Impact of trachoma elimination efforts in afar regional state, Ethiopia: survey findings from 26 evaluation units

Background: Following interventions to eliminate trachoma in the Afar region of Ethiopia, our goal was to reassess the prevalence of trachomatous trichiasis (TT) and trachomatous inflammation-follicular (TF) at the woreda level, and to identify factors associated with the disease.

Methods: Cross-sectional community-based surveys were conducted in 26 trachoma-endemic woredas, employing a standardized approach. Households were selected as the secondary sampling unit. Surveys involved interviews with household heads, direct assessment of water, sanitation, and hygiene (WASH) access, and clinical examination of eligible household members for trachomatous trichiasis (TT) and trachomatous inflammation-follicular (TF).

Result: Overall, 18 out of the 26 woredas (69%) achieved the World Health Organization-recommended threshold for active trachoma elimination, with a prevalence of trachomatous inflammation-follicular (TF) below 5% in children aged 1-9 years. Additionally, 14 woredas (54%) met the threshold for trachomatous trichiasis (TT) elimination, with a prevalence of TT cases unknown to the health system below 0.2% in adults aged 15 years and older. However, access to improved drinking water sources within a 30-minute trip was limited to only 17% of households, and merely 9% had access to improved latrines. Addressing these WASH (Water, Sanitation, and Hygiene) challenges remains critical for sustaining progress in trachoma control and achieving long-term public health improvements in the Afar region.

Conclusion: In seven woredas, further rounds of antibiotic mass drug administration are required, complemented by initiatives to promote facial cleanliness and improve environmental conditions. Additionally, surgical campaigns for trachomatous trichiasis (TT) are needed in 12 woredas. There is a critical need to enhance access to improved Water, Sanitation, and Hygiene (WASH) facilities across all surveyed woredas to consolidate gains in trachoma control and achieve sustained public health improvements.