Factors Associated with Active Trachoma in Alto Amazonas, Peru

Factors associated with trachoma have been well characterized in Sub-Saharan Africa, including poverty, crowding, and poor access to water, sanitation, and hygiene. However, the relationship between these factors and trachoma may be different in non-African settings. The aim of this study was to determine the most important factors associated with active trachoma among children in an area of the Peruvian Amazon. Questionnaires and conjunctival photography were performed in a cross-sectional random sample of children aged 1–9 years from 21 communities in Alto Amazonas, Peru. Conjunctival photographs were graded by three trachoma experts for the presence of active trachoma. Of 750 children with complete data, 229 had active trachoma. Factors most associated with active trachoma included living with a pre-school-aged sibling (adjusted prevalence ratio [PR] 1.61, 95%CI 1.23–2.11), having an unimproved water source for face-washing (PR 1.87, 95%CI 1.23–2.84), absence of a latrine (PR 1.68, 95%CI 1.04–2.70, comparing those with no latrine to those with access to an improved latrine), and household ownership of chickens (PR 1.58, 95%CI 1.13–2.21). Active trachoma was associated with lower scores on a hygiene index (PR 1.18 per unit decrement, 95%CI 1.04–1.33) and an asset-based wealth index (PR 1.14, 95%CI 1.02–1.28). The most important factors associated with active trachoma in this study were exposure to young children, poor access to water, sanitation, and hygiene, and indicators of poverty. These factors are similar to those of previous studies of trachoma in other parts of the world.