IMPACT OF FACE-WASHING ON TRACHOMA IN KONGWA, TANZANIA

Observational studies have suggested that the prevalence of trachoma i s lower in children with clean faces than in those with ocular or nasa l discharge or flies on the face. We carried out a community-based ran domised trial in three pairs of villages to assess the impact on trach oma of a face-washing intervention programme following a mass topical antibiotic treatment campaign. Six villages in Kongwa, Tanzania, were randomly assigned mass treatment plus the face-washing programme or tr eatment only. 1417 children aged 1-7 years in these villages were rand omly selected and followed up for trachoma status and observations of facial cleanliness at baseline and 2, 6, and 12 months. At 12 months, children in the intervention villages were 60% more likely to have bad clean faces at two or more follow-up visits than children in the cont rol villages. The odds of having severe trachoma in the intervention v illages were 0.62 (95% CI 0.40-0.97) compared with control villages. A clean face at two or more follow-up visits was protective for any tra choma (odds ratio 0.58 [0.47-0.72]) and severe trachoma (0.35 [0.21-0. 59]). This community-based participatory approach to face-washing inte rvention had variable penetration rates in the villages and was labour intensive. However, we found that, combined with topical treatment, c ommunity-based strategies for improving hygiene in children in trachom a-endemic villages can reduce the prevalence of trachoma.