Trachoma, a neglected tropical disease, remains the world’s leading infectious cause of blindness, with 200 million people in 42 countries at risk. In an effort to control the disease, the SAFE strategy – surgery, antibiotics, facial cleanliness and environmental improvements – has been adopted, to reduce blindness and infections caused by trachoma.
Until recently, attention has tended to focus on the role of antibiotics and surgery. But good hygiene is increasingly being seen as a key factor in preventing the disease from spreading, as it is very easily transmitted from person to person, by touch from dirty hands and faces. This is the main reason why women, generally the primary caregivers for children, are disproportionately affected by trachoma.
With this in mind, three groups of field surveyors (with 25 people in each group) set off from Kampala, Lilongwe and Dar es Salaam and spent a month visiting schools and communities where trachoma programmes have been running. The teams spoke to and observed a total of more than 4,600 household respondents in 182 communities, and more than 2,500 schoolchildren in 86 schools. They observed hand and face washing practices, interviewed people with caregiving responsibilities for children and schoolchildren to understand the level of knowledge and risk perception around trachoma, and inspected the facial cleanliness of children in their school and home environments
The undertaking brought many challenges. Here are just a few of the issues the teams faced: