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Vasconcelos A, King JD, Nunes-Alves C, Anderson R, Argaw D, Basáñez MG, Bilal S, Blok DJ, Blumberg S, Borlase A, Brady OJ, Browning R, Chitnis N, Coffeng LE, Crowley EH, Cucunubá ZM, Cummings DAT, Davis CN, Davis EL, Dixon M, Dobson A, Dyson L, French M, Fronterre C, Giorgi E, Huang CI, Jain S, James A, Kim SH, Kura K, Lucianez A, Marks M, Mbabazi PS, Medley GF, Michael E, Montresor A, Mutono N, Mwangi TS, Rock KS, Saboyá-Díaz MI, Sasanami M, Schwehm M, Spencer SEF, Srivathsan A, Stawski RS, Stolk WA, Sutherland SA, Tchuenté LAT, de Vlas SJ, Walker M, Brooker SJ, Hollingsworth TD, Solomon AW, Fall IS. Accelerating Progress Towards the 2030 Neglected Tropical Diseases Targets: How Can Quantitative Modeling Support Programmatic Decisions? Clin Infect Dis 2024; 78:S83-S92. [PMID: 38662692 PMCID: PMC11045030 DOI: 10.1093/cid/ciae082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Over the past decade, considerable progress has been made in the control, elimination, and eradication of neglected tropical diseases (NTDs). Despite these advances, most NTD programs have recently experienced important setbacks; for example, NTD interventions were some of the most frequently and severely impacted by service disruptions due to the coronavirus disease 2019 (COVID-19) pandemic. Mathematical modeling can help inform selection of interventions to meet the targets set out in the NTD road map 2021-2030, and such studies should prioritize questions that are relevant for decision-makers, especially those designing, implementing, and evaluating national and subnational programs. In September 2022, the World Health Organization hosted a stakeholder meeting to identify such priority modeling questions across a range of NTDs and to consider how modeling could inform local decision making. Here, we summarize the outputs of the meeting, highlight common themes in the questions being asked, and discuss how quantitative modeling can support programmatic decisions that may accelerate progress towards the 2030 targets.
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Affiliation(s)
- Andreia Vasconcelos
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
- Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
| | - Jonathan D King
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Cláudio Nunes-Alves
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
| | - Roy Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Daniel Argaw
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Shakir Bilal
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, USA
| | - David J Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Anna Borlase
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - Oliver J Brady
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Raiha Browning
- The Department of Statistics, The University of Warwick, Coventry, United Kingdom
| | - Nakul Chitnis
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emily H Crowley
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Zulma M Cucunubá
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Universidad Pontificia Javeriana, Bogotá, Colombia
| | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Christopher Neil Davis
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Emma Louise Davis
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Matthew Dixon
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Andrew Dobson
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
| | - Louise Dyson
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Michael French
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, United Kingdom
- RTI International, Washington, D.C., USA
| | - Claudio Fronterre
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Emanuele Giorgi
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Ching-I Huang
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Saurabh Jain
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Ananthu James
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sung Hye Kim
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Klodeta Kura
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Ana Lucianez
- Communicable Diseases Prevention, Control, and Elimination, Pan American Health Organization, Washington D.C., USA
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pamela Sabina Mbabazi
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Graham F Medley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Edwin Michael
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Antonio Montresor
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Nyamai Mutono
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Thumbi S Mwangi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Kat S Rock
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Martha-Idalí Saboyá-Díaz
- Communicable Diseases Prevention, Control, and Elimination, Pan American Health Organization, Washington D.C., USA
| | - Misaki Sasanami
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Markus Schwehm
- ExploSYS GmbH, Interdisciplinary Institute for Exploratory Systems, Leinfelden-Echterdingen, Germany
| | - Simon E F Spencer
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ariktha Srivathsan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Robert S Stawski
- Institute of Public Health and Wellbeing, School of Health and Social Care, University of Essex, Essex, United Kingdom
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Samuel A Sutherland
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | | | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martin Walker
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, United Kingdom
| | | | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahima Socé Fall
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
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Miecha H, Dejene M, Adugna D, Kebede A, Yadeta D, Alemayehu A, Abateneh A, Dayessa M, Shafi M, Taye E, Balcha L, Negussu N, Mengistu B, Willis R, Jimenez C, Bakhtiari A, Boyd S, Kebede B, Tadesse F, Mamo A, Bekele M, Sinke Z, Solomon AW, Harding-Esch EM. Prevalence of Trachoma in Pre-validation Surveillance Surveys in 11 Evaluation Units (Covering 12 Districts) in Oromia Regional State, Ethiopia: Results from 2018-2020. Ophthalmic Epidemiol 2023; 30:655-662. [PMID: 36519777 PMCID: PMC10581667 DOI: 10.1080/09286586.2022.2119258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Interventions to reduce the prevalence of trachoma and transmission of ocular Chlamydia trachomatis have been implemented in Oromia Region, Ethiopia. Following an impact survey in which the trachomatous inflammation-follicular (TF) prevalence in 1-9-year-olds is <5%, a surveillance survey is recommended 2 years later, without additional antibiotic treatment. We report results of surveillance surveys in 11 evaluation units (EUs) covering 12 districts in Oromia Region, to plan whether future interventions are needed. METHOD We use a two-stage cluster-sampling cross-sectional survey design. In each EU, 26 clusters (villages) were systematically selected with probability proportional to size; from each cluster, 30 households were selected using compact segment sampling. Water, sanitation and hygiene (WASH) access was assessed in all selected households. All residents of selected households aged ≥1 year were examined for TF and trachomatous trichiasis (TT) by certified graders. RESULT Of 31,991 individuals enumerated, 29,230 (91% of) individuals were examined. Eight EUs had an age-adjusted TF prevalence in 1-9-year-olds of ≥5% and seven had a TT prevalence unknown to the health system among adults aged ≥15 years of ≥0.2%. About one-third of visited households had access to an improved water source for drinking, and 5% had access to an improved latrine. CONCLUSION Despite TF reductions to <5% at impact survey, prevalence recrudesced to ≥5% in all but three of the 11 EUs. Operational research is needed to understand transmission dynamics and epidemiology, in order to optimise elimination strategies in high-transmission settings like these.
