Facial cleanliness and prevention of cross-border spread of chlamydial infection are vital in elimination of active trachoma in Narok County, Kenya

Background: Active trachoma is an eye infection caused by Chlamydia trachomatis and a dirty face is the most important risk factor. The interventions recommended by World Health Organization (WHO) are Mass Drug Administration (MDA), facial cleanliness and environmental improvements (FE). Trachoma inflammation-follicular (TF) in children aged 1-9 years old is the monitoring indicator. Objective: To assess the progress towards elimination of TF as a public health problem in Narok County, Kenya. Methods: Project documents were reviewed. The survey methods were published elsewhere. In Kenya, district-baseline trachoma surveys commenced in 2004. From 2010, surveys were conducted in geographical areas (segments) with 100,000 to 200,000 people each. Narok County covers the previous Narok and Transmara districts. A baseline trachoma survey was conducted in Narok district in 2004 and impact surveys in 2010 and 2014. Interventions commenced in 2007. A baseline survey was conducted in Transmara district in 2011 and interventions commenced in 2013. Impact survey is due in 2016. Results: In 2004, 1,348 children aged 1-9 years old were examined in Narok district. Prevalence of TF was 30.5% (95% CI:25.6% - 35.8%). In 2010, 3,998 children were examined in 5 segments. The prevalence of TF in the district was 11.0% (95% CI:8.0% - 14.0%). Three segments (North Eastern, North Western and Central) had prevalence of less than 5%. The prevalence in the South Western segment was 26.7% (95% CI:18.7% - 34%) and in South Eastern segment 21.6% (95% CI:15.4% - 27.8%). In 2014, 800 children were examined in South Eastern and 720 in South Western segment. Prevalence of TF in South Western was 21.0% (95% CI:12.8% - 29.2%) and South Eastern 21.8% (95% CI: 14.2% - 29.3%). Prevalence of a dirty face in the South Eastern segment was 43.0% (95% CI: 35.9% - 50.1%) and South Western segment 31.1% (95% CI: 24.4%-37.9%). In 2011, 1,600 children were examined in two segments in Transmara district. The prevalence of TF in the district was 10.6% (95% CI: 4.6% - 16.5%), North Eastern segment 2.9% (95% CI:0% - 6.5%) and South Western 18.3% (95% CI:7.9% - 28.6%). The prevalence of dirty faces in Transmara West was 34.4% (95% CI:28.1% - 40.6%) and in Transmara East 33.1% (95% CI:19.8% - 46.4%). The South Western segment was incorporated in the Narok County trachoma control project. There were cross-border nomadic migrations between Narok County and Tanzania. Trachoma interventions in Kenya and Tanzania were not harmonized. Conclusions: There was an impressive progress towards elimination of TF in Narok district between 2004 and 2010. Dirty faces, delayed interventions in Transmara district and cross-border migrations dampened the progress in the County. Laboratory testing is needed to verify occurrence of chlamydia infection. Key words: Trachoma, Prevalence, Dirty face, Environmental improvements