Trachoma prevention practice and associated factors among mothers having children aged 1–9 years in Debre Markos Town, Northwestern Ethiopia, 2024

Abstract

Trachoma is a serious disease that gets little attention. It has a higher impact on low-income population categories. Due to this reason, the World Health Organization plans to enhance SAFE strategies to boost community contribution. There are few studies done in Ethiopian cities and towns on trachoma prevention practices. Due to this, the current study focused on the level of trachoma prevention practice among mothers who had children aged 1–9 years to provide timely data for local authorities and scientific communities. A community-based cross-sectional study design was used from 10 November to 30 December 2024 to assess the level of trachoma prevention practice. A single population proportion formula was used to sample the study units. Structured questionnaires and an observational checklist were used to gather data. A pretest was used to verify the quality of the data collection instruments. The binary logistic regression analysis model was used to examine the data using SPSS (Statistical Package for Social Science) version 27.0. For the independent variables, those with p < 0.05 were deemed statistically significant using the 95% CI. Among the respondent, 30.29% (95% CI: 21.31–46.71) of mothers had good trachoma preventive practice. Mothers who completed secondary or higher education had 1.35 times more likely good trachoma prevention practice than those had no formal education (AOR = 1.35; 95% CI: 1.08–3.05). Similarly, mothers who received health education within one year had good trachoma prevention practice 2.45 times more likely than their counterparts (AOR = 2.45; 95% CI: 1.71, 4.20). Mothers who spent < = 30 min for fetching water had good trachoma prevention practice 1.48 times more likely than who spent > 30 min (AOR = 1.48; 95% CI: 1.24, 2.64). Mothers who had good knowledge had good trachoma prevention practice 2 times more likely than their counterparts (AOR = 2.00; 95% CI: 1.45, 5.07). Similarly, Mothers who had good attitude had good trachoma prevention practice 2.01 times more likely than their counterparts (AOR = 2.01; 95% CI:1.24, 5.21). In this study, most mothers had poor trachoma prevention practices. Completed secondary education, good knowledge, a good attitude, and a shorter time traveling to fetch water were significantly associated factors. This indicates that works are required to intervene such factors.

Background

One bacterial infection that has received little attention is trachoma¹. It has a significant impact on communities with low incomes that lack access to basic sanitary facilities, clean water, or sufficient medical care. Blindness is most commonly caused by trachoma¹. It happens when a bacterium called Chlamydia trachomatis continually infects the eye, leading to scarring, eyelash in-turning (trichiasis), and ultimately vision impairment².

To eradicate trachoma as a public health concern, the World Health Organization (WHO) has suggested the SAFE method (surgery, antibiotics, facial cleanliness, and environmental improvement) as an integrated treatment³. In certain regions of the world, namely in South Asia, sub-Saharan Africa, a portion of Latin America, and the Pacific Islands, it still exists endemically^4–7.

Environmental and behavioral factors, such as poor personal hygiene, unclean faces, and crowded living conditions, are directly linked to the prevalence of trachoma. It is spread by flies, direct touch, ocular and nasal secretions, and contaminated materials^8–14. The most impacted subgroup is schoolchildren, particularly those under the age of ten, as they are more likely to live in unhygienic surroundings and interact with such individuals. Due to their tendency to be caretakers who frequently encounter infected children, women are also disproportionately affected^8,13,15–19.

In Ethiopian zonal cities, reports show a higher prevalence of active trachoma, such as 9.9% in Debre Tabor Town among school-aged children²⁰. Similarly, even in the capital city, Addis Ababa, a high prevalence of active trachoma (23.3%) has been reported among children aged 1–9 years²¹. However, there is no well-documented data on the prevalence of active trachoma in Debre Markos City. Since Debre Markos is similar to Debre Tabor in sociodemographic characteristics and both are categorized under the same city structure (regional metropolitan cities), and because trachoma is a water-washed disease, a comparable prevalence of active trachoma may exist in Debre Markos and may even be higher than that reported in Addis Ababa.