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Affiliation(s)
- Hirpa Miecha
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | - Dereje Adugna
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | - Ageru Kebede
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Damtew Yadeta
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Leta Balcha
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | | | | | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | | | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | | | | | - Ayele Mamo
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | | | - Zelalem Sinke
- Oromia Regional State Health Bureau, Addis Ababa, Ethiopia
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Barazanji M, Ngo JD, Powe JA, Schneider KP, Rychtář J, Taylor D. Modeling the "F" in "SAFE": The dynamic game of facial cleanliness in trachoma prevention. PLoS One 2023; 18:e0287464. [PMID: 37352249 PMCID: PMC10289400 DOI: 10.1371/journal.pone.0287464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
Trachoma, a neglected tropical disease (NTDs) caused by bacterium Chlamydia trachomatis, is a leading cause of infectious blindness. Efforts are underway to eliminate trachoma as a public health problem by using the "SAFE" strategy. While mathematical models are now standard tools used to support elimination efforts and there are a variety of models studying different aspects of trachoma transmission dynamics, the "F" component of the strategy corresponding to facial cleanliness has received very little attention so far. In this paper, we incorporate human behavior into a standard epidemiological model and develop a dynamical game during which individuals practice facial cleanliness based on their epidemiological status and perceived benefits and costs. We found that the number of infectious individuals generally increases with the difficulty to access a water source. However, this increase happens only during three transition periods and the prevalence stays constant otherwise. Consequently, improving access to water can help eliminate trachoma, but the improvement needs to be significant enough to cross at least one of the three transition thresholds; otherwise the improved access will have no noticeable effect.
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Affiliation(s)
- Mary Barazanji
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Janesah D. Ngo
- Department of Biology, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Jule A. Powe
- Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Kimberley P. Schneider
- Department of Chemistry, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Jan Rychtář
- Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Dewey Taylor
- Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, VA, United States of America
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Kann RS, Snyder JS, Woreta M, Zewudie K, Freeman MC, Delea MG. Quantifying Factors Associated with Personal Hygiene as Measured by the qPHAT Methodology: Andilaye Trial, Ethiopia. Am J Trop Med Hyg 2023; 108:1277-1286. [PMID: 37127265 PMCID: PMC10540125 DOI: 10.4269/ajtmh.22-0603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/10/2023] [Indexed: 05/03/2023] Open
Abstract
Many water, sanitation, and hygiene (WASH) interventions target improvements in personal hygiene behaviors. Yet measuring personal hygiene behaviors is a challenge due to a lack of reliable, valid, objective, and simple-to-use approaches. The purpose of this study was to examine differences between two types of hygiene outcome measures and their ability to detect relationships between WASH-related behavioral factors and behaviors. We compared hygiene outcomes generated by the Quantitative Personal Hygiene Assessment Tool (qPHAT), which yields objective measures of cleanliness on an 11-point scale, and those generated by conventional, dichotomous indicators of cleanliness. We used cross-sectional data on hygiene outcomes related to facial and hand cleanliness collected during the Andilaye Trial, an impact evaluation of a community-based WASH intervention implemented in Amhara, Ethiopia. We fit multivariable models to examine associations between measures of children's facial and hand cleanliness, via both qPHAT and dichotomous indicators, and 1) household WASH conditions, 2) psychosocial factors, and 3) reported personal hygiene practices. The qPHAT-generated outcomes were able to detect relationships between intermediate behavioral factors and hygiene outcomes that dichotomous indicators were not, including associations with water insecurity and various psychosocial factors. qPHAT-generated outcomes were negatively associated with reported face washing practices, suggesting a bias in reported behaviors. Our study highlights the limitations of reported practices and dichotomous hygiene indicators and indicates that using more quantitative hygiene outcome measures, such as those generated by qPHAT, may reveal important intermediate factors that influence hygiene behavior and support improved monitoring and evaluation of interventions.
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Affiliation(s)
- Rebecca S. Kann
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jedidiah S. Snyder
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | | - Matthew C. Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Maryann G. Delea
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Shobiso MG, Hussen MS, Munaw MB, Tilahun MM. Trachoma Prevention Practice and Associated Factors in Rural Lemo District, Southern Ethiopia, 2021. Ethiop J Health Sci 2023; 33:123-132. [PMID: 36890944 PMCID: PMC9987275 DOI: 10.4314/ejhs.v33i1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/01/2022] [Indexed: 03/10/2023] Open
Abstract
Background Trachoma is a leading cause of preventable blindness. It is more prevalent in areas where there is poor personal and environmental sanitation. Implementing a SAFE strategy will reduce the incidence of trachoma. The purpose of this study was to look into trachoma prevention practices and associated factors in rural Lemo, South Ethiopian communities. Methods We conducted a community-based cross-sectional study in the rural Lemo district of south Ethiopia, covering 552 households, from July 1 - July 30, 2021. We used a multistage sampling technique. Seven Kebeles were selected using a simple random sampling method. Then, a systematic random sampling procedure with a five-interval size was applied to select the households.Our study assessed the association between the outcome variable and explanatory variables using binary and multivariate logistic regressions. The adjusted odds ratio was calculated, and variables with a p-value below 0.05 at the 95% confidence interval (CI) were considered statistically significant. Results The study found that 59.6% (95% CI: 55.5%-63.7%) of participants had good trachoma prevention practices. Having a favorable attitude (odds ratio [AOR]: 1.91, 95% CI: 1.26-2.89), receiving health education (AOR: 2.16, 95% CI: 1.46-3.21), and obtaining water from a public pipe (AOR: 2.48, 95% CI: 1.09-5.66) were significantly associated with good trachoma prevention practice. Conclusions Fifty-nine percent of the participants had good prevention practices for trachoma. Health education, a favorable attitude, and a water source from public pipes were variables associated with good trachoma prevention practice. Improving water sources and disseminating health information are vital to increasing trachoma prevention practices.
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Abstract
Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.
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Freeman MC, Delea MG, Snyder JS, Garn JV, Belew M, Caruso BA, Clasen TF, Sclar GD, Tesfaye Y, Woreta M, Zewudie K, Gobezayehu AG. The impact of a demand-side sanitation and hygiene promotion intervention on sustained behavior change and health in Amhara, Ethiopia: A cluster-randomized trial. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000056. [PMID: 36962125 PMCID: PMC10021625 DOI: 10.1371/journal.pgph.0000056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/07/2021] [Indexed: 04/19/2023]
Abstract
Behaviors related to water, sanitation, and hygiene (WASH) are key drivers of infectious disease transmission, and experiences of WASH are potential influencers of mental well-being. Important knowledge gaps exist related to the content and delivery of effective WASH programs and their associated health impacts, particularly within the contexts of government programs implemented at scale. We developed and tested a demand-side intervention called Andilaye, which aimed to change behaviors related to sanitation, personal hygiene, and household environmental sanitation. This theory-informed intervention was delivered through the existing Ethiopian Health Extension Programme (HEP). It was a multilevel intervention with a catalyzing event at the community level and behavior change activities at group and household levels. We randomly selected and assigned 50 kebeles (sub-districts) from three woredas (districts), half to receive the Andilaye intervention, and half the standard of care sanitation and hygiene programming (i.e., community-led total sanitation and hygiene [CLTSH]). We collected data on WASH access, behavioral outcomes, and mental well-being. A total of 1,589 households were enrolled into the study at baseline; 1,472 households (94%) participated in an endline assessment two years after baseline, and approximately 14 months after the initiation of a multi-level intervention. The intervention did not improve construction of latrines (prevalence ratio [PR]: 0.99; 95% CI: 0.82, 1.21) or handwashing stations with water (PR: 0.96; 95% CI: 0.72, 1.26), or the removal of animal feces from the compound (PR: 1.10; 95% CI: 0.95, 1.28). Nor did it impact anxiety (PR: 0.90; 95% CI: 0.72, 1.11), depression (PR: 0.83; 95% CI: 0.64, 1.07), emotional distress (PR: 0.86; 95% CI: 0.67, 1.09) or well-being (PR: 0.90; 95% CI: 0.74, 1.10) scores. We report limited impact of the intervention, as delivered, on changes in behavior and mental well-being. The effectiveness of the intervention was limited by poor intervention fidelity. While sanitation and hygiene improvements have been documented in Ethiopia, behavioral slippage, or regression to unimproved practices, in communities previously declared open defecation free is widespread. Evidence from this trial may help address knowledge gaps related to challenges associated with scalable alternatives to CLTSH and inform sanitation and hygiene programming and policy in Ethiopia and beyond. Trial registration: This trial was registered with clinicaltrials.gov (NCT03075436) on March 9, 2017.
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Affiliation(s)
- Matthew C. Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Maryann G. Delea
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Jedidiah S. Snyder
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Joshua V. Garn
- School of Community Health Sciences, University of Nevada, Reno, Nevada, United States of America
| | | | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Gloria D. Sclar
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Yihenew Tesfaye
- Department of Social Anthropology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulat Woreta
- Emory Ethiopia, Bahir Dar and Addis Ababa, Ethiopia
| | | | - Abebe Gebremariam Gobezayehu
- Emory Ethiopia, Bahir Dar and Addis Ababa, Ethiopia
- School of Nursing, Emory University, Atlanta, Georgia, United States of America
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8
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Aragie S, Tadesse W, Dagnew A, Hailu D, Dubie M, Wittberg DM, Melo JS, Haile M, Zeru T, Freeman MC, Nash SD, Callahan EK, Tadesse Z, Arnold BF, Porco TC, Lietman TM, Keenan JD. Changing hygiene behaviours: a cluster-randomized trial, Ethiopia. Bull World Health Organ 2021; 99:762-772A. [PMID: 34737469 PMCID: PMC8542271 DOI: 10.2471/blt.21.285915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine whether a water, sanitation and hygiene intervention could change hygiene behaviours thought to be important for trachoma control. METHODS We conducted a cluster-randomized trial in rural Ethiopia from 9 November 2015 to 5 March 2019. We randomized 20 clusters to an intervention consisting of water and sanitation infrastructure and hygiene promotion and 20 clusters to no intervention. All intervention clusters received a primary-school hygiene curriculum, community water point, household wash station, household soap and home visits from hygiene promotion workers. We assessed intervention fidelity through annual household surveys. FINDINGS Over the 3 years, more wash stations, soap and latrines were seen at households in the intervention clusters than the control clusters: risk difference 47 percentage points (95% confidence interval, CI: 41-53) for wash stations, 18 percentage points (95% CI: 12-24) for soap and 12 percentage points (95% CI: 5-19) for latrines. A greater proportion of people in intervention clusters reported washing their faces with soap (e.g. risk difference 21 percentage points; 95% CI: 15-27 for 0-5 year-old children) and using a latrine (e.g. risk difference 9 percentage points; 95% CI: 2-15 for 6-9 year-old children). Differences between the intervention and control arms were not statistically significant for many indicators until the programme had been implemented for at least a year; they did not decline during later study visits. CONCLUSION The community- and school-based intervention was associated with improved hygiene access and behaviours, although changes in behaviour were slow and required several years of the intervention.
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Affiliation(s)
| | | | - Adane Dagnew
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | | | - Melese Dubie
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | - Dionna M Wittberg
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | - Jason S Melo
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | | | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | | | | | | | | | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | - Travis C Porco
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California San Francisco, 490 Illinois Street, Floor 2, Box 0944, San Francisco, CA 94158, United States of America (USA)
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The impact of access to water supply and sanitation on the prevalence of active trachoma in Ethiopia: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009644. [PMID: 34499655 PMCID: PMC8428667 DOI: 10.1371/journal.pntd.0009644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Trachoma is a worldwide infectious disease causing blindness. Trachoma continued as a public health problem in Ethiopia due to a lack of sanitation and inadequate prevention strategies. This study aimed to identify the impact of water supply and sanitation intervention on preventing active trachoma among children. Methods Systematic literature searches were performed from 4 international databases. The search involved articles published from January 1995 up to March 2019. The Cochran Q and I2 statistical tests were used to check heterogeneity among the studies. A random-effect meta-analysis was employed to determine the pooled estimates with a 95% confidence interval (CI). Data analysis was performed using the CMA V.3 and RevMan 5 software program, and the result of the systematic review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings Out of 211 studies screened for the analysis, only 29 studies were finally included in this systematic review and meta-analysis. The result revealed factors that are significantly associated with increased odds of active trachoma. Accordingly, households with no access to toilet facilities (odds ratio [OR]: 2.04, 95% CI: 1.75–2.38), no access to improved water (OR: 1.58, 95% CI: 1.27–1.96), and do not practice regular face washing for children (OR: 4.19, 95% CI: 3.02–5.81) have shown increased odds of active trachoma. Besides, the results show a higher prevalence of active trachoma among children who did not wash their faces with soap and frequently. Conclusions The study found strong evidence that lack of access to water, sanitation, and hygiene (WASH) was associated with increased prevalence of active trachoma among children. Therefore, a comprehensive and partnership-oriented program is needed to tackle the problem, but further study will be required to strengthen its implementation.
