The findings of this study showed overall prevalence of 24.1% active trachoma (range, 21.4–29.3%). Even if it is decreasing in figure compared to Amhara regional prevalence, 62.2% in 2007 , the finding of the study confirmed that trachoma is still a disease of public health interest. This result was almost in agreement with studies in other countries like in Malawi, 25.1% (16). The possible explanation could be increment of mass antibiotic distribution coverage with weak integration of health promotion on primary eye care, health information on personal and environmental hygiene of the Districts. The prevalence was higher than the study in Ghana (16.1%) . This might be due to differences in endemicity and period of study.
The prevalence of active trachoma was higher in lowland than medium land agro-climatic residence area. The potential risk factors related to agro-climatic area differences were illiterate household heads, absence of latrine, more flies on face of children. Children from illiterate household heads were 5 times more likely to have active trachoma than from literate household heads. This result was consistent with a study conducted in Tigray region, Ethiopia . Similar finding was reported from Tanzania . These might be due to the effect of literacy of the father/mother which is especially important because she/he is responsible for the caretaking of the children. An educated mother may be more aware of the benefits of hygiene practices to the health of her children compared to an uneducated mother.
Children from households getting less monthly income were more likely to have trachoma than those from households getting more income. A similar outcome was reported in Ethiopia . The possible explanation could be due to effects of poverty on health care, lack of hygiene, high chance of sharing tools, immunity status, and lack of information.
Those families who walk more than 30 minutes distance from water source were two times more likely to have trachoma than those on less than 30 minutes walk from water bodies. This finding was in line with investigations of Tanzania and Ethiopia [19–21].
The study has also revealed more association between active trachoma and frequency of latrine use than presence of latrine. This result is similar with previous report in Ankober, Ethiopia . This could be due to inaccessibility to latrine facilities and frequent exposed of human feces which are risk factors for the presence of high number of fly-eyes that leads to high chance of transmission of trachoma.
In the present study, there was significant association between active trachoma and unclean face. This finding is similar to studies that identify the presence of ocular and nasal discharge as risk factors for the presence of fly on eyes and active trachoma in Ethiopia and Tanzania [18, 22]. The presence of more flies on face was associated with more chance of having active trachoma. This finding is consistent with different investigations in Brazil; Nigeria and Ethiopia [23–25]. The possible explanation could be the role of eye seeking fly in trachoma transmission which is still remained common and high.
Children with less knowledgeable household heads about trachoma had about four times more likely to have infection than children from knowledgeable household heads. This finding was in line with investigations in Ethiopia which also reported overall reduction of trachoma ranges from 4% to 12% after provision of health education for community [26, 27]. Similar result was reported by the study conducted in Tanzania on comparing effect of antibiotic treatment alone versus antibiotic treatment combined with an intensive health education programme about facial cleanliness . The possible explanation for the differences could be less access to information, education and communication media on trachoma prevention, community based health education by trained health workers or volunteers and eye care units in the District.
The limitation of the study were the estimation of economic status, distance of water source and average monthly income of study households. It was merely based on respondents’ reply to the interviewer questions, which may be uncertain. Due to lack of sufficient resources the positive result of trachoma status could not be confirmed by advanced laboratory tests so that differential diagnosis may exaggerate the result. Moreover, the small sample size used might have an effect on the real magnitude of active trachoma.