title: A cross-sectional survey of water and clean faces in trachoma endemic communities in Tanzania.
abstract: BACKGROUND
  Face washing is important to interrupt the transmission of trachoma, the leading infectious cause of blindness worldwide. We aimed to assess the household and personal factors that affected water use and face washing practices in Kongwa, Tanzania.
  
  
  METHODS
  We conducted a household water use survey in 173 households (329 children) in January, 2010. Self reported data on water use practices, observed water in the household, and observed clean faces in children were collected. Contingency table analyses and logistic regression analyses were used to measure associations between unclean faces and risk factors.
  
  
  RESULTS
  We found that women are recognized as primary decision makers on water use in a household, and respondents who reported laziness as a reason that others do not wash children's faces were significantly more likely to have children with clean faces. Washing was reported as a priority for water use in most households. Sixty four percent (95% Confidence Interval = 59%-70%) of children had clean faces.
  
  
  CONCLUSIONS
  Attitudes toward face washing and household water use appear to have changed dramatically from 20 years ago when clean faces were rare and men made decisions on water use in households. The sources of these attitudinal changes are not clear, but are positive changes that will assist the trachoma control program in strengthening its hygiene efforts.
authors.affiliation: Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rog
authors.forename: Bonnielin
authors.initials: B
authors.lastname: Swenor
authors.forename: Luis C
authors.initials: LC
authors.lastname: Cajas-Monson
authors.forename: Wilson
authors.initials: W
authors.lastname: Mchiwe
authors.forename: Steven
authors.initials: S
authors.lastname: Kiboko
authors.forename: Harran
authors.initials: H
authors.lastname: Mkocha
authors.forename: Sheila
authors.initials: S
authors.lastname: West
mesh_terms: D001494:Baths; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005145:Face / Q000382:microbiology*; D005260:Female; D005618:Fresh Water; D006801:Humans; D007223:Infant; D008297:Male; D040242:Risk Reduction Behavior; D013636:Tanzania / Q000453:epidemiology; D014141:Trachoma / Q000453:epidemiology* / Q000517:prevention & control*