The Added Value of Water, Sanitation, and Hygiene Interventions to Mass Drug Administration for Reducing the Prevalence of Trachoma: A Systematic Review Examining

Trachoma is the leading cause of infectious blindness worldwide. The SAFE strategy, the World Health Organization-recommended method to eliminate blinding trachoma, combines developments in water, sanitation, surgery, and antibiotic treatment. Current literature does not focus on the comprehensive effect these components have on one another. The present systematic review analyzes the added benefit of water, sanitation, and hygiene education interventions to preventive mass drug administration of azithromycin for trachoma. Trials were identified from the PubMed database using a series of search terms. Three studies met the complete criteria for inclusion. Though all studies found a significant change in reduction of active trachoma prevalence, the research is still too limited to suggest the impact of the “F” and “E” components on trachoma prevalence and ultimately its effects on blindness. 1. Introduction Caused by the bacteria Chlamydia trachomatis, trachoma is the world’s leading cause of infectious blindness [1]. Associated with a lack of access to water, sanitation, and hygiene education (WASH), trachoma debilitates some of the world’s most marginalized peoples [2]. The World Health Organization (WHO) estimates that 325 million people in 53 countries live in trachoma-endemic areas [3]. The routes of transmission of trachoma, all of which are hygiene related, include indirect infection by fly vector as well as direct person-to-person and indirect contacts via fomites including clothing, towels, and handkerchiefs [3]. Blindness due to trachoma is caused by repeated infection of Chlamydia trachomatis resulting in the inflammation of the upper eyelid, which eventually leads to scarring. Scarring, over time, constricts the upper lid causing the eye lashes to pull inward, scratching, and tearing the cornea resulting in loss of vision [4, 5]. Trachoma has caused visual impairment in 2.2 million people globally of which 1.2 million endure irreversible blindness [3]. The WHO strategy to eliminate all avoidable blindness by the year 2020 is called VISION 2020: Right to Sight. Blinding trachoma as a public health problem is specifically targeted as a priority condition in this initiative through an alliance of partners working with WHO called the Global Elimination of Trachoma as a Cause of Blindness by the Year 2020 (GET 2020) [4]. These collaborators work toward eliminating trachoma-related blindness through the implementation of an integrated intervention called the SAFE strategy (surgery, antibiotic, face washing, and environmental control); it is a