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Tsang K, de Wildt G, Mwingira U, Mtuy TB. Implementing trachoma control programmes in marginalised populations in Tanzania: A qualitative study exploring the experiences and perspectives of key stakeholders. PLoS Negl Trop Dis 2021; 15:e0009727. [PMID: 34506482 PMCID: PMC8432809 DOI: 10.1371/journal.pntd.0009727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite aspects of the SAFE strategy for reducing trachoma in Tanzania have been somewhat successful, the disease still persists in marginalised communities even with repeated trachoma control interventions. This study aims to understand the facilitators and barriers associated with implementing trachoma control programmes in these communities, from the perspective of non-governmental organisations (NGOs). METHODS Participants were the representatives of NGOs who had knowledge and experience in the implementation of trachoma control programmes. Data was collected using in-depth, semi-structured interviews guided by a topic guide, which was updated after each interview using a constant comparative method. Interviews were audio-recorded and then transcribed verbatim. Thematic analysis was done inductively. Codes were generated from the transcripts and then clustered into themes. FINDINGS The context within marginalised communities often acted as a perceived barrier to successful implementation of control programmes. This included poor environmental cleanliness, lack of trust, poor disease knowledge and traditional lifestyles. Community values could either be a facilitator or a barrier, depending on the scenario. The anatomical location of the disease and the poor understanding of the disease progression also served as barriers. Considerations affecting decision-making among NGO's include financial feasibility, community needs and whether the quality of the intervention could be improved. NGOs felt that the collaboration and the opportunity to learn from other organisations were beneficial aspects of having different actors. However, this also resulted in variability in the effectiveness of interventions between districts. CONCLUSION NGOs should focus on behaviour change and health education that is tailored to marginalised communities and seek innovative ways to implement trachoma intervention programmes whilst being minimally intrusive to the traditional way of life. Partners should also implement ways to ensure high quality programmes are being provided, by increasing staff accountability and compensating volunteers fairly.
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Affiliation(s)
- Kaki Tsang
- The Department of Population Sciences and Humanities, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gilles de Wildt
- The Department of Population Sciences and Humanities, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Upendo Mwingira
- RTI International, Washington DC, United States of America
- NTD Control Programme, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Tara B. Mtuy
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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11
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Prevalence and associated factors of active trachoma among children aged 1-9 years old in mass drug administration graduated and non-graduated districts in Northwest Amhara region, Ethiopia: A comparative cross-sectional study. PLoS One 2020; 15:e0243863. [PMID: 33320864 PMCID: PMC7737887 DOI: 10.1371/journal.pone.0243863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mass drug administration has implemented to reduce trachoma since 2001, however, trachoma is still the major public health problem in Amhara Region, Ethiopia. However, credible evidence on the prevalence of trachoma and its associated factors after the implementation of mass drug administration is limited. OBJECTIVE To assess the prevalence and associated factors of active trachoma among children aged 1-9 years old in mass drug administration graduated and non-graduated districts in the Northwest Amhara Region. METHODS A comparative cross-sectional study was conducted from October to November, 2019. A stratified multistage random sampling was used to select 690 households having children aged 1-9 years. Data were collected using a pretested structured questionnaire. Data were entered into Epi-data version 3.1 and exported to SPSS version 20.0 for analysis. Bivariate and multivariable logistic regressions were employed to identify factors associated with active trachoma. Crude and adjusted odds ratios with 95% confidence interval were computed to assess the degree of association between the independent variables and active trachoma. RESULTS The overall prevalence of active trachoma was 8.3% (95% CI: 6.2% -10.5%) and showed a significant variation between graduated [3.5% (95% CI: 1.8% -5.6%)] and non-graduated [13% (95% CI: 9.7%-16.8%)] districts. Living in graduated districts (AOR = 7.39, 95% CI: 3.19, 17.09), fly presence in the house (AOR = 3.14, 95% CI: 1.43, 6.89), presence of more than two children in the family (AOR = 3.78, 95%CI: 1.79, 7.98), did not wash face daily (AOR = 6.31, 95% CI: 1.81, 21.98), did not use soap during face washing (AOR = 3.34, 95% CI: 1.37, 8.15), presence of sleep in eyes (AOR = 3.16, 95% CI: 1.42, 7.02) and presence of dirt on child face (AOR = 2.44, 95% CI: 1.08, 5.50) increased the odds of having active trachoma. CONCLUSION The prevalence of active trachoma was high in the study area and showed a significant variation between graduated and non-graduated districts with mass drug administration. Living in non-graduated districts, fly presence in the house, more than two children in a household, did not wash the face daily, did not use soap during face washing, presence of sleep in eyes, and dirt on the child's face were the significant predictors of active trachoma. Therefore, the identified modifiable factors are the area of intervention to reduce the burden of active trachoma.
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Zaman S, Nahar P, MacGregor H, Barker T, Bayisenge J, Callow C, Fairhead J, Fahal A, Hounsome N, Roemer-Mahler A, Mugume P, Tadele G, Davey G. Severely stigmatised skin neglected tropical diseases: a protocol for social science engagement. Trans R Soc Trop Med Hyg 2020; 114:1013-1020. [PMID: 33324991 PMCID: PMC7738656 DOI: 10.1093/trstmh/traa141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
More than one billion people are affected by neglected tropical diseases (NTDs) and many of these diseases are preventable. While the grouping of these conditions as NTDs has generated vast mapping, mass drug administration and surveillance programmes, there is growing evidence of gaps and weaknesses in purely biomedical approaches, and the need for responses that also recognise the social determinants of health. In order to unpack the social and political determinants of NTDs, it is important to view the problem from a social science perspective. Given this background, the Social Sciences for Severe Stigmatizing Skin Diseases (5S) Foundation has recently been established by the Centre for Global Health Research at Brighton and Sussex Medical School. The broad aim of the 5S Foundation is to incorporate social science perspectives in understanding and addressing the problems around three NTDs, namely, podoconiosis, mycetoma and scabies. This protocol paper sets out the aims and approaches of the 5S Foundation while activities such as research, public engagement, training and capacity building get underway.
