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 Background 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. Methods A household-based cross-sectional study using a two-stage cluster sampling design was conducted among 1290 children from randomly selected households across six districts with a baseline trachoma prevalence exceeding 10% in Ibb and Hodeidah governorates. These districts were targeted by three rounds of MDA from 2021 to 2024. A structured questionnaire was used to collect data on children's sociodemographic characteristics, as well as the availability and status of water, sanitation, and hygiene (WASH) conditions. The children's eyes were also examined for trachoma using the World Health Organization (WHO) simplified trachoma grading system. Univariate analysis was performed to assess the association between independent variables and TF 1–9 , while multivariable binary logistic regression was used to identify predictors of TF 1–9 at a statistical significance level of < 0.05. Results 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%. 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 . Conclusions The decline in the prevalence of TF 1–9 in previously highly endemic districts of Ibb and Hodeidah governorates below the WHO threshold of 5% indicates substantial progress toward meeting the active-trachoma criterion for elimination as a public health problem and suggests that further MDA is not currently required for TF 1–9 in these districts. However, surveillance surveys should be conducted to monitor potential recrudescence of trachoma. Poor household sanitation and facial uncleanliness with nasal and/or ocular discharge can independently predict TF 1–9 among children. Therefore, strengthening access to adequate sanitation and promoting facial cleanliness are key strategies for preventing trachoma recrudescence after MDA cessation.