Prevalence of and Risk Factors for Trachoma in Southern Nations, Nationalities, and Peoples’ Region, Ethiopia: Results of 40 Population-Based Prevalence Surveys Carried Out with the Global Trachoma Mapping Project

Figures & data

Figure 1. Evaluation units of grouped woredas (districts), Global Trachoma Mapping Project, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, 2013–2014.

Table 1. Demographic characteristics of individuals enumerated, Global Trachoma Mapping Project, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, 2013–2014.

Age group, years	Sex	Examined, n (%)	Absent, n (%)	Refused, n (%)	Other, n (%)	Total, n
1–9	Male	21,296 (96.2)	805 (3.6)	44 (0.2)	4 (0.0)	22,149
	Female	20,919 (97.5)	508 (2.4)	29 (0.1)	3 (0.0)	21,459
10–14	Male	8113 (88.1)	1074 (11.7)	21 (0.2)	0 (0.0)	9208
	Female	7871 (90.9)	761 (8.8)	23 (0.3)	2 (0.0)	8593
≥15	Male	26,085 (82.8)	5333 (16.9)	71 (0.2)	7 (0.0)	31,496
	Female	37,113 (95.3)	1767 (4.5)	73 (0.2)	4 (0.0)	38,957
Total		121,397	10,248	261	20	131,926

Table 2. Trachomatous inflammation – follicular (TF) prevalence in children aged 1–9 years by evaluation unit, Global Trachoma Mapping Project, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, 2013–2014.

Zone	Evaluation unit	Examined, n	TF cases, n	Unadjusted TF, %	Adjusted^a TF, % (95% CI)
Hadiya	Misha, Anna Lemo, Gibe, Limo	1093	498	45.6	45.0 (38.1–51.8)
	Soro, Duna, Gombora	1092	397	36.4	36.0 (28.2–44.9)
	Shashego, Yem, Misrak Badawacho, Mirab Badawacho	1189	446	37.5	37.8 (31.6–44.8)
Sidama	Dale, Shebedino	837	273	32.6	30.6 (24.3–37.2)
	Hawassa Zuria, Boroche, Wenedo Genet	1036	424	40.9	39.5 (31.5–46.9)
	Arbegona, Bona Zuria, Bursa, Chirie	1238	251	20.3	17.4 (10.1–24.2)
	Dara, Aleta Wendo Town, Loka Abaya, Chiko	962	225	23.4	22.7 (16.7–29.3)
	Aroresa, Bensa	1120	324	28.9	27.7 (19.8–37.0)
	Gorchie	1029	68	6.6	6.3 (2.7–10.0)
	Hula	966	118	12.2	10.1 (5.4–15.0)
	Malega	1050	124	11.8	11.8 (7.2–15.3)
	Wenesho	900	150	16.7	13.6 (9.1–18.7)
Gedio	Kochere, Gedeb, Yergachefe	1299	251	19.3	18.3 (13.2–22.4)
	Bule, Wenago, Dilla Zuria	1105	209	18.9	15.0 (9.4–20.1)
South Omo	Basketo, South Ari, Semen Ari, Salamago, Debub Ari, North Ari	1072	304	28.4	26.6 (19.5–35.9)
	Hamer, Bena Tsemay, Dassenech, Malie, Nyngatom	1043	240	23	20.1 (13.3–27.8)
Sheka	Yeki, Masha Anderacha, Masha, Masha Town, Tepi Town	863	110	12.7	12.0 (6.2–18.3)
Kafa	Chena, Gesha, Gewata, Gimbo, Saylem	991	426	43.0	40.8 (32.9–48.9)
	Bita, Cheta, Decha, Menjiwo, Tello	1036	429	41.4	36.9 (29.1–44.5)
Bench Maji	Bero, Shay Bench, Surma, Guraferda, Maji, Meanit Goldiiya, Meint Shasha, Debub Bench	1115	398	35.7	32.0 (24.4–41.8)
	Semen Bench, Sheko, Mizan Aman Town	1212	358	29.5	28.5 (20.1–35.7)
Segen	Amaro, Burji	1301	658	50.6	48.5 (41.5–55.9)
East Gurage/Konta/Dawro	Konta, Isara, Tocha, Mareko	927	330	35.6	35.6 (27.2–44.9)
Dawro	Gena Bosa, Loma, Tercha Town	1030	303	29.4	28.1 (21.2–34.0)
Silti	Alicho Wuriro, Misirak Azerenert Berbere, Sankura, Mirab Azerenert Berbere, Wilbareg	984	315	32.0	26.4 (18.0–36.5)
	Dalocha, Lamfero, Selti	1191	368	30.9	27.0 (18.6–33.4)
Gamo Gofa	Kemba	1158	350	30.2	26.4 (19.1–35.5)
	Bonke	1098	193	17.6	15.8 (9.3–24.3)
	Arbaminch Town	1018	214	21.0	19.0 (13.5–25.5)
Special	Konso	1084	427	39.4	35.5 (28.2–41.9)
Kembata Tembaro/Halaba	Halaba Special woreda, Demboya, Kedida-Gamela	1166	524	44.9	41.0 (33.8–48.5)
	Angacha, Hadero Tunito, Kacha Bira, Doyugena, Tembaro	1005	323	32.1	29.1 (24.2–35.3)
Gurage	Cheha	794	256	32.2	29.1 (22.4–35.4)
	Ezha	798	120	15.0	13.9 (9.8–18.9)
	Mihur Aklil	784	234	29.8	27.6 (18.2–39.8)
	Kebena	959	286	29.8	30.8 (24.5–38.0)
	Kokir	958	157	16.4	15.4 (9.8–23.6)
	Abeshige	958	155	16.2	14.7 (9.6–20.2)
	Sodo	940	400	42.6	41.4 (31.2–49.9)
	Geta, Gumer	754	17	2.3	2.3 (0.6–4.8)