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Affiliation(s)
- Shahaduz Zaman
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Papreen Nahar
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Hayley MacGregor
- Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK
| | - Tom Barker
- Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK
| | | | - Clare Callow
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - James Fairhead
- School of Global Studies, University of Sussex, Brighton, BN1 9S, UK
| | - Ahmed Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, POB 102, Sudan
| | - Natalia Hounsome
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | | | | | - Getnet Tadele
- College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
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Facial cleanliness indicators by time of day: results of a cross-sectional trachoma prevalence survey in Senegal. Parasit Vectors 2020; 13:556. [PMID: 33203456 PMCID: PMC7672817 DOI: 10.1186/s13071-020-04410-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
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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Ssewanyana D, Abubakar A, Newton CRJC, Otiende M, Mochamah G, Nyundo C, Walumbe D, Nyutu G, Amadi D, Doyle AM, Ross DA, Nyaguara A, Williams TN, Bauni E. Clustering of health risk behaviors among adolescents in Kilifi, Kenya, a rural Sub-Saharan African setting. PLoS One 2020; 15:e0242186. [PMID: 33180831 PMCID: PMC7660520 DOI: 10.1371/journal.pone.0242186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 10/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adolescents tend to experience heightened vulnerability to risky and reckless behavior. Adolescents living in rural settings may often experience poverty and a host of risk factors which can increase their vulnerability to various forms of health risk behavior (HRB). Understanding HRB clustering and its underlying factors among adolescents is important for intervention planning and health promotion. This study examines the co-occurrence of injury and violence, substance use, hygiene, physical activity, and diet-related risk behaviors among adolescents in a rural setting on the Kenyan coast. Specifically, the study objectives were to identify clusters of HRB; based on five categories of health risk behavior, and to identify the factors associated with HRB clustering. METHODS A cross-sectional survey was conducted of a random sample of 1060 adolescents aged 13-19 years living within the area covered by the Kilifi Health and Demographic Surveillance System. Participants completed a questionnaire on health behaviors which was administered via an Audio Computer-Assisted Self-Interview. Latent class analysis on 13 behavioral factors (injury and violence, hygiene, alcohol tobacco and drug use, physical activity, and dietary related behavior) was used to identify clustering and stepwise ordinal logistic regression with nonparametric bootstrapping identified the factors associated with clustering. The variables of age, sex, education level, school attendance, mental health, form of residence and level of parental monitoring were included in the initial stepwise regression model. RESULTS We identified 3 behavioral clusters (Cluster 1: Low-risk takers (22.9%); Cluster 2: Moderate risk-takers (67.8%); Cluster 3: High risk-takers (9.3%)). Relative to the cluster 1, membership of higher risk clusters (i.e. moderate or high risk-takers) was strongly associated with older age (p<0.001), being male (p<0.001), depressive symptoms (p = 0.005), school non-attendance (p = 0.001) and a low level of parental monitoring (p<0.001). CONCLUSION There is clustering of health risk behaviors that underlies communicable and non-communicable diseases among adolescents in rural coastal Kenya. This suggests the urgent need for targeted multi-component health behavior interventions that simultaneously address all aspects of adolescent health and well-being, including the mental health needs of adolescents.
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Affiliation(s)
- Derrick Ssewanyana
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Amina Abubakar
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Charles R. J. C. Newton
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Mark Otiende
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - George Mochamah
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - Christopher Nyundo
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - David Walumbe
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - Gideon Nyutu
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - David Amadi
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - Aoife M. Doyle
- London School of Hygiene & Tropical Medicine, Bloomsbury, London, United Kingdom
| | - David A. Ross
- London School of Hygiene & Tropical Medicine, Bloomsbury, London, United Kingdom
| | - Amek Nyaguara
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
| | - Thomas N. Williams
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana
- Department of Medicine, Imperial College, South Kensington Campus, London, United Kingdom
| | - Evasius Bauni
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
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Abebe TA, Tucho GT. Open defecation-free slippage and its associated factors in Ethiopia: a systematic review. Syst Rev 2020; 9:252. [PMID: 33143715 PMCID: PMC7641843 DOI: 10.1186/s13643-020-01511-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Recent studies have shown an increase in open defecation and slippage of open defecation-free certified villages in Ethiopia, despite significant progress the country made on sanitation programs. Hence, realizing of existing facts, this study was conducted aiming at a critical review of available literature and to provide consolidated data showing the level of slippage and its associated factors in Ethiopia. METHODS Systematic literature searches were performed from four international databases. The search involved articles published from December 1, 2013, up to June 4, 2019. The Cochran's Q and I2 test statistics were used to check heterogeneity among the studies. To negotiate heterogeneity from qualitative data, we used a mixed-method approach. The researchers also conducted a publication bias assessment and sensitivity analysis. A random effect meta-analysis was employed to determine the pooled estimates of open defecation free slippage rate with a 95% confidence interval (CI). The data analysis was performed using the CMA V.3 software program. RESULT After screening 1382 studies, 12 studies were finally included in this systematic review. The estimated pooled rate of open defecation-free slippage in Ethiopia was 15.9% (95% CI 12.9-19.4%). The main contributing factors for open defecation-free slippage were lack of technical support, financial constraints, low-quality building materials, improper program implementation, and lack of sanitation marketing. CONCLUSION It was estimated that 1 out of 6 Ethiopian households engaged in open defecation after they have certified open defecation-free status, implying the low possibility of achieving sustainable development goals of 2030, which aims to ensure sanitation for all. Therefore, the government of Ethiopia and donors should better give special attention to the following options: (1) awareness for open defecation-free slippage, (2) launch a post-open defecation-free program, and (3) encourage research on pro-poor sustainable sanitation technologies.
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Affiliation(s)
- Thomas Ayalew Abebe
- Department of Environmental Health Sciences and Technology, Jimma University, P.O. Box 387, Jimma, Ethiopia.
| | - Gudina Terefe Tucho
- Department of Environmental Health Sciences and Technology, Jimma University, P.O. Box 387, Jimma, Ethiopia
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Knowledge, Attitudes, and Practices about Trachoma in Rural Communities of Tigray Region, Northern Ethiopia: Implications for Prevention and Control. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:3270530. [PMID: 32774392 PMCID: PMC7397421 DOI: 10.1155/2020/3270530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 12/03/2022]
Abstract
Background Trachoma is a neglected tropical disease which is the leading infectious cause of blindness in the world. Trachoma is one of the major health problems in Tigray Region, Northern Ethiopia. However, knowledge, attitudes, and practices about trachoma are not yet studied in depth. The objective of the study was to assess knowledge, attitudes, and practices on trachoma and its associated factors among rural communities in two districts of Tigay Region, Northern Ethiopia. Methods A cross-sectional study was conducted in two districts of Tigray Region, Northern Ethiopia, from May 7–24, 2017. Data were collected on paper based, were entered into Epi Info version 3.5.1, and then exported to SPSS version 21 for analysis. Logistic regression analysis was done to identify factors associated with knowledge, attitudes, and practices. Results In this study, a total of 194 respondents were included. The overall level of good knowledge, attitudes, and practices on trachoma was 51%, 49.5%, and 35.6%, respectively. Having ever received health education was significantly associated with good knowledge (adjusted odds ratio (AOR) = 4.10; 95% confidence interval (CI): 1.91–8.79) and attitudes (AOR = 2.10; 95% CI: 1.02–4.25). Moreover, good knowledge was associated with good practices on trachoma prevention and control (AOR = 2.86; 95% CI: 1.46–5.62). Conclusion Our study implies that areas with high burden of trachoma need to improve communities' knowledge, attitudes, and practices towards trachoma prevention and control in order to eliminate trachoma as a public health problem. Therefore, health education focused on SAFE strategy should be provided to increase knowledge and changing attitudes that contribute for good practices towards trachoma prevention and control among communities.
