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Trachoma is a chronic, infectious eye disease causing inflammation, pain, avoidance of light and tearing; if untreated, it may result in blindness. Trachoma is endemic in hot, dry, poor areas of the world, and remains a serious health problem among the rural population of Egypt's Nile delta. A study was undertaken to identify the environmental risk factors associated with inflammatory trachoma in young children (ages 1 to 5) living in a Nile delta village (population 1,107). Clusters of the disease were found within households, emphasizing the transmission from child to child. Three factors were identified which predicted inflammatory trachoma: having school-age siblings with the disease, other siblings with the disease, and absence of a latrine (usually an open-pit toilet) in the household. About half the houses in the village had a pit latrine; the rest had none. The alternative to a latrine was defecation in a common room which also served as kitchen and stable for the animals of the household. It is suggested that in Egypt the presence of a pit latrine in each house might reduce the incidence of trachoma from the present 49 percent to 35 percent. This may be the simplest method of reducing trachoma in this area. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background: Poor sanitation is thought to be a major cause of enteric infections among young children. However, there are no previously published randomized trials to measure the health impacts of large-scale sanitation programs. India's Total Sanitation Campaign (TSC) is one such program that seeks to end the practice of open defecation by changing social norms and behaviors, and providing technical support and financial subsidies. The objective of this study was to measure the effect of the TSC implemented with capacity building support from the World Bank's Water and Sanitation Program in Madhya Pradesh on availability of individual household latrines (IHLs), defecation behaviors, and child health (diarrhea, highly credible gastrointestinal illness [HCGI], parasitic infections, anemia, growth). Methodsand Findings:We conducted a cluster-randomized, controlled trial in 80 rural villages. Field staff collected baseline measures of sanitation conditions, behaviors, and child health (May-July 2009), and revisited households 21 months later (February-April 2011) after the program was delivered. The study enrolled a random sample of 5,209 children < 5 years old from 3,039 households that had at least one child Conclusions: The intervention led to modest increases in availability of IHLs and even more modest reductions in open defecation. These improvements were insufficient to improve child health outcomes (diarrhea, HCGI, parasite infection, anemia, growth). The results underscore the difficulty of achieving adequately large improvements in sanitation levels to deliver expected health benefits within large-scale rural sanitation programs. Trial Registration: Clinicaltrails.gov NCT01465204 Please see later in the article for the Editors' Summary., Introduction The practice of open defecation is thought to be a major cause of the persistent worldwide burden of diarrhea and enteric parasite infection among children < 5 years old [...]