title: Efficacy of latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass antibiotic treatment: a cluster-randomized trial.
abstract: The World Health Organization (WHO) recommends environmental improvements such as latrine construction in the integrated trachoma control strategy, SAFE. We report a cluster-randomized trial assessing the effect of intensive latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass treatment with antibiotics.Twenty-four communities in Goncha Seso Enesie woreda, Amhara Regional State, Ethiopia, were enumerated, and a random selection of 60 children aged 0- 9 years in each was monitored for clinical signs of trachoma and ocular chlamydial infection at baseline, 12 and 24 months. All community members were offered treatment with a single dose of oral azithromycin or topical tetracycline. After treatment, 12 subkebeles were randomized to receive intensive latrine promotion. Mean cluster ocular infection in the latrine and the non-latrine arms were reduced from 45.5% (95% CI 34.1-56.8%) and 43.0% (95% CI 31.1-54.8%) respectively at baseline to 14.6% (95% CI 7.4-21.8%) and 14.8% (95% CI 8.9-20.8%) respectively at 24 months (P=0.93). Clinical signs fell from 72.0% (95% CI 58.2-85.5%) and 61.3% (95% CI 44.0-78.5%) at baseline to 45.8% (36.0-55.6%) and 48.5% (34.0-62.9%) respectively at 24 months (P=0.69). At 24 months, estimated household latrine coverage and use were 80.8% and 61.7% respectively where there had been intensive latrine promotion and 30.0% and 25.0% respectively in the single treatment only arm. We were unable to detect a difference in the prevalence of ocular chlamydial infection in children due to latrine construction.
authors.affiliation: F.I. Proctor Foundation, University of California San Francisco, USA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Stoller
authors.forename: Teshome
authors.initials: T
authors.lastname: Gebre
authors.forename: Berhan
authors.initials: B
authors.lastname: Ayele
authors.forename: Mulat
authors.initials: M
authors.lastname: Zerihun
authors.forename: Yared
authors.initials: Y
authors.lastname: Assefa
authors.forename: Dereje
authors.initials: D
authors.lastname: Habte
authors.forename: Zhaoxia
authors.initials: Z
authors.lastname: Zhou
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.forename: Jenafir I
authors.initials: JI
authors.lastname: House
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Gaynor
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson