Active trachoma prevalence among Yemeni children in previously highly endemic districts following three rounds of mass drug administration: progress toward eliminating trachoma as a public health problem

Abstract

This study estimated the prevalence of trachomatous inflammation–follicular among children aged 1–9 years (TF 1–9 ) in previously highly endemic districts of Yemen following three rounds of mass drug administration (MDA) and identified its predictors. A household-based cross-sectional study using a two-stage cluster sampling approach was conducted among 1290 children from randomly selected households across six districts within evaluation units (EUs) with pooled 2013 baseline TF 1–9 prevalence exceeding 10% in Ibb and Hodeidah governorates. These districts received three rounds of MDA in 2021, 2023, and 2024. A structured questionnaire was used to collect data on children’s sociodemographic characteristics and household water, sanitation, and hygiene conditions. The children’s eyes were examined for trachoma using the World Health Organization (WHO) simplified trachoma grading system. Univariate analysis was performed to assess the associations between independent variables and TF 1–9 , and multivariable binary logistic regression was used to identify predictors of TF 1–9 at a statistical significance level of P  < 0.05. TF 1–9 was prevalent among 0.9% (11/1290) of children in previously highly endemic districts of Ibb and Hodeidah governorates, with reductions ranging from 83.5% to 95.2% compared with pooled 2013 EU baselines. Multivariable binary logistic regression analysis showed that households lacking improved sanitation facilities (AOR = 10.2, 95% CI: 1.70–61.19; P  = 0.011) and the presence of nasal and/or ocular discharge on a child’s face (AOR = 60.0, 95% CI: 6.16–584.54; P  < 0.001) were independent predictors of TF 1–9 . However, because only 11 TF-positive children were observed, the resulting CIs were wide, indicating substantial imprecision and potential instability of these estimates. The decline in TF 1–9 prevalence to below the WHO threshold of 5% in previously highly endemic districts of Ibb and Hodeidah governorates suggests that substantial progress has been made toward achieving the active trachoma component of the elimination criteria and that further MDA is not currently required in these districts. Nevertheless, post-MDA surveillance surveys should be conducted to detect any potential recrudescence. Poor household sanitation and facial uncleanliness with nasal and/or ocular discharge may independently predict TF 1–9 , although these associations should be interpreted with caution because of the associated uncertainty. Improving access to adequate sanitation and promoting facial cleanliness remain key strategies for reducing the risk of trachoma recrudescence following MDA cessation.