{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:25:12Z","timestamp":1769001912377,"version":"3.49.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009902","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000}}],"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funding provided by the El Maghraby chair in preventive ophthalmology of the Wilmer Eye Institute."}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Having a clean face is protective against trachoma. In the past, long distances to water were associated with unclean faces and increased trachoma. Other environmental factors have not been extensively explored. We need improved clarity on the environmental factors associated with facial cleanliness and trachoma prevalence, especially when the disease burden is low.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principle findings<\/jats:title>\n<jats:p>A cross-sectional survey focusing on household environments was conducted in all 92 villages in Kongwa, Tanzania, in a random selection of 1798 households. Children aged 0\u20135 years in these households were examined for facial cleanliness. In each of the 50 randomly-selected villages, 50 children aged 1\u20139 years were randomly selected and examined for trachoma. In a multivariate model adjusting for child age, we found that children were more likely to have clean faces if the house had a clean yard (OR 1.62, 95% CI 1.37\u20131.91), an improved latrine (OR 1.11, 95% CI 1.01\u20131.22), and greater water storage capacity (OR 1.02, 95% CI 1.00\u20131.04), and if there were clothes washed and drying around the house (OR 1.30, 95% CI 1.09\u20131.54). However, measures of crowding, wealth, time spent on obtaining water, or the availability of piped water was not associated with clean faces. Using a cleanliness index (clean yard, improved latrine, washing clothes, \u22651 child in the household having a clean face), the community prevalence of trachoma decreased with an increase in the average value of the index (OR 2.28, 95% CI 1.17\u20134.80).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions\/Significance<\/jats:title>\n<jats:p>Access to water is no longer a significant limiting factor in children\u2019s facial cleanliness in Kongwa. Instead, water storage capacity and the way that water is utilized are more important in facial cleanliness. A household cleanliness index with a holistic measure of household environment is associated with reduced community prevalence of trachoma.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0009902","type":"journal-article","created":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T17:53:49Z","timestamp":1635443629000},"page":"e0009902","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Environmental factors and hygiene behaviors associated with facial cleanliness and trachoma in Kongwa, Tanzania"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6608-1307","authenticated-orcid":true,"given":"Xinyi","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7013-0992","authenticated-orcid":true,"given":"Beatriz","family":"Munoz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meraf A.","family":"Wolle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geordie","family":"Woods","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4510-1887","authenticated-orcid":true,"given":"Michelle","family":"Odonkor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6106-3177","authenticated-orcid":true,"given":"Fahd","family":"Naufal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harran","family":"Mkocha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila K.","family":"West","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"pntd.0009902.ref001","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1016\/S0140-6736(13)62182-0","article-title":"Trachoma","volume":"384","author":"HR Taylor","year":"2014","journal-title":"Lancet"},{"issue":"3","key":"pntd.0009902.ref002","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/14787210.2019.1577136","article-title":"Ocular chlamydia trachomatis infection: Elimination with mass drug administration","volume":"17","author":"M Wolle","year":"2019","journal-title":"Expert Rev Anti Infect Ther"},{"issue":"8","key":"pntd.0009902.ref003","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1046\/j.1365-3156.2000.00603.x","article-title":"Review of the evidence base for the \u2018F\u2019 and \u2018E\u2019 components of the SAFE strategy for trachoma control","volume":"5","author":"PM Emerson","year":"2000","journal-title":"Tropical Medicine & International Health"},{"issue":"1","key":"pntd.0009902.ref004","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/S0035-9203(00)90427-9","article-title":"Transmission ecology of the fly musca sorbens, a putative vector of trachoma","volume":"94","author":"PM Emerson","year":"2000","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"12","key":"pntd.0009902.ref005","doi-asserted-by":"crossref","first-page":"e0007834","DOI":"10.1371\/journal.pntd.0007834","article-title":"Evidence for contamination with C. trachomatis in the household environment of children with active trachoma: A cross-sectional study in Kongwa, Tanzania","volume":"13","author":"SK West","year":"2019","journal-title":"PLOS Neglected Tropical Diseases"},{"issue":"6","key":"pntd.0009902.ref006","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1001\/archopht.1991.01080060119038","article-title":"Facial cleanliness and risk of trachoma in families","volume":"109","author":"SK West","year":"1991","journal-title":"Arch Ophthalmol"},{"issue":"8943","key":"pntd.0009902.ref007","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0140-6736(95)90167-1","article-title":"Impact of face-washing on trachoma in Kongwa","volume":"345","author":"S West","year":"1995","journal-title":"Tanzania. 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