Implementing trachoma control programmes in marginalised populations in Tanzania: A qualitative study exploring the experiences and perspectives of key stakeholders

Treatment-related characteristics of communities in districts characterized by persistent trachoma: an exploratory descriptive study

BACKGROUND

Despite the implementation of surgery, antibiotics mass administration, facial cleanliness and environmental improvement, commonly known as the SAFE strategy for several years, the persistence and recrudescence of trachoma is a prevailing challenge in Ethiopia. This study explores the treatment-related characteristics of communities within districts characterized by persistent trachoma in southern Ethiopia.

METHODS

Nyangatom and Uba Debretsehay districts are predominantly inhabited by pastoralist and farming communities, respectively. A community-based, exploratory descriptive qualitative study was conducted from June to October 2023. A total of 11 key informant interviews and six focus group discussions were conducted. The interviews and discussions were digitally recorded, transcribed and thematically analysed using Atlas ti. 23.

RESULTS

Districts characterized by persistent trachoma are characterized by segments of populations that have never been treated or suboptimally treated. This is due to the competing priorities faced by providers, the nature of campaigns and the limited ability of logistics to reach the 'must reach' population. Other barriers include limited social support and terrain hindering full geographical and population coverage. Treatment slippage is of particular concern because of treatment fatigue, misinformation and the unavailability of treatments for routine care.

CONCLUSIONS

Communities in districts characterized by persistent and recrudescent trachoma face various socioecological barriers that impact the outcome of SAFE strategy implementation. A mix of both random and systematic omissions of people who need treatment most, such as children and women, was evident.

Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department

The Colombian program to end trachoma implements the component F of the SAFE strategy in the Vaupés department of the Amazon rainforest. Cultural, linguistic, and geographical barriers and the coexistence of an ancestral medical system demand the technical and sociocultural adaptation of this component. A cross-sectional survey combined with focus-group discussions to understand the knowledge, attitudes, and practices of the indigenous population related to trachoma was conducted in 2015. Of the 357 heads of households that participated, 45.1% associated trachoma with a lack of hygiene, and 94.7% associated the concept of hygiene with taking one or more body baths per day, using commercial or handcrafted soap. In total, 93% reported cleaning their children's faces and eyes more often when they have conjunctivitis, but 66.1% also did this with clothes or towels in use, and 52.7% of people shared towels; in total, 32.8% indicated that they would use ancestral medicine to prevent and treat trachoma. The SAFE strategy in Vaupés requires an intercultural approach to facilitate stakeholder support and participation to promote general and facial hygiene, washing clothes with soap, and not sharing towels and clothes to dry and clean children's faces for effective and sustainable elimination of trachoma as a public health problem. This qualitative assessment facilitated an intercultural approach locally and in other Amazonian locations.

Perceptions and practices of community members relating to trachoma in Africa: a qualitative systematic review

OBJECTIVE

The objective of this review was to synthesize the perceptions and practices of community members relating to trachoma in Africa.

INTRODUCTION

Trachoma is the leading cause of blindness worldwide, and Africa is the worst-affected continent. Synthesized evidence relating to the disease has focused on various aspects including epidemiology, control, health education, facial cleanliness, interventions for trachomatous trichiasis, and the burden of trachoma on women. Currently, systematic reviews on perceptions and practices relating to trachoma are lacking despite the existence of primary studies. Filling this knowledge gap is critical for decision-making for effective community uptake of interventions.

INCLUSION CRITERIA

Qualitative studies on the perceptions and practices relating to trachoma in both health care and community settings in Africa were considered for inclusion. Studies with participants 14 years or older were considered, regardless of gender, health status, religion, or ethnicity. Perceptions included beliefs, perspectives, views, knowledge, and thoughts relating to trachoma. Practices included regular actions relating to trachoma, such as treatment and prevention behaviors.

METHODS

A search for studies in English was conducted in MEDLINE, CINAHL, Embase, PsycINFO, Sociological Abstracts, BioMed Central, Current Contents, Cochrane Library, and Google Scholar in May 2019 and updated in October 2021. Unpublished studies were searched in MedNar, Index to Thesis, ProQuest Dissertations and Theses Global, World Health Organization, and individual governments' commissioned trachoma reports. Two independent reviewers were involved in study selection, critical appraisal, and data extraction using the JBI tools. Data were synthesized using the JBI meta-aggregative approach.

RESULTS

Seven studies were included in this review. Participants were people either with or without trachoma. A total of 90 findings were extracted, from which 10 categories were produced and three synthesized findings derived from the categories. The synthesized findings are: understanding and awareness of trachoma influences perceptions of treatment and preventive methods; beliefs and behaviors influence treatment options; economic constraints, socio-cultural beliefs, and risk perceptions influence prevention behaviors and practices.

CONCLUSION

Various perceptions and practices relating to trachoma exist among community members in Africa. These perceptions and practices are influenced by knowledge, cultural beliefs, economic factors, and environmental factors. The findings suggest the need for decision-makers in policy and practice to consider and include these perceptions and practices when designing interventions to combat trachoma in endemic countries. However, due to the limited number of included studies and their methodological weaknesses, more high-quality studies are needed to have a deeper and broader view on these perceptions and practices.