Study design and period
A community based cross-sectional study design was employed to determine the prevalence of active trachoma and associated factors among children aged 1–9 years in rural communities of Metema district, from April to May 2018.
This study was conducted in Metema district, West Gondar Zone, Northwest Ethiopia. Metema Districtis located 170 km from Gondar town, in the border of South Sudan. There are 17 rural and 2 urban kebeles in the district. Moreover, it has 5 Health center and 19 heath post. Total projected populations of the district are 149,700.Of this total population, Children aged 1–9 years are 26373. The major source of income of population is agricultural activities especially production sesame and it is known for investment district in the country.
Source and study population
All children in Metema district whose ages between 1–9 years were the source population. Children who are living in 6 kebeles selected by simple random sampling technique were the study population, while children who were living in households selected by systematic random sampling technique were the study subjects. Children who were unable to undergo physical examination for trachoma evaluation due to serious sickness, and those absent during the data collection period were excluded from the study.
Active trachoma (Yes/No)
family size, education level, occupation, Income, Age of household, Sex of household ,Religion, Sex of child and Age of child ,number of animal.
Source of water, water consumption, distance to water source, latrien availablity, latrien utilization, waste disposal practice, animal keeping practice, and cleanliness of compounds.
Behavioral factors: Frequency: Face washing, frequency of washing, Use of soap, eye discharge, Nasal discharge, fly on face, Number of fly’s on children face, facial cleanness.
Sample size determination and sampling procedures
The sample size for the prevalence of active trachoma was determined using single population proportion formula with the assumptions; proportion (P) of IPI 62.6 % (14),95% confidence interval (CI), margin of error of 5%, design effect2 and adding 10% contingency: making a total sample size of792.
For associated factors of prevalence of active trachoma, the sample size was computed using double population proportion formula using EpiInfo ver.7 software by considering the different variables like distance to water source, use of soap, number of fly’s on children face and facial cleanness. But, the sample sizes were low compared to the sample size for the prevalence of active trachoma. Finally, the larger sample size was taken for this study.
A multistage sampling technique was applied to select study subject. At first stage, 6 out of 17 rural kebeles were selected by lottery method. Using probability proportional to size (PPS), the number of households was determined in each kebeles. At the second stage, systematic random sampling technique was applied to select study households. One child per household was included in the study. In case, where there are more than one child with the age of 1–9 years in the same household, lottery method was used to select a child.
Presence of Active trachoma
is the presence of Trachomatous inflammation, follicles (the presence of at least five or more follicles at least 0.5 mm in Diameter in the central part of the upper tarsal conjunctiva) or Trachomatous inflammation intense (pronounced inflammatory thickening of the tarsal conjunctiva that obscures more than half of the normal deep tarsal vessels).
a child who did not have an eye discharge or nasal discharge, fly on face at the time of visit.
Number of flies
Presence of flies on children’s faces for about 3 seconds during the examination time which was graded as none (0 flies), few (1–4 flies), or many (≥ 5 flies).
Data collection tools and procedure
A structured and pre-tested interviewer-administered questionnaire, and eye examination by using binocular loupe to differentiate trachoma cases using observation checklist were used to collect data. The questionnaire was first prepared in English and translated to Amharic, and then again translated back to English by another person. The questionnaire has information on socio-demographic characteristics, Environmental factors and behavioral factors. A total of 10 health professionals were participated in the study among this 2 supervisors were assigned to the data collection for head of household interviews and validate trachoma grading. Trachoma grading was be examine by 2 trend health professional, according to the WHO simplified grading scheme. The rest 6 health professionals were interview head of the households.
Before the commencement of data collection, three days training was given for all data collectors, trachoma examiners and supervisors. Moreover, before the actual data collection, the examination of eye with questionnaire was pre-tested on 5% (40) of final sample size in an adjacent kebele outside of the study area. During the course of the data collection, data collectors were intensively supervised at each site. The completeness and accuracy of data was checked at the end of each day.
Data management and analysis
The data was entered using Epi Info ver.7 software by the principal investigator and exported to SPSS version 20 for analysis. Descriptive statistics were used to describe the socio-demographic characteristics of the respondents, the prevalence of trachoma, and other characteristics of the respondents. The bivariable and multivariable binary logistic regression model was used to assess the association between dependent and independent variables. Hosmer-Lemeshow goodness of fit test was used to check model fitness (P > = 0.05). Variables having P-value ≤ 0.2 in the bivariable analysis were further entered into the multivariable analysis to control the effects of confounders. In the multivariable analysis, P-value < 0.05 was considered to declare statistical significance.
Ethical clearance was obtained from the Institutional Review Board of the University of Gondar, College of Medicine and Health Science, Institute of public health.
Support letter and permission letter were obtained from Metema District Health Office.
The study participants were provided full information regarding the purpose and nature of the research then written consent was obtained from each parent or caregiver of participants.
Participation in the study was on a voluntary basis, and participants were informed about their right not to participate in the study or withdraw at any time. Moreover, the confidentiality of the information was assured by using an anonymous questionnaire. All identified cases of active trachoma were provided with the standard treatment free of charge and complicated cases were referred to the nearest health center for better treatment.