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Background: Trachoma is a public health problem in sub-Saharan Africa. Data on risk factors for active trachoma are limited. There is a need for understanding the factors affecting trachoma in order to plan for targeted interventions. The aim of the study was to examine the relationship between potential risk factors and active trachoma among children aged 1-9 years in Tanzania.Methods: A national community-based cross-sectional survey was conducted in 50 districts. Information on individual characteristics, household and environmental factors were gathered using a structured questionnaire and observation checklist. Eye examinations for presence of trachomatous inflammation-follicular (TF) were done for each child. Facialcleanliness was also assessed.Results: A total of 68624 children 1-9 years from 36714 households were examined in the fifty districts. The prevalence of clean faces among children 1-9 years was 80% and above in only 6 districts. Factors independently associated with active trachoma included dirty face (prevalence ratio [PR]= 3.22 (95% CI 3.04-3.41) and lack of toilet facility (PR =1.25; 95% CI=1.18-1.31). Trachoma prevalence increased with walking time to water source. Presence of a cow pen and human faeces around house were significant determinants of active trachoma among children.Conclusion: The results support facial cleanliness and environmental improvements (the F&E component of SAFE strategy) as community initiatives to combat trachoma. Prioritization of interventions should consider the diverse magnitude of disease and pattern of risk factors.Key words: Active trachoma, risk factors, Tanzania