@article{article,
  keywords = {Facial cleanliness, Environmental factors, Trachoma, pastoral conflict, Kenya},
  author = {Njogu L and Makalliwa G and Kimani B and Karimi K and Kibet Z and Njomo D and Watitu T and Gichuki P},
  editor = {Alam M},
  title = {Facial cleanliness, environmental factors, and the burden of trachoma in a pastoral conflict area of Tiaty East, Baringo County, Kenya},
  abstract = {<p>Trachoma remains the leading infectious cause of preventable blindness globally, disproportionately affecting marginalized and impoverished communities. Despite global and national efforts guided by the World Health Organization{\textquoteright}s (WHO) SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement), the latter two components remain under-implemented. In Kenya, trachoma remains endemic in 13 of 47 counties, including Baringo. This cross-sectional study was conducted in Tiaty East Sub-County, a trachoma Sub-Evaluation Unit in Baringo, to determine the burden of trachoma and assess facial cleanliness and environmental improvement for control of the disease at the household level. Using a structured questionnaire and observation checklist, data were collected from 178 randomly selected households. A total of 279 children aged 1{\textendash}9 years were examined for trachomatous inflammation-follicular (TF). The overall TF prevalence was 5.02\% (95\% CI: 2.8-8.3), with the confidence interval overlapping with the WHO elimination threshold of \&lt;5\%. Facial cleanliness was sub-optimal, with 91.8\% of children having visibly unclean faces. Latrine coverage was low (21.3\%), and 99.1\% of households without latrines practiced open defecation. Most households (61.8\%) sourced water from a dam, and 80.9\% required more than 30 minutes to fetch it. Handwashing stations were absent in 94\% of households. Final multivariable analysis identified older caregiver age (\&gt; 20 years) as significantly associated with lower odds of TF (21{\textendash}30 years: AOR = 0.089, 95\% CI: 0.018{\textendash}0.447; 31{\textendash}40 years: AOR = 0.259, 95\% CI: 0.068{\textendash}0.991; >= 40 years: AOR = 0.160, 95\% CI: 0.029{\textendash}0.871). Caregiver awareness of poor hygiene as a trachoma-related factor was associated with higher odds of TF (AOR = 3.795; 95\% CI:1.272-11.324), suggesting a critical knowledge-practice gap. Although TF prevalence was slightly above the threshold based on a few events, with poor F\&amp;E coverage, there remain sub-EU-level gaps in trachoma control. In this context, strengthening the F\&amp;E aspects of the SAFE strategy with focused investments on WASH and behavior-based hygiene promotion will be important to the achievement of sub-EU disease elimination.</p>
},
  year = {2026},
  journal = {PLOS Global Public Health},
  volume = {6},
  pages = {1 - 21},
  month = {10/2026},
  publisher = {Public Library of Science (PLoS)},
  issn = {2767-3375},
  url = {https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0007534\&type=printable},
  doi = {10.1371/journal.pgph.0007534},
  language = {ENG},
}