The prevalence of Active Trachoma in rural Wadla district among rural preschool children was 21.8%, [(95%, CI), (18%, 25%)]. This puts the district on the second stage of World Health Organization threshold [17]. The research indicates SAFE strategy were unsuccessful in the last 7 years in Wadla district [29]. There are also studies [14, 15, 25, 28] that reported the prevalence of Active Trachoma above 20%. It displays that trachoma is still a public health problem. The finding also agreed with previous reports and researches [15, 30] done in Africa and different parts of Ethiopia, such as the 6th meeting report of WHO, that reported the prevalence of active trachoma in Algeria was 26%, in Burkina Faso was 26.9% [30] and a study in different regions of Ethiopia reported the prevalence as 22.6% in Somali region, in Tigray region 26.5% and 19.1% in Gambela region [15].
The finding of this study was lower than that of the studies done in southern Sudan was 64.5% [31], in Egypt was 49% [32], and in Nigeria was 35.7% [12]. This variation might be the result of different study period and difference in health care service. Because this study conducted after 8 years in relative to these comparing studies. In addition, intensive SAFE strategy implementation in all endemic countries were reached peak in the past seven years. Similarly, the finding is lower than many studies 59.2% [33], 32.4%, 42.4%, 56.9% [28], 62.6% [14], 40.1% [23] conducted before 2015. Therefore, the current reduction of active trachoma in the study area and in other endemic areas across the continent [16] Africa, is mainly the result of SAFE strategy and improved socio-demographic characteristics. But, the finding of this study was higher than a study conducted in 2016 in Gonder, Ethiopia (12.1%) [16]. The difference might be because of different study population, level of urbanization and difference in infrastructure. This study done only in rural children aged 6 moths to 5 years but the comparative one is in urban children aged 1 – 9 years old [16].
The prevalence of TI in this study area was 3.4% agreed with the study conducted in South Wollo zone was 4.3% [34], and lower than the study in South Gonder zone was 7.0% [34]. This discrepancy might be the result of different study subjects and this discrepancy agreed with the statement that the progress of trachoma from one stage to other stage is gradual and increases as age increases [2].
The study showed washing face once weekly (AOR (95%CI), 8.686 (2.577-29.277) and unwashed face for longer than a week (AOR (95% CI), 10.592 (2.974-37.727) as well as presence of fly in near home (AOR (95% CI), 4.603 (2.138-9.911) had positive association with active trachoma, which is in line with a study conducted in southern Sudan, and Gonder, Ethiopia [35, 36]. Absence of toilet (AOR (95% CI), 5.089 (2.011-12.876) also had positive association with active trachoma, which is similar with a study conducted in Nigeria, Egypt, north-west Ethiopia, and Gonder [34, 35, 37, 38]. The presence of human excreta near to home (AOR (95%CI), 5.089 (2.011-12.876) was also increase the odds of active trachoma. This is supported with a study conducted in Dera district, Ethiopia [39]. This study also reported not using soap while washing face were increasing the odds of acquiring active trachoma (AOR (95%CI), 4.493 (1.788-11.290) and it is supported by the study conducted in Dessie city, Ethiopia, and Gonder, Ethiopia [35, 40].
All of these positively risk factors agreed with a literature that trachoma is mainly attributed to environmental factors, sanitation and hygiene practice. The Bazaar vector, Musca Sorben is also proposed as major risk factor of trachoma, which is multiplied in open field human excreta. Therefore, the absence of latrine increase the occasion of fly multiplication sites and densities of fly and in turn causes active trachoma[41]. The poor habit of hygiene and sanitation as well as failure to use soap also contribute for the presence of ocular and nasal discharge on children’s face, which open the opportunities for flies to contact with unclean face of those children.
Thatched grass house roof (AOR (95% CI), 4.402 (1.425-13.597) had association with active trachoma, which is in line with a study done in central Ethiopia [42] and poor economic status (AOR (95% CI), 3.804 (1.267-11.424) also increase the odds of active trachoma supported by the study done in Gonder, Ethiopia [35]. These association are also consistent with a literature that trachoma is a disease of poverty, overcrowding, and poor hygiene [8, 9].
Conclusion
The prevalence of trachoma is high in the study area. Environmental factors weigh other factors and this could capture the intention of policy makers to emphasize on the environmental components like sanitation including face cleanness to decrease the prevalence of trachoma while caring preschool children.