{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T07:52:36Z","timestamp":1749714756512},"reference-count":39,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,2]]},"abstract":"<jats:p>Trachoma is the leading infectious cause of blindness, and facial cleanliness is associated with reduced odds of trachomatous inflammation and <jats:italic>Chlamydia trachomatis<\/jats:italic> infection, but there is little evidence of how to drive this behavior change at scale. We report the results of a program integrating face washing into a school-based handwashing promotion program in Turkana County, Kenya. Children aged 5\u201315 years participated in an intervention delivered to schools in two phases, along with a third phase receiving the intervention after the evaluation, which served as a control. The primary outcome was the number of face washing events that took place when handwashing occurred, which was measured by a 3-hour structured observation at all 67 schools, and a total of 3,871 handwashing events were observed. Differences in observed in face washing behavior between each phase and the control schools were calculated using log-binomial regression with clustering at the school level, whereas survey responses on knowledge of trachoma transmission and prevention were compared using \u03c7<jats:sup>2<\/jats:sup> tests adjusted for clustering at the school level. Face washing during handwashing events was higher in schools after 12 months (59.3%) and 20 months (44.2%) than in control schools (18.7%, <jats:italic>P<\/jats:italic> &lt; 0.001). Trachoma knowledge was higher in schools evaluated after 12 months (80%) and 20 months (70%) than in control schools (42%, <jats:italic>P<\/jats:italic> &lt; 0.001), and knowledge of some of key preventive behaviors was higher in intervention schools. Integrating face washing messages into school-based handwashing promotion programs increased face washing, which may help to prevent trachoma when combined with other interventions.<\/jats:p>","DOI":"10.4269\/ajtmh.19-0205","type":"journal-article","created":{"date-parts":[[2019,8,6]],"date-time":"2019-08-06T07:00:38Z","timestamp":1565074838000},"page":"767-773","source":"Crossref","is-referenced-by-count":14,"title":["Integrating Face Washing into a School-Based, Handwashing Behavior Change Program to Prevent Trachoma in Turkana, Kenya"],"prefix":"10.4269","volume":"101","author":[{"given":"James B.","family":"Tidwell","sequence":"first","affiliation":[{"name":"Harvard Kennedy School of Government, Cambridge, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristin","family":"Fergus","sequence":"additional","affiliation":[{"name":"London School of Economics and Political Science, London, United 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Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geordie","family":"Woods","sequence":"additional","affiliation":[{"name":"Sightsavers, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Wkly Epidemiol Rec","first-page":"359","article-title":"WHO Alliance for the Global Elimination of Trachoma by 2020: progress report on elimination of trachoma, 2014\u20132016","volume":"92","author":"World Health Organization","year":"2017"},{"year":"2018","series-title":"Trachoma Fact Sheet","author":"World Health Organization","key":"b2"},{"key":"b3","series-title":"Br J Ophthalmol","first-page":"614","article-title":"Global estimates of visual impairment: 2010","volume":"96","author":"Pascolini","year":"2012"},{"year":"2003","series-title":"Report of the 2nd Global Scientific Meeting on Trachoma","author":"World Health Organization","key":"b4"},{"key":"b5","series-title":"Br J 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