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Ellis A, McClintic EE, Awino EO, Caruso BA, Arriola KRJ, Ventura SG, Kowalski AJ, Linabarger M, Wodnik BK, Webb-Girard A, Muga R, Freeman MC. Practices and Perspectives on Latrine Use, Child Feces Disposal, and Clean Play Environments in Western Kenya. Am J Trop Med Hyg 2020; 102:1094-1103. [PMID: 32124727 PMCID: PMC7204574 DOI: 10.4269/ajtmh.19-0389] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Exposure to fecal pathogens contributes to childhood diarrhea and stunting, causing harmful short- and long-term impacts to health. Understanding pathways of child fecal exposure and nutritional deficiencies is critical to informing interventions to reduce stunting. Our aim was to explore determinants of latrine use, disposal of child feces, and perceptions and provisions of a safe and clean child play environment among families with children under two (CU2) years to inform the design of a behavior change intervention to address water, sanitation, and hygiene (WASH), and nutrition behaviors. In 2016, we conducted a mixed-methods formative research in western Kenya. We conducted 29 key informant interviews with community leaders, health workers, and project staff; 18 focus group discussions with caregivers of CU2 years; and 24 semi-structured household observations of feeding, hygiene, and sanitation behaviors. We used the capability, opportunity, motivation, and behavior model as our theoretical framework to map caregiver behavioral determinants. Latrine use barriers were lack of latrines, affordability of lasting materials, and social acceptability of unobserved open defecation. Barriers to safe disposal of child feces were lack of latrines, time associated with safe disposal practices, beliefs that infant feces were not harmful, and not knowing where children had defecated. Primary barriers of clean play environments were associated with creating and maintaining play spaces, and shared human and animal compounds. The immediate cost to practicing behaviors was perceived as greater than the long-term potential benefits. Intervention design must address these barriers and emphasize facilitators to enable optimal WASH behaviors in this context.
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Affiliation(s)
- Anna Ellis
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emilie E McClintic
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily O Awino
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bethany A Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kimberly R J Arriola
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sandra Gomez Ventura
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Alysse J Kowalski
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia
| | - Molly Linabarger
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Breanna K Wodnik
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amy Webb-Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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18
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Delea MG, Snyder JS, Woreta M, Zewudie K, Solomon AW, Freeman MC. Development and reliability of a quantitative personal hygiene assessment tool. Int J Hyg Environ Health 2020; 227:113521. [PMID: 32278303 PMCID: PMC7116344 DOI: 10.1016/j.ijheh.2020.113521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/12/2020] [Accepted: 03/29/2020] [Indexed: 01/19/2023]
Abstract
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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Affiliation(s)
- Maryann G Delea
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA.
| | - Jedidiah S Snyder
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | | | | | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
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19
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Tidwell JB, Fergus C, Gopalakrishnan A, Sheth E, Sidibe M, Wohlgemuth L, Jain A, Woods G. Integrating Face Washing into a School-Based, Handwashing Behavior Change Program to Prevent Trachoma in Turkana, Kenya. Am J Trop Med Hyg 2020; 101:767-773. [PMID: 31392952 PMCID: PMC6779218 DOI: 10.4269/ajtmh.19-0205] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Trachoma is the leading infectious cause of blindness, and facial cleanliness is associated with reduced odds of trachomatous inflammation and Chlamydia trachomatis infection, but there is little evidence of how to drive this behavior change at scale. We report the results of a program integrating face washing into a school-based handwashing promotion program in Turkana County, Kenya. Children aged 5–15 years participated in an intervention delivered to schools in two phases, along with a third phase receiving the intervention after the evaluation, which served as a control. The primary outcome was the number of face washing events that took place when handwashing occurred, which was measured by a 3-hour structured observation at all 67 schools, and a total of 3,871 handwashing events were observed. Differences in observed in face washing behavior between each phase and the control schools were calculated using log-binomial regression with clustering at the school level, whereas survey responses on knowledge of trachoma transmission and prevention were compared using χ2 tests adjusted for clustering at the school level. Face washing during handwashing events was higher in schools after 12 months (59.3%) and 20 months (44.2%) than in control schools (18.7%, P < 0.001). Trachoma knowledge was higher in schools evaluated after 12 months (80%) and 20 months (70%) than in control schools (42%, P < 0.001), and knowledge of some of key preventive behaviors was higher in intervention schools. Integrating face washing messages into school-based handwashing promotion programs increased face washing, which may help to prevent trachoma when combined with other interventions.
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Affiliation(s)
- James B Tidwell
- Harvard Kennedy School of Government, Cambridge, Massachusetts
| | - Cristin Fergus
- London School of Economics and Political Science, London, United Kingdom
| | | | | | - Myriam Sidibe
- Harvard Kennedy School of Government, Cambridge, Massachusetts
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20
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Ndisabiye D, Gahungu A, Kayugi D, Waters EK. Association of environmental risk factors and trachoma in Gashoho Health District, Burundi. Afr Health Sci 2020; 20:182-189. [PMID: 33402906 PMCID: PMC7750037 DOI: 10.4314/ahs.v20i1.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Burundi is currently not meeting targets for elimination of trachoma and trichiasis by 2020 (GET2020). The recommended SAFE strategy (Surgery, antibiotics, face washing and environmental improvement) is currently not fully implemented in many areas of Burundi. The existence of associations between face-washing, sanitation and trachoma prevalence remain undocumented. Methods A convenience sample of 468 individuals from 117 households was drawn from attendees at trachoma clinics set up in four villages. Trachoma status, sex and age were recorded for all household members. Adult household members were surveyed about access to clean water and toilets, and knowledge of trachoma risk factors. Associations between cases of active trachoma per household and environmental risk factors were evaluated using generalised estimating equations. Results The overall prevalence of active trachoma was 7.1% (95% CI 5.0–9.6%), but 19.5% (95% CI13.7–26.4%) in children under nine years old. 0.9% (95% CI 0.3–2.0) of participants had trichiasis. Access to a sanitary toilet more than halved the odds of active trachoma (OR 0.43, 95% CI 0.25–0.74%), however, participants did not appreciate this association. Conclusion Access to sanitation was associated with the occurrence of active trachoma. Future research should focus on whether improving knowledge of and access to sanitation might reduce trachoma prevalence.