Due to disparities in trachoma prevention practice among people at risk, trachoma persists despite international efforts. Planning successful interventions and policies requires an understanding of the degree of trachoma awareness, perceptions, and preventive measures^14,22–26. To shape attitudes, which in turn influence preventive measures, knowledge is essential²⁷. Socioeconomic issues, cultural views, and misinformation can make it difficult to properly implement prevention. There are likely to be delays in seeking treatment and taking preventative action since most populations are unaware of the origins and effects of trachoma²⁸.

The persistence of unsanitary behaviors that aid in the disease’s transmission may also be due to misconceptions and ingrained beliefs²⁹. The purpose of this study is to evaluate trachoma prevention practices among mothers having children of aged 1–9 years. By identifying areas of weakness and factors influencing preventative behaviors, the study will assist in the development of targeted educational and public health initiatives. Consequently, these initiatives will help to strengthen trachoma control systems.

As a result, politicians, healthcare professionals, and community members will be better equipped to promote sustainable prevention and treatment practices. Additionally, this study will provide information on the sociocultural and economic factors that affect health behaviors and how community-based interventions can be used to reinforce surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) approach compliance.

The study will bridge the gap between the distribution of information and real behavior change by concentrating on trachoma prevention practice. These make trachoma prevention efforts evidence-based and socially and culturally acceptable. The WHO’s neglected tropical disease agenda calls for eradicating trachoma as a public health issue by 2030, and the findings will help with that effort.

Materials and methods

Study design

A community-based cross-section design was applied in Debre Markos Town, located 299 km from the capital city of Ethiopia, Addis Ababa. The study was conducted from 10 Nov 2024 to 30 December 2024. The town elevation above sea level is 2446 m, whereas it is situated at a latitude and longitude of 10° 21′ N and 37° 42′ E, respectively. According to the population projection of 2024, the population of Debre Markos City is 153,710, of whom 77,636 are females. From these, 56,500 are under 15 years old. The main source of water for domestic use in Debre Markos is groundwater.

Study sample

The source population of this study was all mothers that had been living in the study area who had at least 1 under-9 years old child. The study populations of the study were all mother having at least 1 under-9 child and had been living in the study area at least for 6 months before the study period. The sample size was calculated using the single proportion sample size formula with p = 50.16%, a 95% confidence level (Z = 1.96), and a 5% margin of error. This yielded a minimum sample size of 384. After adding a 10% non-response rate and applying a design effect of 1.5, the final sample size became 634. A multistage sampling technique was employed. First, 6 kebeles were randomly selected from the city’s 20 kebeles. Then, mothers of children aged 1–9 years were selected using systematic random sampling based on household lists obtained from health extension workers’ community health logbooks. Based on the households in which eligible participants live, proportional allocation for each kebele was done. Data collectors visited households systematically in each selected kebele to identify eligible mothers and conduct interviews.

Sampling began by randomly selecting one kebele from previously randomly selected kebeles (6 kebeles). In that kebele, health‑extension workers first enumerated all households having at least one child aged 1–9 years; this enumeration was based on log‑book records. From that list — which served as the sampling frame — the eligible households were assigned unique identification codes. These codes allowed the data collectors to locate and revisit the selected households easily during data collection. Finally, the data was collected from eligible households and then drawn randomly from the frame.

Outcomes variables

Trachoma Prevention practice.

Independent variables

Religion, mother’s age, child’s age, marital status, residence area, level of mothers education, level of father’s education, mother’s occupation, sex of child, gaining health education, type of source water, time taken to fetch water, water consumption, frequency of getting water, mother’s knowledge about trachoma, mothers’ attitude towards trachoma.

Operational definitions

Trachoma Prevention Practices. Trachoma prevention practices in this study refer to the specific hygiene and sanitation behaviors adopted by mothers to reduce the risk of trachoma infection in their children^14,30,31.

Good Trachoma Prevention Practice

A mother who correctly answers 60% or more of the trachoma prevention-related questions were classified as having a good practice of trachoma prevention^14,30,31. Those who scored less than 60% on the same questions were considered to have poor trachoma prevention practices.

Good Knowledge of Trachoma Prevention

Mothers who correctly answer 60% or more (i.e., at least 6 out of 10) of the trachoma-related knowledge questions were considered to have good knowledge^14,30,31. Those who scored less than 60% on the same questions were considered to have poor knowledge on trachoma prevention.

