Research report: Facial cleanliness, environmental factors, and the burden of trachoma in a pastoral conflict area of Tiaty East, Baringo County, Kenya

The research, led by Loise Wanjira Njogu and colleagues, examined both the burden of trachoma and the status of the facial cleanliness and environmental improvement components of the World Health Organization’s SAFE strategy at the household level.

The team surveyed 178 randomly selected households using a structured questionnaire and an observation checklist, and examined 279 children aged 1 to 9 years for trachomatous inflammation-follicular, the key clinical sign used in trachoma mapping. The overall prevalence of the sign was 5.02 percent, with a 95 percent confidence interval of 2.8 to 8.3 percent. That interval overlaps the WHO elimination threshold of below 5 percent, and the authors note the estimate rests on a small number of cases, so the area sits in an uncertain zone just around the elimination benchmark.

While the disease measure hovered near the threshold, the hygiene and environmental indicators were clearly poor. Facial cleanliness was described as sub-optimal, with 91.8 percent of children having visibly unclean faces. Latrine coverage stood at only 21.3 percent, and among households without latrines, 99.1 percent practiced open defecation.

Water access emerged as a major constraint. Most households, 61.8 percent, sourced water from a dam, and 80.9 percent needed more than 30 minutes to fetch it. Handwashing stations were absent in 94 percent of households, underscoring how limited the environmental infrastructure for hygiene is in the study area.

The multivariable analysis identified caregiver age as significantly associated with a child’s odds of having trachomatous inflammation-follicular. Children of older caregivers had lower odds: caregivers aged 21 to 30 years had an adjusted odds ratio of 0.089 (95 percent CI 0.018 to 0.447), those aged 31 to 40 had an adjusted odds ratio of 0.259 (95 percent CI 0.068 to 0.991), and those aged 40 and above had an adjusted odds ratio of 0.160 (95 percent CI 0.029 to 0.871), compared with the reference group.

A counterintuitive finding concerned knowledge. Caregiver awareness that poor hygiene is a trachoma-related factor was associated with higher odds of the clinical sign in children, with an adjusted odds ratio of 3.795 (95 percent CI 1.272 to 11.324). The authors interpret this as pointing to a critical knowledge-practice gap: awareness of hygiene as a risk factor does not appear to translate into hygienic practices in this setting.

Kenya’s national context frames these results. Trachoma, the leading infectious cause of preventable blindness worldwide, remains endemic in 13 of Kenya’s 47 counties, including Baringo. The global SAFE strategy combines surgery, antibiotics, facial cleanliness and environmental improvement, but the authors note that the last two components have historically been under-implemented relative to the medical interventions.

The study’s design carries limitations worth noting. As a cross-sectional survey, it captures associations at a single point in time and cannot establish causal directions, and the confidence interval around the prevalence estimate is wide because it is based on few cases. The findings apply to Tiaty East as a trachoma sub-evaluation unit and may not generalize to other endemic areas.

Nevertheless, the authors conclude that sub-unit-level gaps in trachoma control persist in Tiaty East. Given the poor facial cleanliness, low latrine coverage, long water-fetching times and near-absent handwashing infrastructure, they argue that strengthening the facial cleanliness and environmental components of the SAFE strategy, with focused investment in water, sanitation and hygiene and behavior-based hygiene promotion, will be important for achieving elimination at the sub-evaluation-unit level.

Subject of Research: Trachoma burden and hygiene and environmental risk factors in a pastoral conflict area of Baringo County, Kenya

Article Title: Facial cleanliness, environmental factors, and the burden of trachoma in a pastoral conflict area of Tiaty East, Baringo County, Kenya

Article References: Njogu, L. W., Makalliwa, G. A., Kimani, B., Karimi, K., Kibet, Z., Njomo, D., Watitu, T., & Gichuki, P. M. (2026). Facial cleanliness, environmental factors, and the burden of trachoma in a pastoral conflict area of Tiaty East, Baringo County, Kenya. PLOS Global Public Health, 6(10), e0007534. https://doi.org/10.1371/journal.pgph.0007534

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007534

Keywords: trachoma, Kenya, Baringo County, SAFE strategy, facial cleanliness, WASH, open defecation, latrine coverage, blindness prevention, public health, neglected tropical diseases, cross-sectional study