^aAdjusted for age in 1-year age bands.

CI, confidence interval.

Figure 2. Prevalence of trachomatous inflammation – follicular (TF) in children aged 1–9 years, Global Trachoma Mapping Project, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, 2013–2014.

Table 3. Trichiasis prevalence in those aged ≥15 years by evaluation unit, Global Trachoma Mapping Project, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, 2013–2014.

		Examined age 15 years or greater
Zone	Evaluation unit	Examined, n	Trichiasis cases, n	Unadjusted TT, %	Adjusted^a TT, % 95% CI
Hadiya	Misha, Anna Lemo, Gibe, Limo	1649	54	3.3	2.1 (1.3–2.7)
	Soro, Duna, Gombora	1674	74	4.4	2.6 (1.5–4.1)
	Shashego, Yem, Misrak Badawacho, Mirab Badawacho	1615	70	4.3	3.0 (2.0–4.2)
Sidama	Dale, Shebedino	1686	34	2.0	1.6 (0.9–2.5)
	Hawassa Zuria, Boroche, Wenedo Genet	1592	27	1.7	1.1 (0.5–1.9)
	Arbegona, Bona Zuria, Bursa, Chirie	1466	3	0.2	0.1 (0.0–0.1)
	Dara, Aleta Wendo Town, Loka Abaya, Chiko	1596	9	0.6	0.5 (0.1–1.0)
	Aroresa, Bensa	1558	9	0.6	0.4 (0.1–0.6)
	Gorchie	1506	2	0.1	0.1 (0.0–0.1)
	Hula	1478	2	0.1	0.0 (0.0–0.1)
	Malega	1370	7	0.5	0.3 (0.0–0.5)
	Wenesho	1528	8	0.5	0.3 (0.0–0.6)
Gedio	Kochere, Gedeb, Yergachefe	1614	17	1.1	0.8 (0.3–1.5)
	Bule, Wenago, Dilla Zuria	1456	22	1.5	0.7 (0.4–1.0)
South Omo	Basketo, South Ari, Semen Ari, Salamago, Debub Ari, North Ari	1205	13	1.1	0.6 (0.1–1.2)
	Hamer, Bena Tsemay, Dassenech, Malie, Nyngatom	1215	26	2.1	1.1 (0.5–1.5)
Sheka	Yeki, Masha Anderacha, Masha, Masha Town, Tepi Town	1987	21	1.1	0.7 (0.3–1.1)
Kafa	Chena, Gesha, Gewata, Gimbo, Saylem	1727	25	1.4	1.1 (0.5–1.9)
	Bita, Cheta, Decha, Menjiwo, Tello	1592	22	1.4	0.9 (0.5–1.4)
Bench Maji	Bero, Shay Bench, Surma, Guraferda,Maji, Meanit Goldiiya, Meint Shasha, Debub Bench	1306	11	0.8	0.6 (0.2–1.1)
	Semen Bench, Sheko, Mizan Aman Town	1470	15	1.0	0.8 (0.3–1.3)
Segen	Amaro, Burji	1500	59	3.9	2.6 (1.6–3.4)
East Gurage/Konta/Dawro	Konta, Isara, Tocha, Mareko	1462	58	4.0	2.3 (1.4–3.1)
Dawro	Gena Bosa, Loma, Tercha Town	1620	34	2.1	1.2 (0.8–1.7)
Silti	Alicho Wuriro, Misirak Azerenert Berbere, Sankura, Mirab Azerenert Berbere, Wilbareg	1434	27	1.9	0.8 (0.4–1.4)
	Dalocha, Lamfero, Selti	1468	52	3.5	2.0 (1.3–2.7)
Gamo Gofa	Kemba	1456	28	1.9	1.1 (0.5–1.8)
	Bonke	1481	27	1.8	1.2 (0.7–1.9)
	Arbaminch Town	1416	31	2.2	0.8 (0.5–1.2)
Special	Konso	1394	33	2.4	1.0 (0.7–1.4)
Kembata Tembaro/Halaba	Halaba Special woreda, Demboya, Kedida-Gamela	1559	53	3.4	2.0 (1.3–2.7)
	Angacha, Hadero Tunito, Kacha Bira, Doyugena, Tembaro	1640	77	4.7	3.1 (2.3–3.8)
Gurage	Cheha	1606	184	11.5	6.1 (4.4–7.8)
	Ezha	1895	97	5.1	2.2 (1.4–3.3)
	Mihur Aklil	1488	98	6.6	4.3 (2.8–6.3)
	Kebena	1546	125	8.1	4.5 (3.1–6.2)
	Kokir	1425	35	2.5	1.6 (1.0–2.5)
	Abeshige	1730	80	4.6	3.3 (2.2–4.5)
	Sodo	1473	49	3.3	1.4 (0.7–2.0)
	Geta, Gumer	1830	17	0.9	0.3 (0.1–0.6)

