Background: Burundi is currently not meeting targets for elimination of trachoma and trichiasis by 2020 (GET2020). The recommended SAFE strategy (Surgery, antibiotics, face washing and environmental improvement) is currently not fully implemented in many areas of Burundi. The existence of associations between face-washing, sanitation and trachoma prevalence remain undocumented., Methods: A convenience sample of 468 individuals from 117 households was drawn from attendees at trachoma clinics set up in four villages. Trachoma status, sex and age were recorded for all household members. Adult household members were surveyed about access to clean water and toilets, and knowledge of trachoma risk factors. Associations between cases of active trachoma per household and environmental risk factors were evaluated using generalised estimating equations., Results: The overall prevalence of active trachoma was 7.1% (95% CI 5.0-9.6%), but 19.5% (95% CI13.7-26.4%) in children under nine years old. 0.9% (95% CI 0.3-2.0) of participants had trichiasis. Access to a sanitary toilet more than halved the odds of active trachoma (OR 0.43, 95% CI 0.25-0.74%), however, participants did not appreciate this association., Conclusion: Access to sanitation was associated with the occurrence of active trachoma. Future research should focus on whether improving knowledge of and access to sanitation might reduce trachoma prevalence., (© 2020 Ndisabiye D et al.)