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Background  Although many efforts are made by different stakeholders, magnitude of active trachoma remains high among children in Ethiopia. Open field defecation was found to be the main source of active trachoma. However, comparative information on the effect of open field defecation and non-open field defecation on active trachoma is scarce in Ethiopia.    Methods  Comparative community based cross-sectional study was conducted from June 1–30, 2019 in Boricha and Dale districts to assess prevalence of active trachoma among primary school children. We have selected four primary schools purposively from two districts in Sidama. Study participants were selected by using simpe random sampling method. Data were collected through face to face interview, direct observation and ophthalmic examination. Logistic regression analysis was conducted to assess factors associated with active trachoma infection among primary school children. Adjusted Odds Ratios with 95% confidence interval and  p -value less than 0.05 were computed to determine the level of significance.    Result  From the total of 746 study participants, only 701 study participants gave full response for interview questions making a response rate of 94%. The overall prevalence of active trachoma infection was 17.5% (95% CI, 14.1–20.8) among primary school students. Specifically, prevalence of active trachoma infection was 67.5% among children who lived in open field defecation villages, but it was 88.5% among school children who live in Non-ODF Kebeles. Factors like: Living in open field defecation Kebeles (AOR = 2.52, 95% CI, 1.5–4.1), having ocular discharge (AOR = 5.715, 95% CI, 3.4–9.4), having nasal discharge (AOR = 1.9, 95% CI, 1.06–3.39), and fly on the face (AOR = 6.47, 95% CI, 3.36–12.44) of children were positively associated with active trachoma infection. However, finger cleanness (AOR = 0.43, 95% CI, 0.21–0.9) was protective factor against active trachoma infection in this study.    Conclusion  Significant variation in prevalence of active trachoma infection among school children between open filed and non-open field defecation Kebeles was observed. Surprisingly, the prevalence in open field defecation was significantly lower than non-open field defecation. Hence, this indicates active trachoma infection highly depends on the hand hygiene than environmental sanitation. Educational campaign of hand hygiene should be enhanced in the community for school students.

Status of active trachoma infection among school children who live in villages of open field defecation: a comparative cross-sectional study