Volume 102, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Eye-to-eye transmission of , the causative agent of trachoma, may be plausibly interrupted if faces are kept free of ocular and nasal discharge. Between April and June 2018, 83 children aged 1–9 years with active trachoma were recruited from 62 households and allocated to a face cleaning protocol: face washing with water, face washing with water and soap, or face wiping. Faces were examined for the presence of ocular and nasal discharge, and swabs were taken from faces and hands to test for at baseline, immediately post protocol, and after 1, 2, and 4 hours (washing protocols). Washing with soap was more effective at removing ocular discharge than either washing with water (89% and 27% of discharge removed, respectively, = 0.003) or wiping with a hand (42%, = 0.013). The reduction in prevalence of ocular discharge was sustained for at least four hours. The prevalence of on face swabs was reduced by all washing protocols. The importance of soap should not be overlooked during facial cleanliness promotion.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Taylor HR, Burton MJ, Haddad D, West S, Wright H, 2014. Trachoma Lancet 384: 21422152.
    [Google Scholar]
  2. Gower EW et al., 2006. Chlamydial positivity of nasal discharge at baseline is associated with ocular chlamydial positivity 2 months following azithromycin treatment. Invest Ophthalmol Vis Sci 47: 47674771.
    [Google Scholar]
  3. Stocks ME, Ogden S, Haddad D, Addiss DG, McGuire C, Freeman MC, 2014. Effect of water, sanitation, and hygiene on the prevention of trachoma: a systematic review and meta-analysis. PLoS Med 11: e1001605.
    [Google Scholar]
  4. Ejere HO, Alhassan MB, Rabiu M, 2015. Face washing promotion for preventing active trachoma. Cochrane Database Syst Rev 2: CD003659.
    [Google Scholar]
  5. WHO, 2004. WHO simplified trachoma grading system. Community Eye Health 17: 68.
    [Google Scholar]
  6. Last A et al., 2019. Detecting extra-ocular Chlamydia trachomatis in a trachoma-endemic community in Ethiopia: identifying potential routes of transmission. Under Review at PLoS Neglected Tropical Diseases.
  7. West SK, Ansah D, Munoz B, Funga N, Mkocha H, 2017. The “F” in SAFE: reliability of assessing clean faces for trachoma control in the field. PLoS Negl Trop Dis 11: e0006019.
    [Google Scholar]
  8. Butcher R, Houghton J, Derrick T, Ramadhani A, Herrera B, Last AR, Massae PA, Burton MJ, Holland MJ, Roberts Ch, 2017. Reduced-cost Chlamydia trachomatis-specific multiplex real-time PCR diagnostic assay evaluated for ocular swabs and use by trachoma research programmes. J Microbiol Methods 139: 95102.
    [Google Scholar]
  9. King JD, Ngondi J, Kasten J, Diallo MO, Zhu H, Cromwell EA, Emerson PM, 2011. Randomised trial of face-washing to develop a standard definition of a clean face for monitoring trachoma control programmes. Trans R Soc Trop Med Hyg 105: 716.
    [Google Scholar]
  10. Ramadhani AM, Derrick T, Macleod D, Holland MJ, Burton MJ, 2016. The relationship between active trachoma and ocular Chlamydia trachomatis infection before and after mass antibiotic treatment. PLOS Negl Trop Dis 10: e0005080.
    [Google Scholar]

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  • Received : 01 Oct 2019
  • Accepted : 26 Nov 2019
  • Published online : 10 Feb 2020
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