Good Attitude to Trachoma Prevention

Mothers who score 60% or more (i.e., at least 6 out of 10) on attitude-related questions were considered to have a good attitude to trachoma prevention^14,31. Those who scored less than 60% on the same questions were considered to have a poor attitude towards trachoma prevention.

Data collection

In this study, data were collected using a structured and pre-tested questionnaire adapted from previous studies^{14,22,23,26,30,32–34}, initially developed in English, translated into Amharic, and then back-translated into English to maintain language fluency and make it understandable for respondents. The pre-test was done on 5% of the study participants in another similar town of the same region (Finote-Selam Town). Six (6) trained BSc professionals in environmental health science conducted a face-to-face interview. We made modifications based on the results of the pre-test. During the actual data collection processes, two supervisors closely monitored the data collection process and reviewed the collected data daily to identify and correct incomplete or inconsistent responses. Any missing information was recollected on the same day to prevent data loss. Prior to the main data collection, a pretest was conducted in a similar setting, and the internal consistency of the instrument was assessed using Cronbach’s alpha. In addition, multicollinearity diagnostics were performed to evaluate potential correlations among independent variables. We found that no correlation among independent variables.

Statistical analysis

SPSS (Statistical Package for Social Science) version 27.0 was used to analyze the data. A binary logistic regression model was employed for data analysis. Double data entry was implemented to identify errors in data entry that might lead to misinterpretation of the actual data. Furthermore, model fitness was assessed using appropriate goodness-of-fit tests to verify the adequacy of the final regression model. Independent variables with a p-value of less than 0.25 in bivariable analysis were chosen for multivariable analysis to avoid the effects of cofounding variables. The independent factors that were deemed statistically significant were determined by calculating the adjusted multivariable analysis of p-value < 0.05 (AOR at 95% CI).

Result

Sociodemographic characteristics

The response rate of the study was 96.9% (614/634). A little over 60.8% lived in urban areas, and 39.2% lived in semi-urban areas. Over half of the children (55.1%) were under two years old. Of the children included in the study, slightly more were female (50.9%) than male (49.1%). Of the mothers, 47.7% had finished secondary school, 43.8% had finished primary school, and only 8.46% had never attended school. Mothers aged 35 and older made up nearly half (44.3%) of the sample, followed by mothers aged 25–34 (31.8%) and those aged 18–24 (23.9%). The mothers’ occupations were as follows: 32.4% were housewives, 26.1% worked for the government, 21.01% were farmers, and 20.5% were merchants (Table 1).

Table 1.

Sociodemographic, environmental and behavioral and other characteristics of mothers having children aged 1–9 years in Debre Markos City, Northwestern Ethiopia, 2025 (n = 614).

Variables	Frequency	Percentage
Religion
Christian	580	94.5
Muslim	34	5.5
Mother’s age
18–24 years	147	23.9
25–34 years	195	31.8
35 years and above	272	44.3
Child’s age
2 years	276	44.9
2 years	338	55.06
Marital status
Married	430	70.1
Not married	184	29.9
Residence area
Urban	373	60.8
Semi-Urban	241	39.2
Mother’s Education
No formal education	52	8.5
Primary education	269	43.8
Secondary education	293	47.7
Father’s Education
No formal education	143	23.3
Primary education	229	37.3
Secondary education	242	39.4
Mother’s Occupation
Merchant	126	20.5
Government employee	160	26.1
Housewife	199	32.4
Farmer	129	21.0
Sex of child
Male	301	49.1
Female	313	50.9
Health education
Yes	430	70.1
No	184	29.9
Type of source of water
Household	445	72.5
Non-household	169	27.5
Time taken to fetch water
	477	77.7
	137	22.3
Water consumption in liter (per capita/day)
	547	89.1
	67	10.9
Frequency of getting water
All the day	59	9.6
Day or night	206	33.5
In greater than one day	349	56.9
Knowledge about Trachoma
Good	477	77.7
Poor	137	22.3
Attitude about Trachoma prevention
Good	425	69.2
Poor	189	30.8

Environmental and behavioral characteristics

From the total study participants, 77.7% were able to retrieve water in less than 30 min; 22.3% required more time. Most participants showed good knowledge (77.7%) and a favorable attitude (69.2%) regarding trachoma prevention. Nearly 70% (70.1%) of mothers reported receiving health education regarding trachoma within the previous year (Table 1).

