Determinants of Active Trachoma among Children aged 1-9 Years in Ol Donyo Nyokie Location, Kajiado County, Kenya

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).