Volume 89, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Latrine use has been promoted as a component of an integrated strategy for trachoma control. As part of a randomized trial in Ethiopia, 12 communities received a mass azithromycin distribution followed by a latrine promotion intervention. A random sample of children ages 0–9 years in each community was monitored longitudinally for ocular chlamydia. After latrine construction ended, those communities with a higher proportion of households using latrines were more likely to experience a reduction in the prevalence of ocular chlamydia. Specifically, for each 10% increase in latrine use, there was a 2.0% decrease (95% confidence interval = 0.2–3.9% decrease) in the community prevalence of ocular chlamydia over the subsequent year ( = 0.04).


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. West S, , 2003. Blinding trachoma: prevention with the SAFE strategy. Am J Trop Med Hyg 69: 1823. [Google Scholar]
  2. Emerson PM, Bailey RL, Mahdi OS, Walraven GE, Lindsay SW, , 2000. Transmission ecology of the fly Musca sorbens, a putative vector of trachoma. Trans R Soc Trop Med Hyg 94: 2832.[Crossref] [Google Scholar]
  3. Emerson P, Lindsay SW, Alexander N, Bah M, Dibba SM, Faal HB, Lowe KO, McAdam KP, Ratcliffe AA, Walraven GE, Bailey RL, , 2004. Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial. Lancet 363: 10931098.[Crossref] [Google Scholar]
  4. Kuper H, Solomon AW, Buchan J, Zondervan M, Foster A, Mabey D, , 2003. A critical review of the SAFE strategy for the prevention of blinding trachoma. Lancet Infect Dis 3: 372381.[Crossref] [Google Scholar]
  5. Ngondi J, Matthews F, Reacher M, Baba S, Brayne C, Emerson P, , 2008. Associations between active trachoma and community intervention with antibiotics, facial cleanliness, and environmental improvement (A, F, E). PLoS Negl Trop Dis 2: e229.[Crossref] [Google Scholar]
  6. Ngondi J, Gebre T, Shargie EB, Adamu L, Ejigsemahu Y, Teferi T, Zerihun M, Ayele B, Cevallos V, King J, Emerson PM, , 2009. Evaluation of three years of the SAFE strategy (surgery, antibiotics, facial cleanliness and environmental improvement) for trachoma control in five districts of Ethiopia hyperendemic for trachoma. Trans R Soc Trop Med Hyg 103: 10011010.[Crossref] [Google Scholar]
  7. Astle WF, Wiafe B, Ingram AD, Mwanga M, Glassco CB, , 2006. Trachoma control in Southern Zambia—an international team project employing the SAFE strategy. Ophthalmic Epidemiol 13: 227236.[Crossref] [Google Scholar]
  8. Stoller NE, Gebre T, Ayele B, Zerihun M, Assefa Y, Habte D, Zhou Z, Porco TC, Keenan JD, House JI, Gaynor BD, Lietman TM, Emerson PM, , 2011. Efficacy of latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass antibiotic treatment: a cluster-randomized trial. Int Health 3: 7584.[Crossref] [Google Scholar]
  9. House JI, Ayele B, Porco TC, Zhou Z, Hong KC, Gebre T, Ray KJ, Keenan JD, Stoller NE, Whitcher JP, Gaynor BD, Emerson PM, Lietman TM, , 2009. Assessment of herd protection against trachoma due to repeated mass antibiotic distributions: a cluster-randomised trial. Lancet 373: 11111118.[Crossref] [Google Scholar]
  10. Gebre T, Ayele B, Zerihun M, Genet A, Stoller NE, Zhou Z, House JI, Yu SN, Ray KJ, Emerson PM, Keenan JD, Porco TC, Lietman TM, Gaynor BD, , 2012. Comparison of annual versus twice-yearly mass azithromycin treatment for hyperendemic trachoma in Ethiopia: a cluster-randomised trial. Lancet 379: 143151.[Crossref] [Google Scholar]
  11. Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR, , 1987. A simple system for the assessment of trachoma and its complications. Bull World Health Organ 65: 477483. [Google Scholar]
  12. Keenan JD, See CW, Moncada J, Ayele B, Gebre T, Stoller NE, McCulloch CE, Porco TC, Gaynor BD, Emerson PM, Schachter J, Lietman TM, , 2012. Diagnostic characteristics of tests for ocular Chlamydia after mass azithromycin distributions. Invest Ophthalmol Vis Sci 53: 235240.[Crossref] [Google Scholar]
  13. Diamant J, Benis R, Schachter J, Moncada J, Pang F, Jha HC, Bhatta RC, Porco T, Lietman T, , 2001. Pooling of Chlamydia laboratory tests to determine the prevalence of ocular Chlamydia trachomatis infection. Ophthalmic Epidemiol 8: 109117.[Crossref] [Google Scholar]
  14. Ngondi J, Gebre T, Shargie EB, Graves PM, Ejigsemahu Y, Teferi T, Genet A, Mosher AW, Endeshaw T, Zerihun M, Messele A, Richards FO, Jr Emerson PM, , 2008. Risk factors for active trachoma in children and trichiasis in adults: a household survey in Amhara Regional State, Ethiopia. Trans R Soc Trop Med Hyg 102: 432438.[Crossref] [Google Scholar]
  15. Ngondi J, Matthews F, Reacher M, Onsarigo A, Matende I, Baba S, Brayne C, Zingeser J, Emerson P, , 2007. Prevalence of risk factors and severity of active trachoma in southern Sudan: an ordinal analysis. Am J Trop Med Hyg 77: 126132. [Google Scholar]
  16. Schémann J, Guinot C, Ilboudo L, Momo G, Ko B, Sanfo O, Ramde B, Ouedraogo A, Malvy D, , 2003. Trachoma, flies and environmental factors in Burkina Faso. Trans R Soc Trop Med Hyg 97: 6368.[Crossref] [Google Scholar]
  17. Taylor HR, West SK, Mmbaga BB, Katala SJ, Turner V, Lynch M, Munoz B, Rapoza PA, , 1989. Hygiene factors and increased risk of trachoma in central Tanzania. Arch Ophthalmol 107: 18211825.[Crossref] [Google Scholar]
  18. Courtright P, Sheppard J, Lane S, Sadek A, Schachter J, Dawson CR, , 1991. Latrine ownership as a protective factor in inflammatory trachoma in Egypt. Br J Ophthalmol 75: 322325.[Crossref] [Google Scholar]
  19. Burton MJ, Holland MJ, Makalo P, Aryee EA, Alexander ND, Sillah A, Faal H, West SK, Foster A, Johnson GJ, Mabey DC, Bailey RL, , 2005. Re-emergence of Chlamydia trachomatis infection after mass antibiotic treatment of a trachoma-endemic Gambian community: a longitudinal study. Lancet 365: 13211328.[Crossref] [Google Scholar]
  20. Rotondo LA, Ngondi J, Rodgers AF, King JD, Kamissoko Y, Amadou A, Jip N, Cromwell EA, Emerson PM, , 2009. Evaluation of community intervention with pit latrines for trachoma control in Ghana, Mali, Niger and Nigeria. Int Health 1: 154162.[Crossref] [Google Scholar]
  21. Keenan JD, Lakew T, Alemayehu W, Melese M, House JI, Acharya NR, Porco TC, Gaynor BD, Lietman TM, , 2011. Slow resolution of clinically active trachoma following successful mass antibiotic treatments. Arch Ophthalmol 129: 512513.[Crossref] [Google Scholar]
  22. Simms VM, Makalo P, Bailey RL, Emerson PM, , 2005. Sustainability and acceptability of latrine provision in The Gambia. Trans R Soc Trop Med Hyg 99: 631637.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 29 May 2013
  • Accepted : 10 Jul 2013
  • Published online : 09 Oct 2013

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error