A randomised trial of three face-washing methods for the removal of <i>Chlamydia trachomatis</i> from the faces of children with severe active trachoma

Abstract

Abstract Objectives A three-arm, open, parallel-group randomised trial compared three face-washing methods for cleaning Chlamydia trachomatis (Ct) from the faces of children with severe active trachoma. The impact of face-washing on Ct on the hands of children and their caregivers, and Ct duration on faces and hands were investigated as secondary objectives. Methods Children aged 1–7 years in Oromia, Ethiopia, were screened for active trachoma. We aimed to recruit 470 children with severe conjunctival inflammation; 141 were expected to have concurrent conjunctival infection and facial Ct , detected by qPCR. Those with severe inflammation were randomly assigned to water alone, water with soap, or damp, microfibre towel protocols. Swabs (children’s faces/hands, caregivers’ hands), were collected pre-wash, post-wash, and at one, two, four, six and eight hours. Conjunctival swabs were tested for ocular Ct infection; only infected children with facial Ct were included in primary analysis, comparing the proportion of faces without Ct after each washing method. Results Of 470 children screened with severe inflammation, 25 (5%) had conjunctival infection and facial Ct . All three protocols (n=12 water only, n=8 water and soap, n=5 damp towel) reduced discharge, but none removed Ct from faces immediately post-wash. No major facial Ct load reduction was observed. Face-washing removed Ct from some children’s and caregivers’ hands, but loads were not significantly reduced where Ct persisted. Though Ct was transiently absent from one face at 1 hour and four at 2 hours post-wash, all baseline Ct -positive children retained it at eight hours. Conclusions No evidence of differential or overall effectiveness of the three washing methods at removing facial Ct from children with trachoma was found. This finding is limited by a smaller-than-anticipated sample size, potentially hindering detection of subtle differences or overall effects. Trial registration The trial is registered on ISRCTN ( ISRCTN12814010 ).