Regional Inequalities in Trachoma Prevention in Ethiopia: A Meta-Analysis.

Abstract

<h4>Background and aims</h4>Trachoma remains a significant public health problem in Ethiopia, particularly affecting children. Mothers play a crucial role in implementing preventive practices that interrupt trachoma transmission. Therefore, this systematic review and meta-analysis seek to address Regional Inequalities in Trachoma Prevention in Ethiopia.<h4>Methods</h4>A comprehensive systematic search was conducted in PubMed, EMBASE, HINARI, Scopus, Google Scholar, and Web of Science for studies published between January 2010 and November 2023. Data extraction and quality assessment were performed using standardized tools. Statistical analysis was conducted using R version 4.5.1 with <b>meta</b>, <b>metafor</b>, and <b>ggplot2</b> packages. Pooled prevalence was estimated using random-effects meta-analysis with generalized linear mixed models (GLMM) and logit transformation. Heterogeneity was assessed using the <i>I</i>² statistic.<h4>Results</h4>Four cross-sectional studies, comprising a total of 2240 mothers from diverse regions of Ethiopia, were included in the final analysis. The pooled prevalence of good trachoma prevention practices among mothers was 49% (95% CI: 41-58%). Substantial heterogeneity was observed across studies (<i>I</i>² = 91.5%, <i>p</i> < 0.001), with regional prevalence ranging from 36% in Tigray to 60% in the Southern Nations, Nationalities, and Peoples' Region (SNNPR). Subgroup analysis by publication year suggested a higher prevalence in studies published in or after 2022 (55%) compared to earlier studies (44%), though this difference was not statistically significant (<i>p</i> = 0.1107). Sensitivity analysis confirmed the robustness of the pooled estimate. Publication bias was assessed and deemed non-significant (Egger's test <i>p</i> = 0.351).<h4>Conclusion</h4>This meta-analysis reveals significant regional inequalities in trachoma prevention practices among Ethiopian mothers, with a pooled national prevalence of 49%, below the level required to interrupt transmission. The high heterogeneity observed underscores the substantial variation in implementation across regions. Future studies should prioritize identifying context-specific interventions and key modifiable factors to address these disparities and accelerate progress toward elimination.