Adjusted for sex and age in 5-year age bands.

CI, confidence interval.

Figure 3. Prevalence of trichiasis in those aged ≥15 years, Global Trachoma Mapping Project, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, 2013–2014.

Table 4. Multilevel univariable analysis of factors related to trachomatous inflammation – follicular (TF) and trachomatous inflammation – intense (TI) in children aged 1–9 years, Global Trachoma Mapping Project, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, 2013–2014.

		TF		TI
Variable	Examined, n	%	Odds ratio^a (95% CI)	%	Odds ratio^a (95% CI)
Individual
Age, years
1–4	17,649	36.4	2.66 (2.53–2.81)	5.3	2.40 (2.16–2.68)
5–9	25,960	20.5	1 (reference)	2.4	1 (reference)
Sex
Male	22,149	26.9	1 (reference)	3.5	1 (reference)
Female	21,459	27.0	1.01 (0.97–1.06)	3.7	0.89 (0.77–1.02)
Household
Children aged 1–9 years in household, n
1–3	34,061	27.2	1 (reference)	3.7	1 (reference)
≥4	9547	26.0	1.02 (0.96–1.09)	3.3	0.89 (0.78–1.02)
Inhabitants in household, n
1–7	36,477	27.8	1 (reference)	3.6	1 (reference)
≥8	7131	22.6	0.91 (0.85–1.02)	3.2	0.97 (0.82–1.14)
Time to main source of drinking water, minutes
<30	20,378	26.7	1 (reference)	3.8	1 (reference)
≥30	23,230	27.2	0.97 (0.90–1.05)	3.4	0.94 (0.81–1.09)
Time to main source of water used for face-washing, minutes
All washing at source	112	28.6	1.02 (0.43–2.39)	6.3	2.81 (0.69–11.27)
<30	21,996	26.4	1 (reference)	3.8	1 (reference)
≥30	21,500	27.4	1.00 (0.93–1.08)	3.3	0.90 (0.77–1.04)
Surface water^b used as drinking source
Yes	5296	30.5	1.19 (1.03–1.38)	4.6	1.21 (0.95–1.55)
No	38,312	26.4	1 (reference)	3.4	1 (reference)
Surface water^b used for face-washing
Yes	8018	28.4	1.11 (0.99–1.24)	4.5	1.29 (1.06–1.58)
No	35,590	26.6	1 (reference)	3.4	1 (reference)
Latrine type^c
Improved latrine	2367	23.8	1 (reference)	3.0	1 (reference)
Unimproved latrine	33,937	26.3	1.07 (0.93–1.22)	3.5	1.10 (0.83–1.46)
Open defecation (no facilities, bush, or field)	7304	31.1	1.18 (1.02–1.37)	4.1	1.28 (0.95–1.76)
Kebele (cluster)
Altitude^d, m above sea level
<2500	34,696	31.5	1 (reference)	4.3	1 (reference)
≥2500	8883	8.9	0.21 (0.17–0.25)	0.8	0.18 (0.13–0.24)
Mean annual precipitation^e, mm
<1000	6403	35.4	2.01 (1.54–2.63)	4.7	1.66 (1.23–2.24)
1000–1499	27,968	24.5	1 (reference)	3.2	1 (reference)
≥1500	9237	28.5	1.41 (1.13–1.77)	4.0	1.44 (1.11–1.85)
Mean annual temperature^e, ◦C
<15	7724	7.0	0.10 (0.08–0.13)	0.8	0.16 (0.11–0.23)
≥15	35,884	31.2	1 (reference)	4.2	1 (reference)
