Trachomatous inflammation-follicular among children aged 1-9 years in northeastern Ethiopia: environmental and hygiene-related disparities between Health Extension Program model and non-model households.

Trachoma remains a leading cause of preventable blindness in low-income settings, and its prevalence among children in Ethiopia continues to exceed the World Health Organization (WHO) elimination threshold. Evidence comparing trachomatous inflammation - follicular (TF) and its environmental and hygiene-related determinants between Health Extension Program (HEP) model and non-model households is limited. This study compared TF prevalence and associated factors among children aged 1-9 years in Dessie Zuria District, northeastern Ethiopia. A community-based comparative cross-sectional study was conducted from February to March 2021 using a two-stage cluster sampling design. Data were collected through interviews, observation, and ocular examination using the WHO simplified grading scheme. Logistic regression analyses were performed for model households, non-model households, and the pooled sample. Among 1502 children, the overall TF prevalence was 10.7% (95% CI: 9.1-12.3), with lower prevalence in model households (6.4%) than non-model households (14.3%). TF was associated with ocular discharge, unclean facial status, and infrequent face washing in both groups, while lack of latrine use and improper child feces disposal were significant predictors only in non-model households. TF prevalence exceeded the WHO elimination threshold, particularly among non-model households. Strengthening environmental sanitation and hygiene interventions within the SAFE strategy remains essential.