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Affiliation(s)
- Desire Ndisabiye
- School of Medicine, University of Notre Dame Australia, 160 Oxford St Darlinghurst NSW 2010 Australia
| | - Athanase Gahungu
- National Integrated Program for Neglected Tropical Diseases, Ministry of Health, Rue Pierre Ngendandumwe, Bujumbura, Burundi
| | - Donatien Kayugi
- National Integrated Program for Neglected Tropical Diseases, Ministry of Health, Rue Pierre Ngendandumwe, Bujumbura, Burundi
| | - Edward K Waters
- School of Medicine, University of Notre Dame Australia, 160 Oxford St Darlinghurst NSW 2010 Australia
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21
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Khan AA, Florea VV, Hussain A, Jadoon Z, Boisson S, Willis R, Dejene M, Bakhtiari A, Mpyet C, Pavluck AL, Gillani M, Qureshi B, Solomon AW. Prevalence of Trachoma in Pakistan: Results of 42 Population-Based Prevalence Surveys from the Global Trachoma Mapping Project. Ophthalmic Epidemiol 2020; 27:155-164. [PMID: 31916887 PMCID: PMC7048080 DOI: 10.1080/09286586.2019.1708120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: Previous phases of trachoma mapping in Pakistan completed baseline surveys in 38 districts. To help guide national trachoma elimination planning, we set out to estimate trachoma prevalence in 43 suspected-endemic evaluation units (EUs) of 15 further districts. Methods: We planned a population-based trachoma prevalence survey in each EU. Two-stage cluster sampling was employed, using the systems and approaches of the Global Trachoma Mapping Project. In each EU, residents aged ≥1 year living in 30 households in each of 26 villages were invited to be examined by trained, certified trachoma graders. Questionnaires and direct observation were used to evaluate household-level access to water and sanitation. Results: One EU was not completed due to insecurity. Of the remaining 42, three EUs had trichiasis prevalence estimates in ≥15-year-olds ≥0.2%, and six (different) EUs had prevalence estimates of trachomatous inflammation—follicular (TF) in 1–9-year-olds ≥5%; each EU requires trichiasis and TF prevalence estimates below these thresholds to achieve elimination of trachoma as a public health problem. All six EUs with TF prevalences ≥5% were in Khyber Pakhtunkhwa Province. Household-level access to improved sanitation ranged by EU from 6% to 100%. Household-level access to an improved source of water for face and hand washing ranged by EU from 37% to 100%. Conclusion: Trachoma was a public health problem in 21% (9/42) of the EUs. Because the current outbreak of extremely drug-resistant typhoid in Pakistan limits domestic use of azithromycin mass drug administration, other interventions against active trachoma should be considered here.
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Affiliation(s)
- Asad Aslam Khan
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan.,College of Ophthalmology and Allied Vision Sciences, King Edward Medical University, Lahore, Pakistan.,Mayo Hospital, Lahore, Pakistan
| | - Victor V Florea
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Arif Hussain
- College of Ophthalmology and Allied Vision Sciences, King Edward Medical University, Lahore, Pakistan
| | - Zahid Jadoon
- Pakistan Institute of Community Ophthalmology, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Sophie Boisson
- Department of Public Health, The Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria.,Sightsavers, Kaduna, Nigeria.,Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alexandre L Pavluck
- International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
| | | | - Babar Qureshi
- Neglected Tropical Diseases, CBM, Oakington, Cambridge, UK.,Eastern Mediterranean Region Alliance for Trachoma Control, Cairo, Egypt
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.,London Centre for Neglected Tropical Disease Research, London, UK
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22
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Altherr FM, Nute AW, Zerihun M, Sata E, Stewart AEP, Gessese D, Melak B, Astale T, Ayenew G, Callahan EK, Chanyalew M, Gashaw B, Waller LA, Tadesse Z, Nash SD. Associations between Water, Sanitation and Hygiene (WASH) and trachoma clustering at aggregate spatial scales, Amhara, Ethiopia. Parasit Vectors 2019; 12:540. [PMID: 31727155 PMCID: PMC6857222 DOI: 10.1186/s13071-019-3790-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background Trachoma 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. Methods Data 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. Results The 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. Conclusions Water 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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23
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Greenland K, White S, Sommers K, Biran A, Burton MJ, Sarah V, Alemayehu W. Selecting behaviour change priorities for trachoma 'F' and 'E' interventions: A formative research study in Oromia, Ethiopia. PLoS Negl Trop Dis 2019; 13:e0007784. [PMID: 31596851 PMCID: PMC6785218 DOI: 10.1371/journal.pntd.0007784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Trachoma is the leading infectious cause of blindness. However, little is known about the behavioural and environmental determinants of transmission of the causative organism, Chlamydia trachomatis. We conducted formative research in a trachoma hyper-endemic area of Ethiopia to explore the behaviours which are likely to contribute to trachoma transmission and map their determinants. METHODOLOGY/PRINCIPAL FINDINGS Data on water use, hygiene, defecation, and sleeping arrangements were collected from five communities during the dry and rainy seasons in 2016. Data collection involved direct observation in households (n = 20), interviews with caregivers (n = 20) and focus group discussions (n = 11). Although several behaviours that likely contribute to trachoma transmission were identified, no single behaviour stood out as the dominant contributor. Hygiene practices reflected high levels of poverty and water scarcity. Face washing and soap use varied within and between households, and were associated with other factors such as school attendance. Children's faces were rarely wiped to remove nasal or ocular discharge, which was not perceived to be socially undesirable. Bathing and laundry were performed infrequently due to the amount of time and water required. Open defecation was a normative practice, particularly for young children. Latrines, when present, were poorly constructed, maintained and used. Young children and parents slept closely together and shared bedding that was infrequently washed. CONCLUSIONS/SIGNIFICANCE Existing norms and enabling factors in this context favour the development of interventions to improve facial cleanliness as more feasible than those that reduce unsafe faeces disposal. Interventions to increase the frequency of bathing and laundry may also be infeasible unless water availability within the home is improved.
