Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis
Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH covera...
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| Published in | PLoS neglected tropical diseases Vol. 17; no. 2; p. e0011103 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
01.02.2023
Public Library of Science (PLoS) |
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| Abstract | Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission.
We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive.
Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma. |
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| AbstractList | Background Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. Methods/Findings We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF.sub.1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF.sub.1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF.sub.1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF.sub.1-9 . For nearby face-washing water, we estimated a [greater than or equal to]25% decrease in TF.sub.1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF.sub.1-9 accelerated from 80% coverage upward, with a [greater than or equal to]25% decrease in TF.sub.1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. Conclusions Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma. Background Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. Methods/Findings We used g-computation to estimate the impact on the prevalence of trachomatous inflammation—follicular among children aged 1–9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for “nearby” face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015–2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. Conclusions Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma. Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF.sub.1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF.sub.1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma. Previous work has been unable to determine what water, sanitation, and hygiene (WaSH)-related coverages are needed to optimally limit trachoma transmission. This study uses a large, multi-national dataset to explore the impact of hypothetical WaSH interventions designed to increase coverages of face-washing water and latrine use in districts that have met and those that have not met trachoma elimination targets. We used statistical models to explore how these interventions impacted the prevalence of trachoma among children as compared to the observed data. Our findings provide evidence-based insight into potential WaSH coverage targets that could be hypothesized to achieve meaningful reductions in trachoma prevalence. We found that in areas working to reach trachoma elimination targets, increasing face-washing water and latrine use coverages to a minimum of ≥30% were consistently associated with (modelled) reductions in active trachoma prevalence. However, in areas that had already met trachoma elimination targets, we did not see the same pattern. This finding supports our theory that the WaSH-trachoma relationship differs in these areas and suggests a need for additional research to explore these relationships. Our estimates can be used to inform programmatic WaSH targets and future field trials. Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma. BackgroundTrachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission.Methods/findingsWe used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive.ConclusionsOur results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma. |
| Audience | Academic |
| Author | Mwale, Consity Harding-Esch, Emma M Mpyet, Caleb D Sullivan, Kristin M Epee, Emilienne Bakhtiari, Ana Bucumi, Victor Masika, Michael P Keil, Alexander P Gower, Emily W Amza, Abdou Baayenda, Gilbert Bio Issifou, Amadou A Kadri, Boubacar Nassirou, Beido Sanha, Salimato Badiane, Mouctar D Batcho, Wilfrid E Massangaie, Marília E Bella, Assumpta L Seife Gebretsadik, Fikre Abdala, Mariamo Solomon, Anthony W Freeman, Matthew C Minnih, Abdallahi O Kabona, George E Westreich, Daniel Kaitaba, Oscar Simon, Alistidia Al-Khateeb, Tawfik Q Kalua, Khumbo M Elshafie, Balgesa E Bobo Barkesa, Segni Olobio, Nicholas |
| AuthorAffiliation | 18 Programme National de Promotion de La Santé Oculaire, Ministère de la Santé et de L’Action sociale, Dakar, Senegal 20 National Disease Control, Ministry of Health, Kampala, Uganda 3 Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America 11 Blantyre Institute for Community Outreach, Blantyre, Malawi 8 Department Of Ophthalmology, University of Yaoundé 1 Yaounde Centre, Yaoundé, Cameroun 25 Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland 2 Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom 15 Programme National De Santé Oculaire Ministère De La Santé Publique, Niamey, Niger 21 Neglected Tropical Disease Control Program, Ministry of Health, Dodoma, United Republic of Tanzania 5 Département D’ophthalmologie, Université De Parakou, Parakou, Borgou, Benin 7 Programme National De Lutte Contre La Cécité, Ministère De La Santé Publique, Yaounde, Camer |
