Social sciences for the prevention of blindness

ABSTRACT

Organizationsworking for the elimination of Chlamydia triggered blindness (trachoma) followthe WHO SAFE (surgery of trichiasis, antibiotics, face washing andenvironmental changes) strategy with the aim to achieve a minimum of 80% ofchildren with clean faces in the endemic communities, mass treatment coveringthe whole district with trachoma rates of 10% or more and surveillance plans.Trachoma recurrence is common after implementing 3, 5 or even 7 times the SAFEstrategy, revealing that the cognitive processes that require assimilation andintegration of knowledge did not register with parents, care takers andchildren. Moreover, repeated awareness campaigns to improve hygiene did notsystematically produce irreversible changes of behavior in neglectedpopulations. Facing evidence, the rational supporting mass drug administrationas the mainstay of preventable blindness elimination requires a wider scopethan those of mathematical models. The inhibition to perceive disappointingoutcomes requiring repeated interventions may suggest from a sociologic pointof view that the strategies are product of those evaluating the activities ofthose that fund them and vice versa. In this field, similar articulationappears for reciprocal interactions of researchers with those judging thepertinence and quality of their work. So far, the lack of autocritic forcertain elimination strategy approaches may reveal inbred circles that did notclearly assess that antibiotics, trichiasis surgery and education limited toimprovement of hygiene are inefficient if not associated with long term basiceducational actions in schools.