The health consequences for the 2.5 billion individuals without improved sanitation can be devastating. One disease associated with a lack of sanitation is trachoma, the world's leading cause of preventable blindness. The global campaign to eliminate trachoma is largely focused on treatment, in part, due to a lack of conclusive evidence on the effectiveness of sanitation in preventing trachoma.;The objective of this research is to advance the sanitation evidence base by analyzing how latrine use, latrine quality, and spatial characteristics of diseased and non-latrine use households, are associated with risk of trachoma in rural Tanzania. Field research was conducted in 678 randomly selected households, 95 of which had a child with trachoma and were designated as cases. Enumerators conducted an environmental health and sanitation questionnaire and examined latrine structures.;Data analysis involved a suite of statistical methods and software (SAS 9.0, ArcGIS 9.2, and R 3.2). Bivariate associations between independent variables and case-control status were assessed and multivariate logistic models were developed to compare case and control households in regards to latrine use, latrine quality, and distance to social gathering places. The kth nearest neighbors and kernel density estimation was used to examine spatial clustering of trachoma and non-latrine use households.;The results demonstrate that latrine use is significant in preventing risk of trachoma (adjusted odds ratio (OR=0.52 [95% CI: 0.32-0.98]). However, there was no evidence of a dose-response effect between latrine quality and risk of trachoma. Trachoma and non-latrine households were significantly spatially clustered on the periphery in three of the eight villages. Households living greater than 1,050 m from a social gathering place have the greatest risk of trachoma. The ORs associated with the three examined social gathering places are comparable; (commercial/government center: adjusted OR=1.78 [95% CI=1.04-3.05: bar/cafe: adjusted OR=2.38 [95% CI=1.35-1.4.2]; and religious establishment: adjusted OR=1.94 [95% CI=1.41-2.68D.;This research underscores the importance of latrine use for preventing trachoma. Latrine promotion should focus on clusters of households on the village periphery. Furthermore, bars/cafes and religious establishments offer a culturally appropriate and physically proximate avenue for fostering sustainable behavior change to prevent trachoma as well as a multitude of other water-, sanitation-, and hygiene-related diseases.
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