya has made great progress towards eliminating trachoma by 2027, but challenges remain in pastoralist communities. Because these communities are often on the move, it is difficult to provide consistent health services and to improve water, sanitation, and hygiene. Facial cleanliness and environmental hygiene improvement are especially important for stopping the spread of infection and should be part of the larger intervention to eliminate trachoma. In our study, we found that some areas still have signs of infection and gaps in hygiene and environmental improvements. Addressing these gaps is essential if Kenya is to meet the World Health Organization’s target for trachoma elimination and restore dignity to the community by breaking the disease transmission.

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