• 1.

    Montgomery MA, Elimelech M, 2007. Water and sanitation in developing countries: including health in the equation. Environ Sci Technol 41: 1624.

    • Search Google Scholar
    • Export Citation
  • 2.

    Resnikoff S, Pascolini D, Etya'ale D, Kocur L, Pararajasegaram R, Pokharel GP, Mariotti SP, 2004. Global data on visual impairment in the year 2002. Bull World Health Organ 82: 844851.

    • Search Google Scholar
    • Export Citation
  • 3.

    Wright HR, Turner A, Taylor HR, 2007. Trachoma. Lancet 371: 19451954.

  • 4.

    Miller K, Pakpour N, Yi E, Melese M, Alemayehu W, Bird M, Schmidt G, Cevallos V, Olinger L, Chidambaram J, Gaynor B, Whitcher J, Lietman T, 2004. Pesky trachoma suspect finally caught. Br J Ophthalmol 88: 750751.

    • Search Google Scholar
    • Export Citation
  • 5.

    Emerson PM, Bailey RL, Walraven GEL, Lindsay SW, 2001. Human and other faeces as breeding media of the trachoma vector Musca sorbens. Med Vet Entomol 15: 314320.

    • Search Google Scholar
    • Export Citation
  • 6.

    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.

    • Search Google Scholar
    • Export Citation
  • 7.

    Cumberland P, Hailu G, Todd J, 2005. Active trachoma in children aged three to nine years in rural communities in Ethiopia: prevalence, indicators and risk factors. Trans R Soc Trop Med Hyg 99: 120127.

    • Search Google Scholar
    • Export Citation
  • 8.

    WHO/UNICEF, 2008. Progress on Drinking-water and Sanitation: special focus on sanitation. New York: UNICEF, Geneva: WHO, World Health Organization, United Nations Children Fund, 158.

    • Search Google Scholar
    • Export Citation
  • 9.

    Polack S, Brooker S, Kuper H, Mariotti S, Mabey D, Foster A, 2005. Mapping the global distribution of trachoma. Bull World Health Organ 83: 913919.

  • 10.

    Zack R, Mkocha H, Zack E, Munoz B, West SK, 2008. Issues in defining and measuring facial cleanliness for national trachoma control programs. Trans R Soc Trop Med Hyg 102: 426431.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 12.

    Montgomery MA, Desai MM, Menachem M, 2009. Assessment of latrine use and quality and association with risk of trachoma in rural Tanzania. Trans R Soc Trop Med Hyg. doi:10.1016/j.trstmh.2009.10.009.

    • Search Google Scholar
    • Export Citation
  • 13.

    McClave JT, Dietrich F, Sincich T, 1997. Statistics. Englewood, NJ: Prentice Hall, Inc.

  • 14.

    Budds J, Obika A, Howard G, Jenkins M, Curtis V, 2002. Social Marketing of Urban Sanitation. Water E and Development Centre, eds. Loughborough, UK.

  • 15.

    Dondo S, Scott R, 2006. Rural Sanitation in Southern Africa: A Focus on Institutions and Actors. New York: UNDP Human Development Report 2006.

    • Search Google Scholar
    • Export Citation
  • 16.

    Harding-Esch EM, Edwards T, Sillah A, Sarr-Sissoho I, Aryee EA, Snell P, Holland MJ, Mabey DCW, Bailey RL, 2008. Risk factors for active trachoma in The Gambia. Trans R Soc Trop Med Hyg 102: 12551262.

    • Search Google Scholar
    • Export Citation
  • 17.

    Montgomery MA, Bartram J, Elimelech M, 2009. Increasing functional sustainability of water and sanitation supplies in rural sub-Saharan Africa. Environ Eng Sci 26: 10171023.

    • Search Google Scholar
    • Export Citation

 

 

 

 

Comparing the Effectiveness of Shared versus Private Latrines in Preventing Trachoma in Rural Tanzania

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  • 1 Civil and Environmental Engineering, Stanford University, Stanford, California; School of Public Health, Yale University, New Haven, Connecticut; Environmental Engineering Program, Yale University, New Haven, Connecticut

Sharing latrines is common in sub-Saharan Africa with anecdotal accounts suggesting a link between water-, sanitation-, and hygiene-related disease and poorly maintained communal latrines. This study examines this link by assessing the association between shared latrines compared with private latrines and risk of trachoma. In 2007, as part of a larger case-control study, we conducted a sub-study on latrine sharing in 594 households (92 cases, 502 controls) in seven rural Tanzanian communities. Case households were defined by having a child with clinical signs of trachoma. Latrine use was associated with a decreased risk of trachoma and there was no difference in risk between households using shared compared with private latrines (adjusted odds ratio = 0.95 [95% confidence interval = 0.55–1.67]). This study emphasizes the need to promote latrine use, which can be facilitated through latrine sharing in resource scarce areas, for prevention of trachoma.

Author Notes

*Address correspondence to Maggie A. Montgomery, Civil/Environmental Engineering, Stanford University, Stanford, CA 94305. E-mail: magsmont@stanford.edu

Financial Support: Funding for this study was provided by the National Science Foundation Graduate Research Fellowship, P.E.O. International Scholarship, and the Yale Lindsay Fellowship for Research in Africa.

Authors' addresses: Maggie A. Montgomery, Civil/Environmental Engineering, Stanford University, Stanford, CA, E-mail: magsmont@stanford.edu. Mayur M. Desai, School of Public Health, Yale University, New Haven, CT, E-mail: mayur.desai@yale.edu. Menachem Elimelech, Environmental Engineering Program, Yale University, New Haven, CT, E-mail: menachem.elimelech@yale.edu.

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