Abstract
The World Health Organization promotes the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements) strategy for trachoma control and prevention. The F&E components of the strategy focus on promotion of healthy hygiene and sanitation behaviors. In order to monitor F&E activities implemented across villages and schools in Malawi, Tanzania, and Uganda, an F&E Monitoring and Evaluation (FEME) framework was developed to track quarterly program outputs and to provide the basis for a pre and post evaluation of the activities. Results showed an increase in knowledge at the school and household levels, and in some cases, an increase in presence of hand/face washing stations. However, this did not always result in a change in trachoma prevention behaviors such as facial cleanliness or keeping compounds free of human feces. The results highlight that the F&E programs were effective in increasing awareness of trachoma prevention but not able to translate that knowledge into changes in behavior during the time between pre and post-surveys. This study also indicates the potential to improve the data collection and survey design and notes that the period of intervention was not long enough to measure significant changes.
Highlights
Trachoma and water, sanitation, and hygieneTrachoma, the result of ocular infection with the bacterium Chlamydia trachomatis, is the leading infectious cause of blindness worldwide [1]
The evaluation units (EUs) in Tanzania showed a significant increase in the percentage of schools that had hand washing facilities with soap with 4.8% (Confidence Interval (CI): 0.6–30.7) at baseline and 35.0% (CI: 17.3–58.0) at post-survey (P = 0.043)
The two school EUs in Malawi showed a significant change in the percentage of school compounds free of human feces, with those in the Central region increasing from 19.6% (CI: 6.0–48.1) at baseline to 92.6% (72.6–98.3) at post-survey (P < 0.01) and those in the Southern region increasing
Summary
Sanitation, and hygieneTrachoma, the result of ocular infection with the bacterium Chlamydia trachomatis, is the leading infectious cause of blindness worldwide [1]. Flies have been documented to transmit Chlamydia trachomatis when the fly feeds on the ocular and nasal secretions of an infected person and lands on the eyes of another person [7] These same flies are strongly attracted to odors produced by human feces and lay their eggs on exposed feces on the ground [8]. Increasing communities’ sufficient and reliable access to water helps increase the likelihood that residents will be able to keep their faces, clothes, and bedding clean thereby reducing risk [12] It is because of the transmission dynamics and progression of the disease that the World Health Organization (WHO) promotes the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements) for trachoma control and prevention [1]. The lack of standardization and consistency in how these interventions are designed and implemented present a challenge in comparing across settings and clearly demonstrating effectiveness
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