Trachoma prevention practice

In this study, 30.29% (95% CI: 21.31–46.71) of mothers had good trachoma prevention practice, while 69.71% (95% CI: 53.29–78.69) had poor trachoma prevention practice (Fig. 1). Most households (96.3%) had a latrine, and 93.5% had separate animal housing. Most mothers (88.4%) reported washing with soap, and 88.1% of mothers had clean faces, while 81.3% of latrines were regularly used. About 65.5% did not share household fomites, whereas 64.1% disposed of infant feces improperly. Only 35.9% disposed infant feces in latrines, and just 19.1% had a waste disposal pit, with only 7.5% using one (Table 2).

Fig. 1.

Trachoma prevention practice among mothers having children aged 1–9 years in Debre Markos Town, Northwestern Ethiopia, 2025 (n = 614).

Table 2.

Trachoma prevention practices assessment among mothers having children aged 1–9 years in Debre Markos City, Northwestern Ethiopia, 2025 (n = 614).

Assessment variables		Frequency	Percentage
Mothers’ facial cleanliness	Clean	541	88.1
	Not clean	73	11.9
Child facial cleanliness	Clean	334	54.4
	Not clean	280	45.6
Soap utilization for washing	Yes	543	88.4
	No	71	11.6
No fomite sharing among the family	Yes	402	65.5
	No	212	34.5
Availability of Household Latrine	Yes	591	96.3
	No	23	3.7
Utilization of Latrine	Yes	499	81.3
	No	115	18.7
Disposal of infant feces to the latrine	Yes	221	35.9
	No	393	64.1
Availability of the waste disposal pit	Yes	117	19.1
	No	497	80.9
Utilization of the Waste disposal pit	Yes	46	7.5
	No	568	92.5
Availability of separate animal doweling	Yes	574	93.5
	No	40	6.5
Mean score (1 for positive, 0 for negative)	6.3

Factors associated with trachoma prevention practice

Bivariable and multivariable binary logistic regression analyses were computed to analyze the association between trachoma prevention practice and its associated factors. Completed secondary education (AOR = 1.34; 95% CI: 1.08–3.05, p < 0.05), received health education within the previous year (AOR = 2.45, 95% CI: 1.71–4.20, p < 0.05), spending ≤ 30 min for fetching (AOR = 1.48, 95% CI: 1.24–2.64, p < 0.05), having a positive attitude toward trachoma (AOR = 2.01, 95% CI: 1.24–5.21, p < 0.05), and having good knowledge of trachoma were also associated factors for having good trachoma prevention practices (AOR = 2.00, 95% CI: 1.45–5.07, p < 0.05)(Table 3).

Table 3.

Factors associated with trachoma prevention practice among mothers having children aged 1–9 years in Debre Markos City, Northwestern Ethiopia, 2025 (n = 614).

