Impact of mass drug administration on active trachoma prevalence among Yemeni children in highly endemic areas: Eliminating trachoma as a public health problem

Background This study assessed the impact of multiple rounds of mass drug administration (MDA) with azithromycin on the prevalence of trachomatous inflammation-follicular among children aged 1–9 years (TF _1–9 ) in highly endemic districts of Yemen and identified its predictors. Methods A cross-sectional study using a two-stage cluster sampling approach was conducted among 1290 children from randomly selected households across six districts with a baseline trachoma prevalence exceeding10% in Ibb and Hodeidah governorates. These districts were targeted by three rounds of MDA from 2021 to 2024. A structured questionnaire was used to collect data on the sociodemographic characteristics of children, as well as the availability and status of water, sanitation, and hygiene (WASH) access. Additionally, children's eyes were examined for trachoma. Univariate analysis was performed to assess the association between independent variables and TF _1–9 , while multivariable binary logistic regression was used to identify predictors of TF _1–9 at a statistical level of < 0.05. Results TF _1–9 was prevalent among 0.9% (11/1290) of children in previously highly endemic districts of Ibb and Hodeidah governorates, with reductions ranging from 83.5–95.2%. Multivariable binary logistic regression analysis showed that unemployed fathers (AOR = 7.7, 95% CI: 1.33–44.68, P  = 0.023), households lacking improved sanitation facilities (AOR = 11.9, 95% CI: 1.85–76.61, P  = 0.009), and the presence of nasal and/or ocular discharges on a child's face (AOR = 92, 95% CI: 7.07–1196.76, P  < 0.001) were independent predictors of TF _1–9 . Conclusions The prevalence of TF _1–9 in previously highly endemic districts of Ibb and Hodeidah governorates has decreased below the WHO-recommended threshold for eliminating trachoma as a public health problem, indicating that additional MDA is unnecessary. However, surveillance surveys are required after two years to monitor any resurgence of trachoma. TF _1–9 can be independently predicted in children whose fathers are unemployed and who live in households with poor sanitation and have dirty faces with nasal or ocular discharges. Therefore, interventions to improve sanitation facilities and promote good hygiene practices are crucial for reducing the prevalence of trachoma in endemic areas.