Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries
Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the...
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| Published in | PLoS neglected tropical diseases Vol. 12; no. 1; p. e0006110 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
01.01.2018
Public Library of Science (PLoS) |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds.
We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1-9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation-follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83-0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75-0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR80-90% = 0.87; 95%CI: 0.73-1.02; PR90-100% = 0.76; 95%CI: 0.67-0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62-0.97)-that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage.
Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem. |
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| AbstractList | Background Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds. Methods and findings We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1-9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation-follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83-0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75-0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR.sub.80-90% = 0.87; 95%CI: 0.73-1.02; PR.sub.90-100% = 0.76; 95%CI: 0.67-0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62-0.97)-that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage. Conclusions Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem. Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds. We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1-9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation-follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83-0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75-0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR80-90% = 0.87; 95%CI: 0.73-1.02; PR90-100% = 0.76; 95%CI: 0.67-0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62-0.97)-that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage. Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem. Background Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds. Methods and findings We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1-9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation-follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83-0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75-0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR80-90% = 0.87; 95%CI: 0.73-1.02; PR90-100% = 0.76; 95%CI: 0.67-0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62-0.97)-that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage. Conclusions Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem. Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds. We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1-9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation-follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83-0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75-0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR.sub.80-90% = 0.87; 95%CI: 0.73-1.02; PR.sub.90-100% = 0.76; 95%CI: 0.67-0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62-0.97)-that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage. Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem. Background Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds. Methods and findings We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1-9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation-follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83-0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75-0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR80-90% = 0.87; 95%CI: 0.73-1.02; PR90-100% = 0.76; 95%CI: 0.67-0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62-0.97)-that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage. Conclusions Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem. Trachoma is the leading infectious cause of blindness. Previous association studies have primarily assessed household-level exposures, ignoring potential community-level protection from water and sanitation coverage in neighboring houses. There is biological plausibility that increased community-level coverage of facial cleanliness and/or sanitation could reduce trachoma transmission, even to non-face washers or to those without access to sanitation. Our study investigates relationships between active trachoma and community-level coverage of sanitation and water, is novel in concept and unprecedented in scale, including data from trachoma-endemic areas of 13 countries. Our findings support the plausibility of community-level or herd protection from trachoma with increasing water and sanitation coverage. We also observed lower TF prevalence among those with household-level access to sanitation and water. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem. Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds.We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1-9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation-follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83-0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75-0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR80-90% = 0.87; 95%CI: 0.73-1.02; PR90-100% = 0.76; 95%CI: 0.67-0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62-0.97)-that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage.Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem. |