Variable Factors	Outcome variable		COR at 95% CI	AOR at 95% CI	P value
	Good (N, %)	Poor (N, %)
Religion
Christian Muslim	164(28.28) 22(64.70)	416(71.72) 12(35.30)	4.65(0.78,6.99) + 1.00
Mother’s age
18-24 years 25-34 years 35 years and above	34(23.13) 64(32.82) 88(32.35)	113(76.87) 131(67.18) 184(67.65)	1.59(0.87, 2.45) + 0.98 (0.14, 2.86) + 1.00
Child’s age
Above 2 years 2 years and under 2 years	79(28.62) 107(44.21)	197(71.38) 231(55.79)	1.16 (0.79 ,2.67) + 1.00
Marital status
Married Not married	137(31.86) 49(26.63)	293(68.14) 135(73.37)	0.79 (0.33, 3.11) + 1.00
Residence area
Urban Semi-Urban	106(28.42) 80(33.19)	267(71.42) 161(66.81)	1.25(1.01, 2.78) * 1.00	1.16(0.74,2.43) ++	0.42
Mother’s Education
No formal education Primary education Secondary education and above	18(34.62) 87(32.34) 81(21.65)	34(65.38) 182(67.66) 212(78.35)	1.00 1.12 (1.55, 2.98) * 1.39 (1.13, 3.09) *	1.00 1.03 (0.98, 2.76) 1.35(1.08, 3.05)	0.23 <0.001
Father’s Education
No formal education Primary education Secondary education and above	11(7.69) 78(34.06) 97(40.09)	132(92.31) 151(65.94) 145(59.91)	1.00 0.16 (0.01, 1.46) + 0.12 (0.06, 1.07) +
Mother’s Occupation
Merchant Government employee Housewife Farmer	27(21.43) 56(35.00) 91(45.73) 12(9.30)	99(78.57) 104(65.00) 108(54.27) 117(90.70)	0.38(0.11, 2.01) + 0.19 (0.01, 1.86) + 0.12 (0.01, 1.05) + 1.00
Sex of child
Male Female	89(29.57) 97(30.99)	212(70.43) 216(69.01)	1.00 0.97 (0.01, 1.96) +
Health education in the past one year
Yes No	102(23.72) 84(45.65)	328(76.28) 100(54.35)	2.70 (1.74, 4.52) * 1.00	2.45 (1.71, 4.20) ** 1.00	0.01
Type of source of water
Household Non-household	114(25.62) 72(36.18)	331(74.38) 97(63.82)	2.16(1.67, 3.89) * 1.00	2.02 (0.97, 3.81)	0.74
Time taken to fetch water
	134(28.09) 52(37.96)	343(71.91) 85(62.04)	1.56(1.33,2.75) * 1.00	1.48 (1.24, 2.64) **	<0.001
Water consumption in liter (per capita/day)
	152(27.79) 34(44.16)	395(72.21) 33(55.84)	2.68(1.33, 4.21) * 1.00	2. 43 (0.78, 4.04)	0.12
Frequency of getting water
All the day Day or night In greater than one day	14(23.73) 42(20.39) 130(45.85)	45(76.27) 164(79.61) 219(54.15)	1.93 (1.42, 3.12) * 2.32 (1.76, 4.41) * 1.00	0.78 (0.63, 2.22)	0.65
Knowledge about Trachoma
Good Poor	126(26.41) 60(43.79)	351(73.59) 77(56.21)	2.17 (1.03, 5.62) *	2.00 (1.45, 5.07) **	0.04
Attitude about trachoma prevention
Good Poor	98(23.06) 88(46.56)	327(76.94) 101(53.44)	2.91 (2.11, 5.78) * 1.00	2.01 (1.24, 5.21) **	<0.001

N.B: ⁺ = P>0.25; ^* = P 0.25; ** = P< 0.05.

Discussion

The purpose of this study was to evaluate the magnitude and prevalence of trachoma prevention practice with its associated factors among mothers in Debre Markos City. The study revealed that 30.29% (95% CI: 21.31–46.71) of them had good trachoma prevention practices. The finding is in line with the study done in Adis Zemen and Tigray, Ethiopia^14,23. However, it was lower than the findings of studies in Andabet District, Lomi District, and Oromia, Ethiopia^30,31,35. The observed discrepancies in the Ethiopian case, compared with the results of different setups, such as the time when the investigations were conducted. In a similar vein, infrastructure and cultural factors may be the cause of the variances between this study and previous research done outside of Ethiopia.

According to the current study, in comparison to mothers without formal education, those with a secondary education were significantly 1.35 times more likely to have good prevention practices. The results of studies conducted in Andabet, Ethiopia³¹, and Vietnam³⁶, which also showed that improved education contributed to better trachoma prevention behaviors among study participants, corroborate the findings. This could be because a higher level of education raises the awareness and proficiency needed to implement preventive practice, as the mother can apply each SAFE strategy for better caring for her children²⁶.

To further highlight the influence of health promotion interventions on behavioral change, mothers who had received health education within the previous year were 2.45 times more likely to practice good prevention as their counterparts. Investigations conducted in the Andabet and Lemo districts, Ethiopia^31,35 supported the current study. Mothers who attended health education focused on trachoma prevention may have improved their ability to apply trachoma preventive techniques, which could account for this correlation^37–39.