Maximum temperature of warmest month^e, °C
<25	11,150	12.3	0.18 (0.15-0.22)	1.2	0.23 (0.18-0.31)
≥25	32,458	32.0	1 (reference)	4.4	1 (reference)

^aMultilevel univariable random effects regression accounting for clustering at kebele-level, with 95% CI; p-value from Wald’s test; variables significant at the p < 0.10 level are shown in bold.

^bRiver, dam, lake, canal.

^cWHO/UNICEF Joint Monitoring Programme improved sanitation definitions; open defecation displayed separately.

^dEstimate from GPS coordinates of household measured on smartphones at the time of survey.

^eEstimate from GPS coordinates of household, extracted at kebele(cluster)-level from Bioclim rasters (Worldclim.org).

CI, confidence interval; WHO, World Health Organization; GPS, global positioning system.

Table 5. Multivariable multi-level risk factor model for the outcomes trachomatous inflammation – follicular (TF) and trachomatous inflammation – intense (TI) in children aged 1–9 years, Global Trachoma Mapping Project, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, 2013–2014.

Variable	TF model		TI model
	Odds ratio^a (95% CI)	P-value^b	Odds ratio^a (95% CI)	P-value^b
Age, years		<0.0001		<0.0001
1–4	2.65 (2.52–2.79)		2.38 (2.13–2.65)
5–9	1 (reference)		1 (reference)
Mean annual temperature^c, °C		<0.0001		0.001
<15	0.16 (0.11–0.23)		0.42 (0.25–0.69)
≥15	1 (reference)		1 (reference)
Altitude^d, metres above sea level		<0.0001		<0.0001
<2500	1 (reference)		1 (reference)
≥2500	0.50 (0.40–0.70)		0.31 (0.20–0.49)
Latrine type^e		0.0311		0.1163^f
Improved latrine	1 (reference)		1 (reference)
Unimproved latrine	1.10 (0.96–1.26)		1.17 (0.88–1.56)
Open defecation (no facilities, bush, or field)	1.19 (1.02–1.38)		1.33 (0.97–1.82)

^aMultilevel multivariable random effects regression accounting for clustering at kebele-level. Sex was included in the model a priori, but was not statistically significant for either TF or TI (p < 0.05 level, likelihood ratio test).

^bLikelihood ratio test.

^cEstimate from GPS coordinates of household, extracted at kebele-level from Bioclim rasters (Worldclim.org).

^dEstimate from GPS coordinates of household measured on smartphones at the time of survey.

^eWHO/UNICEF Joint Monitoring Programme improved sanitation definitions; open defecation displayed separately.

^fNot included in final TI model, but presented for illustrative purposes.

CI, confidence interval; WHO, World Health Organization; GPS, global positioning system.