title: How much is not enough? A community randomized trial of a Water and Health Education programme for Trachoma and Ocular C. trachomatis infection in Niger.
abstract: OBJECTIVE
  To determine the impact after 2 years of a water and health education (W/HE) programme on ocular Chlamydia trachomatis infection and trachoma.
  
  
  METHODS
  We randomized 12 trachoma-endemic communities in Maradi, Niger 1:1 to W/HE intervention and control arms and collected data on 10 of the 12 villages. In the intervention villages, at least one clean water well was constructed, and a 3 month, modest health education programme was provided immediately prior to the 2 year survey. We censused all households, and 557 children ages 1-5 years were randomly selected as sentinel children and examined at baseline and at one and 2 years from baseline. Trachoma was clinically assessed and a swab taken and analyzed for C. trachomatis. Tetracycline eye ointment was provided to all children in either arm during the surveys who had signs of trachoma.
  
  
  RESULTS
  Infection with C. trachomatis declined slightly, and not significantly, in the children in the control villages over the 2 years, from 15% to 11%. The decline in infection was more pronounced, and significant, in the children in the intervention villages, from 26% to 15%. However, the change in infection rates in the intervention villages was not significantly different from the change in infection rates in the control villages (P = 0.39, and 0.11 for change from baseline to 1 year and 2 year, respectively). There was also no difference in the change in overall trachoma rates between the two arms.
  
  
  CONCLUSIONS
  These data suggest that the provision of water plus a modest health education programme did not result in a significant difference in trachoma or ocular C. trachomatis infection in endemic communities in Niger. A more substantial health education intervention is likely necessary to produce change.
authors.affiliation: Programme National de Lutte Contre la Cecité, Niamey, Niger.
authors.forename: Amza
authors.initials: A
authors.lastname: Abdou
authors.forename: Beatriz E
authors.initials: BE
authors.lastname: Munoz
authors.forename: Baido
authors.initials: B
authors.lastname: Nassirou
authors.forename: Boubacar
authors.initials: B
authors.lastname: Kadri
authors.forename: Fati
authors.initials: F
authors.lastname: Moussa
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Baarè
authors.forename: Joseph
authors.initials: J
authors.lastname: Riverson
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Opong
authors.forename: Sheila K
authors.initials: SK
authors.lastname: West
mesh_terms: D002675:Child, Preschool; D003153:Community Health Services / Q000379:methods; D003235:Conjunctivitis, Inclusion / Q000453:epidemiology / Q000517:prevention & control*; D019353:Endemic Diseases; D005260:Female; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D006801:Humans; D006920:Hygiene; D007223:Infant; D008297:Male; D009548:Niger / Q000453:epidemiology; D015397:Program Evaluation; D012423:Rural Health / Q000706:statistics & numerical data; D014141:Trachoma / Q000453:epidemiology / Q000517:prevention & control*; D014881:Water Supply / Q000592:standards*
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