| Audience | Academic |
| Author | Courtright, Paul Solomon, Anthony W Freeman, Matthew C Madeleine, Kouakou IIunga Marie Mbofana, Mariamo Saide Abdala Garn, Joshua V Al-Khatib, Tawfik Macleod, Colin K Kalua, Khumbo Kebede, Biruck Bakhtiari, Ana Goepogui, Andre Boisson, Sophie Pavluck, Alexandre L Mpyet, Caleb Southisombath, Khamphoua Dejene, Michael Amer, Khaled Taleo, Fasihah Willis, Rebecca Sokana, Oliver Batcho, Wilfrid Olobio, Nicholas Ndjemba, Jean |
| AuthorAffiliation | 8 Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia 12 Sightsavers, Haywards Heath, United Kingdom 11 Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia 21 World Health Organization, Port Vila, Vanuatu RTI International, UNITED REPUBLIC OF TANZANIA 16 Sightsavers, Kaduna, Nigeria 6 Programme National de Lutte contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Bénin 1 Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America 13 Programme National de la Santé Oculaire et de la Lutte contre l'Onchocercose, Abidjan, Côte-d'Ivoire 5 Department of Ophthalmology, Ministry of Health, Cairo, Egypt 9 Ministère de la Santé, Programme Oncho-Cécité-MTN, Conakry, République de Guinée 22 Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom 15 Department of Ophthalmology, University of Jos, Jos, Nigeria 18 Department of P |
| AuthorAffiliation_xml | – name: 1 Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America – name: 2 Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland – name: 18 Department of Public Health, Federal Ministry of Health, Abuja, Nigeria – name: 19 Eye Department, Ministry of Health and Medical Services, Honiara, Solomon Islands – name: 5 Department of Ophthalmology, Ministry of Health, Cairo, Egypt – name: 6 Programme National de Lutte contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Bénin – name: 22 Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom – name: 7 Division of Ophthalmology, Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa – name: 10 Department of Ophthalmology, Blantyre Institute for Community Ophthalmology, College of Medicine, Blantyre, Malawi, Malawi – name: 14 Programa Nacional de Oftalmologia, Maputo, Mocambique – name: 23 Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland – name: 21 World Health Organization, Port Vila, Vanuatu – name: 12 Sightsavers, Haywards Heath, United Kingdom – name: 13 Programme National de la Santé Oculaire et de la Lutte contre l'Onchocercose, Abidjan, Côte-d'Ivoire – name: RTI International, UNITED REPUBLIC OF TANZANIA – name: 17 Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Republique Democratique du Congo – name: 8 Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia – name: 3 International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, United States of America – name: 16 Sightsavers, Kaduna, Nigeria – name: 4 Department of Ophthalmology, Sana'a University, Sana'a, Yemen – name: 20 National Ophthalmology Center, Ministry of Health, Vientiane, Lao People’s Democratic Republic – name: 9 Ministère de la Santé, Programme Oncho-Cécité-MTN, Conakry, République de Guinée – name: 15 Department of Ophthalmology, University of Jos, Jos, Nigeria – name: 11 Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia |
| Author_xml | – sequence: 1 givenname: Joshua V orcidid: 0000-0002-4360-466X surname: Garn fullname: Garn, Joshua V organization: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America – sequence: 2 givenname: Sophie surname: Boisson fullname: Boisson, Sophie organization: Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland – sequence: 3 givenname: Rebecca surname: Willis fullname: Willis, Rebecca organization: International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, United States of America – sequence: 4 givenname: Ana surname: Bakhtiari fullname: Bakhtiari, Ana organization: International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, United States of America – sequence: 5 givenname: Tawfik surname: Al-Khatib fullname: Al-Khatib, Tawfik organization: Department of Ophthalmology, Sana'a University, Sana'a, Yemen – sequence: 6 givenname: Khaled surname: Amer fullname: Amer, Khaled organization: Department of Ophthalmology, Ministry of Health, Cairo, Egypt – sequence: 7 givenname: Wilfrid surname: Batcho fullname: Batcho, Wilfrid organization: Programme National de Lutte contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Bénin – sequence: 8 givenname: Paul surname: Courtright fullname: Courtright, Paul organization: Division of Ophthalmology, Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa – sequence: 9 givenname: Michael surname: Dejene fullname: Dejene, Michael organization: Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia – sequence: 10 givenname: Andre surname: Goepogui fullname: Goepogui, Andre organization: Ministère de la Santé, Programme Oncho-Cécité-MTN, Conakry, République de Guinée – sequence: 11 givenname: Khumbo surname: Kalua fullname: Kalua, Khumbo organization: Department of Ophthalmology, Blantyre Institute for Community Ophthalmology, College of Medicine, Blantyre, Malawi, Malawi – sequence: 12 givenname: Biruck surname: Kebede fullname: Kebede, Biruck organization: Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia – sequence: 