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Carolina, United States of America – sequence: 33 givenname: Anthony W surname: Solomon fullname: Solomon, Anthony W organization: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland – sequence: 34 givenname: Emily W surname: Gower fullname: Gower, Emily W organization: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36780437$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1080_09286586_2023_2249546 crossref_primary_10_1007_s40471_023_00328_w crossref_primary_10_3390_hygiene3020008 crossref_primary_10_1371_journal_pntd_0011662 crossref_primary_10_1093_inthealth_ihad069 |
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| ContentType | Journal Article |
| Copyright | Copyright: © 2023 Sullivan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. COPYRIGHT 2023 Public Library of Science 2023 Sullivan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2023 Sullivan et al 2023 Sullivan et al |
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| DOI | 10.1371/journal.pntd.0011103 |
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| DocumentTitleAlternate | Exploring water, sanitation, and hygiene coverages for trachoma |
| EISSN | 1935-2735 |
| Editor | Werneck, Guilherme L. |
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| License | Copyright: © 2023 Sullivan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors also contributed equally to this work. I have read the journal’s policy and the authors of this manuscript have the following competing interests: AB is employed by the International Trachoma Initiative at The Task Force for Global Health, which receives an operating budget and research funds from Pfizer Inc., the manufacturers of Zithromax (azithromycin); EMHE is funded by the International Trachoma Initiative, a program of The Task Force for Global Health, which receives funding from Pfizer Inc., the manufacturers of Zithromax (azithromycin). All other authors have no completing interests to declare. |
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| References | PM Emerson (pntd.0011103.ref012) 2001; 15 MC Freeman (pntd.0011103.ref024) 2017; 220 J Ahern (pntd.0011103.ref017) 2009; 169 (pntd.0011103.ref028) 2020 PM Emerson (pntd.0011103.ref014) 2005; 10 B Thylefors (pntd.0011103.ref005) 1987; 65 MC Freeman (pntd.0011103.ref029) 2013; 7 M Hafez (pntd.0011103.ref013) 1958; 42 (pntd.0011103.ref007) 2018 JM Snowden (pntd.0011103.ref016) 2011; 173 JV Garn (pntd.0011103.ref021) 2018; 12 (pntd.0011103.ref004) 2016 AW Solomon (pntd.0011103.ref006) 2006 P Courtright (pntd.0011103.ref008) 2019 S. Greenland (pntd.0011103.ref025) 2002; 21 (pntd.0011103.ref011) 2017 A Overbo (pntd.0011103.ref023) 2016; 219 K Greenland (pntd.0011103.ref026) 2022; 16 WHO (pntd.0011103.ref002) 2021; 96 AW Solomon (pntd.0011103.ref003) 2015; 22 D. Westreich (pntd.0011103.ref010) 2017; 28 I Golovaty (pntd.0011103.ref022) 2009; 4 CJ Howe (pntd.0011103.ref018) 2011; 22 EM Harding-Esch (pntd.0011103.ref027) 2020; 13 pntd.0011103.ref001 World Health Organization Regional Office for The Western Pacific (pntd.0011103.ref019) 2018 S Greenland (pntd.0011103.ref015) 1999; 10 AW Solomon (pntd.0011103.ref009) 2020; 98 ME Stocks (pntd.0011103.ref020) 2014; 11 |
| References_xml | – volume: 42 start-page: 83 year: 1958 ident: pntd.0011103.ref013 article-title: Studies on the ecology of Musca sorbens Wied. in Egypt (Diptera: Muscidae). publication-title: Bulletin de la Societe Entomologique d’Egypte contributor: fullname: M Hafez – volume: 15 start-page: 314 issue: 3 year: 2001 ident: pntd.0011103.ref012 article-title: Human and other faeces as breeding media of the trachoma vector Musca sorbens publication-title: Med Vet Entomol doi: 10.1046/j.0269-283x.2001.00318.x contributor: fullname: PM Emerson – volume: 169 start-page: 1140 issue: 9 year: 2009 ident: pntd.0011103.ref017 article-title: Estimating the effects of potential public health interventions on population disease burden: a step-by-step illustration of causal inference methods publication-title: Am J Epidemiol doi: 10.1093/aje/kwp015 contributor: fullname: J Ahern – volume: 28 start-page: 525 issue: 4 year: 2017 ident: pntd.0011103.ref010 article-title: From Patients to Policy: Population Intervention Effects in Epidemiology. publication-title: Epidemiology doi: 10.1097/EDE.0000000000000648 contributor: fullname: D. 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| Title | Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis |
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