{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T02:09:19Z","timestamp":1775441359361,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Few randomised trials have been done to assess the impact of hygiene interventions on trachoma even though hygiene improvements feature prominently in the strategy for global elimination of trachoma. This study's aim was to determine if implementing an integrated water, sanitation, and hygiene (WASH) intervention in a hyperendemic region of Ethiopia would reduce clinical signs of trachoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a parallel\u2010group cluster\u2010randomised trial, 40 Ethiopian communities were randomised in a 1:1 ratio to a WASH intervention or to delayed intervention (i.e., control) (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      NCT02754583). No antibiotic mass drug administration was undertaken. Annual monitoring visits included photography of the superior tarsal conjunctiva. Clinical trachoma\u2014a pre\u2010specified secondary outcome\u2014was assessed from photographs presented in a random order to masked photo\u2010graders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At baseline, conjunctival photographs were taken on 1131 children aged 0\u20139\u2009years in the WASH arm and 1229 children in the control arm. The mean number of follicles at baseline was 3.8 (95% CI: 3.1, 4.6) in the WASH arm and 3.7 (95% CI: 2.9, 4.4) in the control arm, which increased to a mean of 5.9 (95% CI: 5.1\u20136.6) in the WASH arm and 5.4 (95% CI: 4.6\u20136.1) in the control arm after 3\u2009years (0.5 higher in the WASH arm, 95% CI: \u22120.6 to 1.5,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.66). The mean papillary score increased from 3.3 (95% CI: 3.1\u20133.5) to 3.7 (95% CI: 3.5\u20133.9) in the WASH arm and from 3.2 (95% CI: 3.0\u20133.4) to 3.5 (95% CI: 3.3\u20133.7) in the control arm (month 36 values 0.2 greater in the WASH arm, 95% CI: \u22120.1 to 0.4;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.49). No adverse events were reported in either treatment arm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An integrated WASH intervention delivered in the absence of mass antibiotic distributions did not reduce clinical trachoma outcomes in an area with hyperendemic trachoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.70086","type":"journal-article","created":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T23:44:57Z","timestamp":1768779897000},"page":"457-464","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of a Water, Sanitation, and Hygiene Intervention on Clinical Trachoma: A Cluster\u2010Randomised Trial"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9887-5993","authenticated-orcid":false,"given":"Dionna M.","family":"Wittberg","sequence":"first","affiliation":[{"name":"Francis I Proctor Foundation, University of California  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fisseha","family":"Admassu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4967-9627","authenticated-orcid":false,"given":"Solomon","family":"Aragie","sequence":"additional","affiliation":[{"name":"The Carter Center Ethiopia  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4105-6129","authenticated-orcid":false,"given":"Adane","family":"Dagnew","sequence":"additional","affiliation":[{"name":"The Carter Center Ethiopia  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1066-7197","authenticated-orcid":false,"given":"Dagnachew","family":"Hailu","sequence":"additional","affiliation":[{"name":"The Carter Center Ethiopia  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zerihun","family":"Tadesse","sequence":"additional","affiliation":[{"name":"The Carter Center Ethiopia  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0736-2955","authenticated-orcid":false,"given":"Taye","family":"Zeru","sequence":"additional","affiliation":[{"name":"Amhara Public Health Institute  Bahir Dar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel J. B.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seid","family":"Abdu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Social","family":"Beyecha","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tibebe","family":"Birhanu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Habib","family":"Getachew","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Banchalam","family":"Getnet","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Endale","family":"Kabtu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meskerem","family":"Shibiru","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon","family":"Tekew","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bilen","family":"Wondimteka","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1517-2572","authenticated-orcid":false,"given":"Matthew C.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Gangarosa Department of Environmental Health Rollins School of Public Health, Emory University  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5741-8537","authenticated-orcid":false,"given":"Scott D.","family":"Nash","sequence":"additional","affiliation":[{"name":"The Carter Center  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8216-0240","authenticated-orcid":false,"given":"Thomas M.","family":"Lietman","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California  San Francisco California USA"},{"name":"Department of Ophthalmology  San Francisco California USA"},{"name":"Department of Epidemiology &amp; 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