Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Objective To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. Methods Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. Findings: A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. Conclusion :The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.

Objectif Déterminer si une intervention au niveau de l'eau, de l'assainissement et de l'hygiène pourrait avoir une influence sur les comportements en la matière, considérés comme importants dans la lutte contre le trachome. Méthodes Nous avons mené un essai randomisé par grappes dans les régions rurales d'Éthiopie entre le 9 novembre 2015 et le 5 mars 2019. Nous avons réparti aléatoirement 20 échantillons où l'intervention consistait à développer les infrastructures d'assainissement et d'approvisionnement en eau et à promouvoir l'hygiène, et 20 échantillons n'ayant fait l'objet d'aucune intervention. Tous les échantillons du groupe d'intervention ont suivi une formation sur l'hygiène à l'école primaire, disposaient d'un point d'eau communautaire, d'un poste de lavage par ménage, de savon à domicile, et recevaient des visites de la part de travailleurs chargés d'enseigner les bonnes pratiques en matière d'hygiène. Nous avons évalué le niveau d'observance des mesures en effectuant des enquêtes annuelles au sein des foyers. Résultats En l'espace de 3 ans, le nombre de postes de lavage, de savons et de latrines dans les ménages a davantage augmenté dans le groupe d'intervention que dans le groupe de contrôle: la différence de risque s'élevait à 47 points de pourcentage (intervalle de confiance de 95%, IC: 41­53) pour les postes de lavage, à 18 points de pourcentage (IC de 95%: 12­24) pour le savon et à 12 points de pourcentage (IC de 95%: 5­19) pour les latrines. La proportion de gens déclarant se laver le visage au savon était plus grande dans le groupe d'intervention (différence de risque de 21 points de pourcentage; IC de 95%: 15­27 pour les enfants de 0 à 5 ans), tout comme celle mentionnant l'usage de latrines (différence de risque de 9 points de pourcentage; IC de 95%: 2­15 pour les enfants de 6 à 9 ans). Pour de multiples indicateurs, il a fallu attendre minimum un an après l'instauration du programme pour que les variations observées entre les groupes d'intervention et de contrôle deviennent statistiquement significatives; ces variations se sont ensuite maintenues lors des visites ultérieures. Conclusion Intervenir à l'école et au sein de la communauté a permis d'améliorer l'accès à l'hygiène et les comportements en la matière. Néanmoins, cette évolution prend du temps et plusieurs années d'intervention sont nécessaires.

Pattern of Corneal Blindness in Goro District; Gurage Zone; Southern Ethiopia

There are about 37 million blind people in the world. In Ethiopia there are 1.15 million blind people; corneal blindness accounted for 19of cases. The objective is to identify determinants and pattern of corneal blindness in Goro district; Gurage Zone in Southern Ethiopia. A cross sectional descriptive study and multistage sampling technique were used to identify the study units and subjects. The prevalence of blindness in the study area was 1.5and out of which corneal blindness accounted for 20.8of the blindness. Trachomal had caused 80of the corneal blindness. Determinants like application of herbal medicine; recurrent painful red eye or ocular trauma was not reported to cause bilateral corneal blindness. The prevalence of monocular blindness was 1.89. Corneal blindness accounted for 36.7of the cases. Trauma and trachoma were found in 31.6and 15.8of unilateral corneal blindness respectively. Trachoma is the leading cause of bilateral corneal blindness. Non trachomatous corneal opacity is the major cause of unilateral corneal blindness. Health education and training mid level health workers on the management of treatable and preventable cause of corneal blindness is highly recommended

Trichiasis Recurrence in North Ethiopia: a one Year Prospective Study of Trachomatous Trichiasis Surgery done by Integrated Eye Care Workers

Background: Blindness due to trachomatous trichiasis can be prevented by simple eyelid surgery that can be performed by trained nurses. Objective: To evaluate the post- operative outcome of posterior tarsal rotation done by integrated eye care workers (IECWs) at the twelfth postoperative month. Methods: A prospective study to evaluate trichiasis surgery for recurrence was conducted in Yilmana Densa District. Trained IECWs did transverse tarsotomy with lid margin rotation for 455 patients with trichiasis following the standard procedure. Post-operative follow-up evaluation was done at the 12th month by IECWs who neither took part in the operation nor knew the specific surgeons for the corresponding patients. Results: Out of 695 a total of 560 operated eyelids were available for follow-up just at the 12th month. In terms of persons; 79.3(361/455) patients came for follow-up evaluation. The recurrence rate among the operated eyelids was found to be 16.6. There was an increase in likelihood of having recurrence with increasing age of patients (X2=5.6; P=0.02). We also found a statistically significant difference in rates of recurrence among patients operated by different surgeons(X2 =12.8; P=0.005). Conclusion: Trichiasis recurrence following surgery done by non-ophthalmologists is low indica- ting the possibility of avoiding preventable blindness due to trachoma through the training of integrated eye care workers. Moreover; monitoring mechanism appeared essential to track the performance of IECWs

