Sullivan, Kristin M; Harding-Esch, Emma M; Keil, Alexander P; Freeman, Matthew C; Batcho, Wilfrid E; Bio Issifou, Amadou A; Bucumi, Victor; Bella, Assumpta L; Epee, Emilienne; Bobo Barkesa, Segni; +24 more... Seife Gebretsadik, Fikre; Sanha, Salimato; Kalua, Khumbo M; Masika, Michael P; Minnih, Abdallahi O; Abdala, Mariamo; Massangaie, Marília E; Amza, Abdou; Kadri, Boubacar; Nassirou, Beido; Mpyet, Caleb D; Olobio, Nicholas; Badiane, Mouctar D; Elshafie, Balgesa E; Baayenda, Gilbert; Kabona, George E; Kaitaba, Oscar; Simon, Alistidia; Al-Khateeb, Tawfik Q; Mwale, Consity; Bakhtiari, Ana; Westreich, Daniel; Solomon, Anthony W; Gower, Emily W; (2023) Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis. PLOS Neglected Tropical Diseases, 17 (2). e0011103-. ISSN 1935-2727 DOI: https://doi.org/10.1371/journal.pntd.0011103
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Abstract
BACKGROUND: Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. METHODS/FINDINGS: We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. CONCLUSIONS: Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma.
Item Type | Article |
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Faculty and Department | Faculty of Infectious and Tropical Diseases > Dept of Clinical Research |
Research Centre | Centre for Maternal, Reproductive and Child Health (MARCH) |
PubMed ID | 36780437 |
Elements ID | 198795 |
Official URL | http://dx.doi.org/10.1371/journal.pntd.0011103 |
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Filename: Sullivan_etal_2023_Exploring-water-sanitation-and-hygiene.pdf
Licence: Creative Commons: Attribution 4.0
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