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Families or villages with limited access to water tend to have a high prevalence of trachoma. Mothers and children in Ethiopia and other developing countries walk several hours a day to fetch water for their family. Given the constraints on collecting water, women are forced to prioritize it for major household activities, including drinking, food preparation, and washing clothes. Consequently, families allocate less water for daily hygiene and sanitation, making them more susceptible to the repeated bacterial infections that cause trachoma.

Poor facial hygiene resulting from insufficient water supply then accelerates the transmission of trachoma. Mothers in Ethiopia tend to have between four and seven children, increasing the susceptibility of the family members to infection. Crowded households exacerbate the large proportion of Ethiopians with inadequate hygiene habits. Many are unaware that daily face washing flushes the bacteria from the eyes and decreases the likelihood that flies will be attracted to the infectious facial secretions.

The connection between a lack of adequate water to maintain daily facial cleanliness and the prevalence of trachoma is particularly salient among rural regions in Ethiopia. The 2000 Ethiopia Demographic Health Survey reported that 81 percent of urban households have access to a protected water source, whereas only 5 percent of rural households in Ethiopia have access to clean water. Health officials estimate that the water supply in rural areas is a meager 10 liters per capita per day. The average consumption of water per person in Ethiopia falls well short of the global minimum standard for an adequate daily water supply-20 liters of water per person. Without water, households living in rural areas of Ethiopia are more susceptible to trachoma as well as to many other diseases.

Women are particularly vulnerable to developing trachoma. The strong intimacy between an Ethiopian mother and her children explains the mother-to-child, child-to-mother, and child-to-child transmission of trachoma. A mother with many children-the main agents of trachoma transmission- faces a higher risk of developing trachoma. A study in Jimma, in southwestern Ethiopia, also revealed that women living in rural areas have a significantly higher risk of developing trachoma than women living in urban areas. Rural communities in Ethiopia have larger families, meaning that more people sleep together in one room, increasing the transmission between family members.

The high incidence of trachoma around the world has prompted the World Health Organization (WHO) to develop an integrated strategy, "SAFE," to treat and prevent trachoma in Ethiopia and other endemic regions. SAFE stands for surgery, antibiotic therapy, facial cleanliness, and environmental change. Though some progress has been made in each of these areas, these four steps warrant more attention from the international community.