03655nas a2200385   4500000000100000008004100001260003700042653001300079653001300092653001800105653002300123653000900146653002300155653001800178653002300196100001400219700001300233700001400246700001400260700001400274700001600288700001200304700001300316700001300329700001600342700001500358700001400373700001300387245014900400856009800549300000700647490000700654520259400661022001403255       2025                            d  bPublic Library of Science (PLoS)10aTrachoma10aEthiopia10aMeta-analysis10aSystematic reviews10aFace10aDatabase searching10aSurface water10aPublication ethics1 aAsmare ZA1 aAnley DT1 aBelete MA1 aDessie AM1 aZemene MA1 aAlemayehu E1 aMoges N1 aKebede N1 aTsega SS1 aGebeyehu AA1 aAnteneh RM1 aChanie ES1 aParker A00aBeyond the SAFE strategy: Systematic review and meta-analysis of prevalence and associated factors of active trachoma among children in Ethiopia  uhttps://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0312024&type=printable  a150 v203 a<p><strong>Background:</strong> Although the Surgery, Antibiotic, facial cleanliness, and environmental improvement (SAFE) strategy was adopted in Ethiopia over the last five years, there is still a high incidence of trachoma in areas with poor hygiene. In Ethiopia, a systematic review and meta-analysis were conducted before the implementation of SAFE implying, a need for the update. Therefore, this review gives the updated pooled prevalence and associated factors of active trachoma in Ethiopia after the implementation of SAFE.</p>

<p><strong>Method:&nbsp;</strong>The literature search was performed from PubMed, Google Scholar, EMBASE, HINARI, Scopus, and Web of Sciences from January 1–30, 2024. Data were extracted by using a pre-tested and standardized data extraction format and analyzed using STATA 17 statistical software. I2 tests to appraise the heterogeneity across the included studies, a random-effect model to estimate the pooled prevalence, and a sub-group analysis to discern the viable source of heterogeneity were executed. Potential publication bias was also assessed by funnel plot, Egger’s weighted correlation, and Begg’s regression. The odds ratio with its 95% confidence was used to reckon the association between the prevalence and factors.</p>

<p><strong>Results:</strong> From 504 identified studies, 20 articles were included. After the SAFE intervention, the national pooled prevalence of active trachoma among children was 21.16% (95% CI 17.28, 25.04). Fly-eye contact(Adjusted odds ratio (AOR) = 3.83, 95% CI: 2.25, 6.52), facial uncleanliness(AOR = 5.48, 95% CI: 3.02, 9.96), non-utilization of latrine (AOR = 3.30, 95% CI: 2.10, 5.18), and retrieving water from river(AOR = 2.94; 95%CI: 1.42, 6.05) were significantly associated with active trachoma.</p>

<p><strong>Conclusion:&nbsp;</strong>In Ethiopia, the pooled prevalence of active trachoma after SAFE intervention was much higher than the World Health Organization (WHO) threshold prevalence. It continues to pose a significant public health concern and is far from the elimination of trachoma as a public health problem. Fly-eye contact, facial cleanliness, latrine utilization, and source of water increase the odds of active trachoma. Therefore, it is imperative to fine-tune the intervention focus on personal hygiene-related activities in removing dirt, fly-eye contact, and a well-structured approach for both constructing and ensuring the functionality of household taps and latrines. Additionally, It is crucial to initiate a reliable SAFE intervention in Ethiopia.</p>
  a1932-6203