‘Because people here are ignorant’: The failure of a community intervention to prevent mycetoma in Sudan

Abstract

Background: This study is based on fieldwork conducted amongst a community in Sudan where the neglected tropical disease (NTD), mycetoma, is endemic. In 2018 government officials attempted an unsuccessful intervention and we examine what caused this to fail. This intervention was a collaborative project building animal enclosures, designed specifically to counteract some principal causes of mycetoma, i.e., scratches and cuts common in disease transmission. It was a carefully researched, privately funded, and government-endorsed project, which was almost unequivocally rejected by the community. Methods: Data collection took place in July 2018. Eight interviews and two focus group discussions (FGDs) were conducted with village residents. One FGD was conducted with government officials in charge of the implementation and enforcement of the project; three key-informant interviews with officials from the State Ministry of Health and three interviews with community leaders in the village were conducted, including those responsible for allocation of the new enclosures. The data was analysed using framework analysis. Results: The village residents explained that they didn’t use the enclosures for three reasons: (1) it interferes with the relationship they have with their livestock, (2) the function and design are not practical, and (3) they continually feel let down by government officials. The government officials and representatives from the State Ministry of Health identified two reasons the project failed: (1) ignorance of the people in the village, and (2) poor enforcement. Conclusions: This study shows that government enforcement isn’t a viable intervention to reduce disease burden without considering community ways of life, values, and priorities. We revealed that government officials and villagers have contrasting views on the failure and original necessity of the project. Future behaviour-change interventions need to show respect for different ways of life and the values, beginning with the open facilitation of communication between divergent perspectives.