Prevalence, Risk Factors and Trachoma Causing Species Circulating in East Pokot, Baringo County, Kenya

Abstract

Trachoma is the leading cause of infectious blindness and is caused by the bacterium Chlamydia trachomatis. Trachoma is mainly found in the developing world among marginalized communities where there is scarcity of clean water and lack of proper sanitation and hygiene. These communities are also plagued by poor access to health care and health facilities. Trachoma has also been found to disproportionately afflict women and children in view of the fact that women are the main care givers. Trachoma was found to be endemic in six counties in Kenya including Baringo County. The Ministry of Health in Kenya has adopted the WHO SAFE or elimination of trachoma by 2020. Despite these interventions, the prevalence of trachoma is still high at 23% and 3.3% for both infectious and blinding trachoma respectively. This study investigated the prevalence and risk factors for trachoma among residents of East Pokot, Baringo County. This was a descriptive cross-sectional study, targeting 450 people of all ages living in East Pokot. The sample size was calculated using the Cochrane formula.The study objective was to determine prevalence, risk factors and Trachoma causing Chlamydia species circulating in East Pokot, Baringo County, Kenya. The study employed a multi-stage and simple random sampling procedure. Villages in target area were classified as clusters where households were selected randomly within the villages. Cluster Random Sampling was done at household level and all household members within the house were sampled. A structured questionnaire was used to collect social demographic data for each household. Conjunctival swabs were collected using a sterile swab. DNA was extracted from the eye swab and PCR analysis carried out for diagnosis of the different Chlamydia species. Data was analyzed using STATA and descriptive statistics were used to summarize demographic profiles and determine prevalence and odds ratio, multiple regression analysis to assess the independent effect of each determinant risk factor after controlling for all other factors. The significance level of this study was 5% (p=0.05). Out of the 450 samples collected, a total of 405 samples were analyzed. The prevalence of trachoma was found to be 44.44%. Of this, 14.07% (57) were confirmed PCR positive. PCR results showed dual infection: 12.28% (7) had C. trachomatis and C. psittaci, 8.77% (5) had C. psittaci and C. pneumonia, and none had C. trachomatis and C. pneumonia. None of the samples had triple infection with all the three species: C. trachomatis, C. psittaci and C. pneumonia. Adults aged above 9 years had higher odds of getting trachoma (OR=3.88, 95% CI 1.07-14.12, p=0.04) compared to the children aged 9 years and below. There was however no significant difference in the prevalence of trachoma between males and females (p=0.79). The findings of this study indicate that guardians and children in East Pokot are at considerable risk of trachoma infection due to the behavioral practices and attitudes. The factors significantly associated with trachoma were found to be secondary education (p=0.036) and indigenous religion (p=0.0258). A total of 180 (44.44%) out of the 405 participants were diagnosed as clinically Trachoma positive. Of these, 25 (13.89%) tested laboratory positive for Chlamydia. On the other hand, 225 (55.56%) were diagnosed as clinically Trachoma negative and of these 20 (8.89%) tested chlamydia negative in the laboratory. Therefore, the overall concordance between the clinical diagnosis and laboratory diagnosis was 29.94%Results showed that active trachoma is still a major public health concern in the study area. Health education and promotion activities for awareness creation with an aim of changing cultural perceptions and practices that contribute to trachoma transmission need to be emphasized. The community also needs to be encouraged to build and utilize latrines for human waste disposal and the County Government of Baringo should consider drilling water points to promote proper hygiene practices that will help control trachoma transmission and bring down the prevalence levels below the WHO threshold (<10 % prevalence).