Prevention: Hygiene and the Environment

Trachoma is a highly contagious infection that thrives in environments where it can easily move from person to person ^[1]. Because the bacteria (Chlamydia trachomatis) live in the fluid from an infected person’s eyes and nose, the infection spreads through contact with those secretions ^[2].

Preventing trachoma requires more than just medicine; it involves changing the environment and daily habits to break the cycle of transmission. This focus on prevention is captured in the “F” (Facial cleanliness) and “E” (Environmental improvement) parts of the WHO’s SAFE strategy ^[3].

How the Bacteria Move

The bacteria do not survive long outside the human body, so they rely on several routes to move between people ^[4]:

• Hands and Faces: This is the primary path. When an infected child rubs their eyes and then touches another child, or when children play closely together, the bacteria are transferred directly ^[1].
• Eye-Seeking Flies: Certain types of flies (Musca sorbens) are attracted to eye and nose discharge. When a fly lands on an infected person’s face, it can pick up the bacteria and carry them to the eyes of the next person it visits ^[5][6].
• Shared Items (Fomites): Though secondary to hand and face contact, the bacteria can survive for a short time on surfaces. Sharing damp washcloths used to wipe an infected person’s face can spread the infection ^[4][7].

‘F’ is for Facial Cleanliness

Keeping a child’s face clean is one of the most practical and powerful ways to reduce transmission. Research shows that removing eye and nose discharge makes a face less attractive to flies and reduces the amount of bacteria available to spread ^[8].

Practical Steps for Caregivers:

• Wash Frequently: Clean your child’s face whenever you see “sleep” in their eyes or a runny nose ^[8].
• Water First, Soap on Hands: Use clean water to gently wash away discharge from the eyes. Do not rub soap into the eyes, as this will cause irritation and make the eyes redder. Soap is excellent for washing hands and washing the skin away from the eye ^[8]. If irritation occurs from soap, rinse thoroughly with clean water.
• Individual Cloths or Clean Hands: If you use a cloth to wash faces, ensure each person has their own, or simply use clean water and clean hands. Sharing a damp face cloth is a risk factor for spreading the infection ^[7].
• Handwashing: Wash your own hands frequently with soap, especially after helping a child clean their face ^[7].

‘E’ is for Environmental Improvement

The environment around your home plays a significant role in how easily trachoma spreads. Improving community-wide sanitation reduces the breeding grounds for flies and makes hygiene easier to maintain ^[9].

• Latrine Use: The flies that spread trachoma often breed in human waste left on the ground. Using a latrine and ensuring all family members (including young children) use it helps drastically reduce the fly population in your community ^[10][11].
• Water Access: Having a reliable source of clean water close to home is essential. When water is easier to get, families are more likely to use it for washing faces and hands ^[9].
• Waste Management and Laundry: Keeping animal pens and solid waste (garbage) away from main living areas helps reduce fly attraction ^[12][13]. Regularly washing bedding and clothing—especially items that come into contact with faces—helps remove bacteria that may be lingering on the fabric ^[4][14].

While these steps are powerful, they work best when the whole community takes action. Improved community-wide sanitation lowers the risk for everyone, but it does not replace the need for regular face washing and clinical care. Prevention is a shared responsibility that protects the sight of the next generation.