Behavioural change interventions for sustained trachoma elimination

Dodson, Sarity; Heggen, Anne; Solomon, Anthony W.; Sarah, Virginia; Woods, Geordie; Wohlgemuth, Leah

doi:10.2471/blt.18.212514

Cited by 15 publications

(15 citation statements)

References 10 publications

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“…Although the role of clean face as a trachoma indicator will continue to be debated, transmission reduction through improving hygiene should remain a key component of the SAFE strategy. Promoting knowledge about hygiene behavior is likely not sufficient, rather distinct F and E interventions must be designed with a grounding in behavior change theory, and adapted to each community with local support to create lasting behavioral change [28, 29]. Geographically targeting hotspots would allow programmes to more efficiently deploy these resource intensive projects.…”

Section: Discussionmentioning

confidence: 99%

Associations between Water, Sanitation and Hygiene (WASH) and trachoma clustering at aggregate spatial scales, Amhara, Ethiopia

et al. 2019

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BackgroundTrachoma is the leading infectious cause of blindness globally. The WHO has recommended the SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvements) strategy to eliminate trachoma as a public health problem. The F and E arms of the strategy will likely be important for sustained disease reductions, yet more evidence is needed detailing relationships between hygiene, sanitation and trachoma in areas with differing endemicity. This study addressed whether the regional differences in water, sanitation, and hygiene (WASH) variables were associated with the spatial distribution of trachomatous inflammation-follicular (TF) among children aged 1 to 9 years in the Amhara National Regional State of Ethiopia.MethodsData from 152 multi-stage cluster random trachoma surveys were used to understand the degree of clustering of trachoma on two spatial scales (district and village) in Amhara using a geographical information system and the Getis-Ord Gi* (d) statistic for local clustering. Trained and certified graders examined children for the clinical signs of trachoma using the WHO simplified system. Socio-demographic, community, and geoclimatic factors thought to promote the clustering of the disease were included as covariates in a logistic regression model.ResultsThe mean district prevalence of TF among children aged 1 to 9 years in Amhara was 25.1% (standard deviation = 16.2%). The spatial distribution of TF was found to exhibit global spatial dependency with neighboring evaluation units at both district and village level. Specific clusters of high TF were identified at both the district and the village scale of analysis using weighted estimates of the prevalence of the disease. Increased prevalence of children without nasal and ocular discharge as well as increased prevalence of households with access to a water source within 30 minutes were statistically significantly negatively associated with clusters of high TF prevalence.ConclusionsWater access and facial cleanliness were important factors in the clustering of trachoma within this hyperendemic region. Intensified promotion of structural and behavioral interventions to increase WASH coverage may be necessary to eliminate trachoma as a public health problem in Amhara and perhaps other hyper-endemic settings.

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Section: Discussionmentioning

confidence: 99%

Associations between Water, Sanitation and Hygiene (WASH) and trachoma clustering at aggregate spatial scales, Amhara, Ethiopia

et al. 2019

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“…In low and middle-income settings, interventions promoting personal hygiene are often undertaken within community-based water, sanitation, and hygiene (WASH) and neglected tropical disease (NTD) programming ( Boisson et al, 2016 ). The intervention techniques used in many of those efforts, however, may not be sufficient to produce sustainable change ( Delea et al, 2018 ); more evidence is needed to clarify which intervention approaches bring about sustained personal hygiene improvements ( Dodson et al, 2018 ; Ejere et al, 2015 ). Valid, reliable measurement of personal hygiene practices would be useful for monitoring, evaluation, and development of better interventions.…”

