Facial cleanliness, environmental factors, and the burden of trachoma in a pastoral conflict area of Tiaty East, Baringo County, Kenya

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'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 1-9 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 <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 (> 20 years) as significantly associated with lower odds of TF (21-30 years: AOR = 0.089, 95% CI: 0.018-0.447; 31-40 years: AOR = 0.259, 95% CI: 0.068-0.991; ≥ 40 years: AOR = 0.160, 95% CI: 0.029-0.871). 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&E coverage, there remain sub-EU-level gaps in trachoma control. In this context, strengthening the F&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.