Trachoma: an Ancient and Contemporary Scourge

Trachoma is an ancient yet contemporary scourge. It is a specific kerato-conjunctivitis caused by certain serovars of Chlamydia trachomatis. It affects an estimated 84 million people and remains the commonest communicable cause of blindness in 6 million people. WHO has introduced the SAFE strategy which needs to be implemented with more determination in Nigeria if the level of trachoma blindness is to be positively impacted. This is particularly in the area of identification of communities in need of intervention through more widespread application of Rapid assessment methods. The challenges in trachoma research remain to improve the accurate diagnosis of active disease; to monitor emergence of antibiotic resistance and to improve the understanding of transmission and reservoirs of the infectious agent

Impact of trachoma among rural Ethiopian women

Trachoma; an endemic disease in Ethiopia; is known to be associated with poverty; poor personal and environmental hygiene; overcrowding; female gender; living in rural areas; etc. In a cross sectional; community-based; ocular morbidity study among; 7;423 people in Jimma zone; about 1 percent were found to be blind (20;000 people) in the zone. Trachoma accounted for 29 percent of males. About 7 percent of women over 15 years of age had trichiasis. An overall prevalence of blinding trachoma (CO/TT) of 4.6 percent was documented among females as opposed to 3 percent prevalence among males. There was a significant difference in the prevalence of blinding trachoma by gender (X2=11.84; p inferior to 0.01). This higher prevalence of blinding trachoma among women has been recognized for quite some time. The reason is believed to be the close contact of mothers and older female siblings with infected children. Children; in rural Ethiopia; have important socio-economic roles. They contribute to the family income through direct labor in the fields; tending to cattle; or in domestic labor. A family with many children is expected to have more agricultural produce. It augments the family income; secures the family status in society; and ensures parental security in old age. Women are more responsible than men for the success of this noble venture of child upbringing in rural Ethiopia. During the process; they are under constant risk; of acquiring trachoma and its blinding complications

Primary Health Care: Role and Functions

Primary Health Care (PHC) can be defined as the health care availed and accessed to individuals and their families in a particular community; through strategies/interventions that are acceptable to and affordable by the concerned target population. Such health care; as defined; must be broad-based and integrated in approach. It must recognise the interactions among the factors that influence health and give due consideration to these factors and points of interaction. Take; for example; water sources and environmental sanitation; these two factors are closely related and at the sametime affect health together. Diseases such as typhoid; trachoma and malaria are directly related to water supply and basic sanitation. Effective care against these diseases calls for involvement of hospital; health centre and dispensary staff in addition to the community. Teams addressing such diseases comprise of doctors; nurses; administrators; to mention but a few. This illustrates the broad-based nature and intergrated approaches in PHC. Experts in the subject have summarised the desired approaches of PHC into four pillars

Analyse comparative de la prevalence du trachome dans les departements de Zinder et Maradi a partir de l'enquete nationale sur les affections ophtalmologiques du Niger

Les auteurs rapportent le resultat d'une enquete sur les affections ophtalmologiques au Niger avec un accent particulier sur le trachome. Ils notent des prevalences differentes entre deux departements pourtant situes sur la meme latitude. Ils soulignent la necessite d'une autre enquete portant essentiellement sur le trachome

Pattern of eye diseases in Nigerian children seen at Lagos University Teaching Hospital : a decade after

Analysis of 1;000 new paediatric eye patients over a one year period showed that conjunctival diseases were the commonest as opposed to refractive error found a decade ago. More cases of eye injuries; neuro-ophthalmological conditions; squints and congenital abnormalities were also encountered. Females attend hospital more readily than males constituting 50.9 per cent and 29.8 per cent of new patients seen were children 16 years and below. Uveitis and chronic open angle glaucoma were uncommon compared to adult patients. Trachoma was not found in this environment as opposed to Nothern Nigeria. Some of these eye diseases cause blindness which can be prevented if suggested steps are taken. The demand on specialist services could be reduced if eye care delivery is incorporated into primary health care programme

Prevention de la cecite chez l'enfant : une methodologie d'evacuation simplifiee

Parmi les causes de cecite rencontrees dans les pays en developpement et precisement au Mali; la xerophtalmie et le trachome affectent plus particulierement les enfants. Leur prise en charge; sur le plan de la sante publique; necessite non seulement la connaissance de la situation epidemiologique initiale; mais aussi celle de son evolution sous l'effet des mesures prises. Ceci implique l'utilisation de methodes d'evacuation qui soient non seulement fiables; mais aussi suffisamment simples et peu couteuses pour pouvoir etre utilisees aussi souvent qu'il faut

Trachoma grading: observer trials conducted in southern Malawi

A variety of grading schemes have been proposed for the clinical classification of inflammatory trachoma. During a population based study of ocular disease conducted in southern Malawi we tested a simplified version of the current WHO grading scheme. Intraobserver agreement statistics were less than satisfactory for three of four graders. Interobserver agreement when compared against either a well experienced standard ophthalmologist or a consensus grade improved over time for two of the three graders. However; initial agreement for all three graders was only fair to moderate. Previous studies of trachoma grading schemes support these unsatisfactory results. A new system of classification is needed that is both accurate and reliable in a field setting

Lower Shire Valley ocular disease survey: report on nutritional status and general morbidity

The primary objective of the survey was to provide a baseline data on the magnitude of the problem; the principle causes of blindness and their geographical distribution within the valley which can be utilized in the planning of health and nutrition programs for communities in the Lower Shire Valley