13 givenname: Colin K surname: Macleod fullname: Macleod, Colin K organization: Sightsavers, Haywards Heath, United Kingdom – sequence: 14 givenname: Kouakou IIunga Marie surname: Madeleine fullname: Madeleine, Kouakou IIunga Marie organization: Programme National de la Santé Oculaire et de la Lutte contre l'Onchocercose, Abidjan, Côte-d'Ivoire – sequence: 15 givenname: Mariamo Saide Abdala surname: Mbofana fullname: Mbofana, Mariamo Saide Abdala organization: Programa Nacional de Oftalmologia, Maputo, Mocambique – sequence: 16 givenname: Caleb surname: Mpyet fullname: Mpyet, Caleb organization: Sightsavers, Kaduna, Nigeria – sequence: 17 givenname: Jean surname: Ndjemba fullname: Ndjemba, Jean organization: Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Republique Democratique du Congo – sequence: 18 givenname: Nicholas surname: Olobio fullname: Olobio, Nicholas organization: Department of Public Health, Federal Ministry of Health, Abuja, Nigeria – sequence: 19 givenname: Alexandre L surname: Pavluck fullname: Pavluck, Alexandre L organization: International Trachoma Initiative, The Task Force for Global Health, Decatur, GA, United States of America – sequence: 20 givenname: Oliver surname: Sokana fullname: Sokana, Oliver organization: Eye Department, Ministry of Health and Medical Services, Honiara, Solomon Islands – sequence: 21 givenname: Khamphoua surname: Southisombath fullname: Southisombath, Khamphoua organization: National Ophthalmology Center, Ministry of Health, Vientiane, Lao People's Democratic Republic – sequence: 22 givenname: Fasihah surname: Taleo fullname: Taleo, Fasihah organization: World Health Organization, Port Vila, Vanuatu – sequence: 23 givenname: Anthony W surname: Solomon fullname: Solomon, Anthony W organization: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland – sequence: 24 givenname: Matthew C surname: Freeman fullname: Freeman, Matthew C organization: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29357365$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | COPYRIGHT 2018 Public Library of Science 2018 Public Library of Science. 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: Garn JV, Boisson S, Willis R, Bakhtiari A, al-Khatib T, Amer K, et al. (2018) Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries. PLoS Negl Trop Dis 12(1): e0006110. https://doi.org/10.1371/journal.pntd.0006110 2018 World Health Organization 2018 World Health Organization 2018 Public Library of Science. 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: Garn JV, Boisson S, Willis R, Bakhtiari A, al-Khatib T, Amer K, et al. (2018) Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries. PLoS Negl Trop Dis 12(1): e0006110. https://doi.org/10.1371/journal.pntd.0006110 |
| Copyright_xml | – notice: COPYRIGHT 2018 Public Library of Science – notice: 2018 Public Library of Science. 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: Garn JV, Boisson S, Willis R, Bakhtiari A, al-Khatib T, Amer K, et al. (2018) Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries. PLoS Negl Trop Dis 12(1): e0006110. https://doi.org/10.1371/journal.pntd.0006110 – notice: 2018 World Health Organization 2018 World Health Organization – notice: 2018 Public Library of Science. 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: Garn JV, Boisson S, Willis R, Bakhtiari A, al-Khatib T, Amer K, et al. (2018) Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries. PLoS Negl Trop Dis 12(1): e0006110. https://doi.org/10.1371/journal.pntd.0006110 |
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| Notes | new_version MCF has received funding as a consultant for WHO as part of separate assessments of sanitation on health. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated. The authors declare no other competing interests exist. |
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| Snippet | Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds.... Background Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection... Trachoma is the leading infectious cause of blindness. Previous association studies have primarily assessed household-level exposures, ignoring potential... Background Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection... |
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| SubjectTerms | Access Analysis Biology and Life Sciences Child Child, Preschool Children Chlamydia trachomatis Communities Control Countries Cross-Sectional Studies Data Disease transmission Disease Transmission, Infectious Ecology and Environmental Sciences Environmental health Epidemiology Global Health Health aspects Households Humans Hygiene Infant Infections Medicine and Health Sciences Modelling Poisson density functions Prevalence Prevention Protection Public health Regression analysis Regression models Sanitation Sanitation - methods Sanitation facilities Software Statistical analysis Studies Systematic review Task forces Thresholds Trachoma Trachoma - epidemiology Trachoma - prevention & control Trachoma - transmission Transmission Tropical diseases Washing Water Supply |
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| Title | Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/29357365 https://www.proquest.com/docview/2002618010 https://pubmed.ncbi.nlm.nih.gov/PMC5800679 https://doaj.org/article/f5f2620ce4864abbbc9931c1669bcc64 http://dx.doi.org/10.1371/journal.pntd.0006110 |
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