The family’s reduced time spent fetching water was another aspect that helped improve trachoma prevention. Mothers who visited a water point for 30 min or less were 1.48 times more likely to have better trachoma preventive practices than mothers who visited for more than 30 min, according to the current study. This is inline with the studies conducted Andabet District and Oromia, Ethiopia^30,31 and Kenya⁴⁰. This is due to the possibility that the mother will spend more time getting water than tending to their kids. Additionally, the amount of water consumed will be reduced to lessen fatigue from long-distance travel when the time spent viewing water is extended. This correlation is supported by different findings^41,42.

This study showed that mothers who had good knowledge about the disease trachoma and its prevention mechanism had 2 times more likely better trachoma prevention practice than their counterparts. this is inline with studies conducted in Adis Zemen, and Tigray, Ethiopia^14,23. Women who may have been well-informed about trachoma were more capable of adhering to preventive measures. The mother’s propensity to implement protective measures increased without any skill deficiencies once she mastered the concepts and methods of trachoma prevention systems. This may be the result of improved health-related behaviors brought about by the given health education^43,44.

The current study revealed that attitude of mothers towards trachoma prevention determined their trachoma prevention practice capabilities. Mothers who had good attitude towards trachoma prevention had 2.01 times more likely better trachoma prevention practice than their counterparts. This significant correlation of attitude and practice supported by studies done on other similar communicable disease⁴⁵. The most Justifiable reason for this correlation might be good attitude can increase the intention to apply the principles and the techniques used for preventing trachoma⁴⁶.

Strengths and limitations of the study

This study employed a community-based cross-sectional design with door-to-door data collection rather than relying on institutional data, enhancing the representativeness of the findings. In addition, observational assessments of facial cleanliness, latrine utilization, and waste management practices strengthened data validity by minimizing self-report bias. However, logistical, and contextual constraints prevented the implementation of a case–control design, limiting the ability to establish causal relationships.

Conclusion

When compared to earlier research, this study found that mothers had lower percentages of good trachoma prevention practice, with only 30.29% of trachoma prevention practices observed. Good trachoma preventive practices were influenced by completing secondary and higher education, gaining health education within a year, having good knowledge and a good attitude, and taking less time to gather water. Therefore, considering the results, these population groups should be given serious consideration to improve their chances of protecting their children from the avoidable eye illness, trachoma.

Recommendation

At the local level, it is crucial to strengthen the implementation of the SAFE strategy by improving access to a dependable water supply and expanding community health education that focuses on knowledge and attitudes regarding trachoma prevention. Additionally, community engagement in obtaining health information and putting recommended preventive behaviors into practice is still crucial. Additionally, as this study used a cross-sectional methodology, longitudinal or interventional methodologies should be used in future research to better establish causal links and evaluate the impact of water availability and education interventions on long-term trachoma prevention practices.

Abrieviations

AOR

Adjusted Odds Ratio

CI

Confidence Interval

SAFE

Surgery, Antibiotics, Facial cleanliness and Environmental improvement

WHO

World Health Organization

Author contributions

MM, AT, GMK, BA, TY, EW conceptualized and supervised the study. MM and AT and BA performed the Analysis. AA, MM, AFD and YB drafted the manuscript. BA, MM, TY, EW, and AFD contributed to data interpretation. All authors reviewed the manuscript. All authors read and approved the final manuscript.

Funding

This work was not funded by any funder.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Competing interests

The authors declare no competing interests.

Ethics approval and concent to participate.

The study was performed based on the norms and standards of the revised Helsinki declaration adopted in October 2024⁴⁷. The College of Medicine and Health Sciences Research Ethics Committee provided us letters of ethics approval(Ref No: CMHSC/Eth/041/2024) after careful reviewing our proposal. Study participants were fully informed about the purpose, procedures, benefits, and risks of the study, and informed consent was obtained prior to participation. Participation was entirely voluntary, and participants were assured of their right to withdraw from the study at any time without any precondition or consequence. Confidentiality of all information was strictly maintained, and data were used solely for research purposes.

Informed written concent

From all participmnts, informed written concent was obtained.