Reduction of infection was significant in both groups with the 2-day dosing group selleck chem Axitinib at 96% and the 1-day dosing at 80%. It was generally found that the 2-day dosing group had fewer high-risk children with infection after 6 weeks, which could therefore further reduce the reinfection of the community. However, mass treatment strategies would have to grade trachoma to determine the number of days dosing, which is currently not done. While this study did not consider drug resistance to be a risk, Gebre et al. [73] advocated for less dosage to prevent resistance in children. A random sample of children aged 0�C9 years in 12 Ethiopian communities were given annual and twice-annual antibiotics treatments. After 42 months, both the annual and twice-annual groups had similar reinfection rates, suggesting that there may not be significant impact in conducting 2 annual treatments [73].

Another potential source of reinfection may be individuals from a community who do not participate in mass treatment. There are a variety of risk factors to consider regarding why individuals are absent from mass treatment. One study [74] looked at the nonparticipation of children in 2 treatment rounds in Tanzania and concluded their guardian risk factors included being of a younger age, perceiving their household health to be excellent at the time of mass treatment, and having less social reliance on the community at large. Household risk factors included family health problems that prevented members from going to the treatment and multiple young children. It was generally difficult to bring all household members to the mass treatment.

Many believed that the household and children’s needs outweighed the value of the antibiotic treatment. It was suggested that such at-risk households should be targeted by social mobilization programs in the communities. Program risk factors included poor visibility, accessibility, and organization. The main issue was if individuals did not know or recognize their community treatment assistants (CTAs), who are responsible for ensuring community uptake of the mass treatments. CTAs are expected to go door-to-door to households that do not participate in mass treatments, but the study found that this was difficult if they lived more than an hour away from the household. It was recommended to increase the number of distribution days and the number of CTAs to ensure better coverage.

While this study cited distance from the CTA as a risk, another study [75] found that the most-difficult-to-reach children were actually less infected in 12 communities in Ethiopia. Provided that 80% of the community members were treated, the authors concluded that it was not necessary to put in the extra time and expense to find absent community members, when a significant increase Carfilzomib in the rate of infection was unlikely.