Section: Introductionmentioning

confidence: 99%

Development and reliability of a quantitative personal hygiene assessment tool

Delea

Snyder

Woreta

et al. 2020

International Journal of Hygiene and Environmental Health

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Personal hygiene practices, including facewashing and handwashing, reduce transmission of pathogens, but are difficult to measure. Using color theory principles, we developed and tested a novel metric that generates quantitative measures of facial and hand cleanliness, proxy indicators of personal hygiene practices. In this cross-sectional study, conventional qualitative cleanliness metrics (e.g., presence or absence of nasal and ocular discharge, dirt under nails or on finger pads and palms) were also recorded. We generated Gwet’s agreement coefficients to determine the inter-rater reliability of novel and conventional metrics between various rating groups, where appropriate, including two non-blinded raters, non-blinded vs. blinded raters, three blinded raters, and blinded vs. computer raters. Inter-rater reliability of the novel metric was high across all rating groups, ranging from 0.98 (95% CI: 0.97, 0.99) to 0.90 (95% CI: 0.90, 0.91) for facial cleanliness, and 0.97 (95% CI: 0.96, 0.98) to 0.92 (95% CI: 0.91, 0.93) for hand cleanliness. Our novel metric generates more nuanced data than conventional qualitative metrics, and allows for quantifiable assessments of facial and hand cleanliness.

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“…However, accurately measuring facial cleanliness is problematic, with the WASH-NTD Toolkit (2019) indicating that the clean face indicator is: “…investigational, requiring further research to confirm its programmatic relevance, repeatability, utility and/or safety” [ 12 ]. One key (albeit ambitious) target for further research is to determine a universally agreed upon measure of clean faces, which includes indicators that have high intra- and inter-grader reliability and consistency, that can be employed in a methodology without being confounded by place of assessment, time of day, environmental conditions, or cultural practices [ 8 , 9 , 16 ]. This would enable national programmes to standardise training and data collection, enabling within- and between-country comparisons of face washing campaign effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Facial cleanliness indicators by time of day: results of a cross-sectional trachoma prevalence survey in Senegal

et al. 2020

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Background The World Health Organization-recommended strategy for trachoma elimination as a public health problem is known by the acronym “SAFE”, where “F” stands for facial cleanliness to reduce transmission of ocular Chlamydia trachomatis infection. Accurately and reliably measuring facial cleanliness is problematic. Various indicators for measuring an unclean face exist, however, the accuracy and reliability of these indicators is questionable and their relationship to face washing practices is poorly described. Methods Clean face indicator (ocular or nasal discharge, flies on the face, and dirt on the face), trachoma clinical sign, and ocular C. trachomatis infection data were collected for 1613 children aged 0–9 years in 12 Senegalese villages as part of a cross-sectional trachoma prevalence study. Time of examination was recorded to the nearest half hour. A risk factor questionnaire containing Water, Sanitation and Hygiene (WASH) questions was administered to heads of compounds (households that shared a common doorway) and households (those who shared a common cooking pot). Results WASH access and use were high, with 1457/1613 (90.3%) children living in households with access to a primary water source within 30 min. Despite it being reported that 1610/1613 (99.8%) children had their face washed at awakening, > 75% (37/47) of children had at least one unclean face indicator at the first examination time-slot of the day. The proportion of children with facial cleanliness indicators differed depending on the time the child was examined. Dirt on the face was more common, and ocular discharge less common, in children examined after 11:00 h than in children examined at 10:30 h and 11:00 h. Conclusions Given the high reported WASH access and use, the proportion of children with an unclean face indicator should have been low at the beginning of the day. This was not observed, explained either by: the facial indicators not being reliable measures of face washing; eye discharge, nose discharge or dirt rapidly re-accumulated after face washing in children in this population at the time of fieldwork; and/or responder bias to the risk factor questionnaire. A high proportion of children had unclean face indicators throughout the day, with certain indicators varying by time of day. A reliable, standardised, practical measure of face washing is needed, that reflects hygiene behaviour rather than environmental or cultural factors.

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Behavioural change interventions for sustained trachoma elimination

Cited by 15 publications

References 10 publications

Associations between Water, Sanitation and Hygiene (WASH) and trachoma clustering at aggregate spatial scales, Amhara, Ethiopia

Associations between Water, Sanitation and Hygiene (WASH) and trachoma clustering at aggregate spatial scales, Amhara, Ethiopia

Development and reliability of a quantitative personal hygiene assessment tool

Facial cleanliness indicators by time of day: results of a cross-sectional trachoma prevalence survey in Senegal

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