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Affiliation(s)
- Katie Greenland
- Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sian White
- Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katina Sommers
- Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adam Biran
- Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Virginia Sarah
- Partnerships and Advocacy, The Fred Hollows Foundation, London, United Kingdom
| | - Wondu Alemayehu
- Berhan Public Health and Eye Care Consultancy, Addis Ababa, Ethiopia
- Technical Advisor, The Fred Hollows Foundation, Addis Ababa, Ethiopia
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24
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Mwale C, Mumbi W, Funjika M, Sokesi T, Silumesii A, Mulenga M, Mutati G, Kwendakwema D, Chelu C, Adamu Y, Alemayehu W, Al-Khatib T, Bakhtiari A, Dejene M, Massae PA, Mpyet C, Nwosu C, Willis R, Courtright P, Solomon AW. Prevalence of Trachoma in 47 Administrative Districts of Zambia: Results of 32 Population-Based Prevalence Surveys. Ophthalmic Epidemiol 2019; 25:171-180. [PMID: 30806543 PMCID: PMC6444202 DOI: 10.1080/09286586.2018.1546880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Purpose: A number of previous administrative-district-level baseline trachoma prevalence estimates in Zambia required verification. We used methodologies and systems for trachoma surveys considered to represent international best practice in order to generate reliable estimates of the prevalence of trachoma. Methods: Between March 2016 and July 2017, we undertook 32 population-based prevalence surveys covering 47 administrative districts. In each of the 32 evaluation units (EUs), we selected 31 households in each of 24 clusters. In selected households, trained, certified graders examined all residents aged 1 year and above for evidence of trachomatous inflammation—follicular (TF) and trichiasis. In eyes that had trichiasis, the presence or absence of trachomatous scarring (TS) was recorded, and the subject was asked about previous trichiasis management recommendations from health workers. Results: Five EUs (encompassing seven administrative districts) had prevalence estimates of trichiasis+TS unknown to the health system in ≥15-year-olds of ≥0.2%, and require public-health-level implementation of trichiasis surgery services. Eleven EUs (encompassing 16 administrative districts) had TF prevalence estimates in 1–9-year-olds of ≥5%. Intervention with the A, F and E components of the SAFE strategy for trachoma elimination is required for nearly 1.5 million people. Conclusion: Trachoma is a public health problem in some parts of Zambia. The Ministry of Health will continue to partner with other stakeholders to implement the multi-sectoral SAFE strategy. Consideration should be given to re-surveying other suspected-endemic administrative districts in which surveys using older methodologies returned TF prevalence estimates ≥5%.
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Affiliation(s)
- Consity Mwale
- a Lusaka Provincial Health Office , Lusaka , Zambia.,b University Teaching Eye Hospital , Lusaka , Zambia
| | - Willard Mumbi
- c Ophthalmology Unit , Kabwe General Hospital , Kabwe , Zambia
| | - Misa Funjika
- d Ophthalmology Unit , Ndola Teaching Hospital , Ndola , Zambia
| | - Teddy Sokesi
- d Ophthalmology Unit , Ndola Teaching Hospital , Ndola , Zambia
| | | | - Muma Mulenga
- b University Teaching Eye Hospital , Lusaka , Zambia
| | - Grace Mutati
- b University Teaching Eye Hospital , Lusaka , Zambia
| | | | | | - Yilikal Adamu
- g Department of Ophthalmology, Faculty of Medicine , Addis Ababa University , Addis Ababa , Ethiopia
| | - Wondu Alemayehu
- h The Fred Hollows Foundation , Addis Ababa , Ethiopia.,i Berhan Public Health and Eye Care Consultancy , Addis Ababa , Ethiopia
| | - Tawfik Al-Khatib
- j Prevention of Blindness Program , Ministry of Public Health & Population , Sana'a , Yemen.,k Department of Ophthalmology, College of Medicine , University of Sana'a , Sana'a , Yemen.,l Eye Unit , Al-Thawra Hospital , Sana'a , Yemen
| | | | - Michael Dejene
- n Michael Dejene Public Health Consultancy Services , Addis Ababa , Ethiopia
| | | | - Caleb Mpyet
- p Department of Ophthalmology , University of Jos , Jos , Nigeria.,q Sightsavers , Kaduna , Nigeria.,r Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | | | | | - Paul Courtright
- r Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Anthony W Solomon
- s Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,t Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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25
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Mpyet C, Muhammad N, Adamu MD, Ladan M, Willis R, Umar MM, Alada J, Aliero AA, Bakhtiari A, Flueckiger RM, Olobio N, Nwosu C, Damina M, Gwom A, Labbo AA, Boisson S, Isiyaku S, William A, Rabiu MM, Pavluck AL, Gordon BA, Solomon AW. Impact Survey Results after SAFE Strategy Implementation in 15 Local Government Areas of Kebbi, Sokoto and Zamfara States, Nigeria. Ophthalmic Epidemiol 2019; 25:103-114. [PMID: 30806537 PMCID: PMC6444276 DOI: 10.1080/09286586.2018.1481984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: To determine prevalence of trachoma after interventions in 15 local government areas (LGAs) of Kebbi, Sokoto and Zamfara States, Nigeria. Methods: A population-based impact survey was conducted in each LGA using Global Trachoma Mapping Project (GTMP) protocols. In each LGA, 25 villages were selected, except in Arewa LGA, where we selected 25 villages from each of four subunits to obtain finer-resolution prevalence information. Villages were selected with probability proportional to size. In each village, 25 households were enrolled and all consenting residents aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation—follicular (TF) and trachomatous trichiasis (TT). Information on sources of household water and types of sanitation facilities used was collected through questioning and direct observation. Results: The number of households enrolled per LGA ranged from 623 (Kware and Tangaza) to 2488 (Arewa). There have been marked reductions in the prevalence of TF and TT since baseline surveys were conducted in all 15 LGAs. Eight of the 15 LGAs have attained TF prevalences <5% in children, while 10 LGAs have attained TT prevalences <0.2% in persons aged ≥15 years. Between 49% and 96% of households had access to water for hygiene purposes within 1 km of the household, while only 10–59% had access to improved sanitation facilities. Conclusion: Progress towards elimination of trachoma has been made in these 15 LGAs. Collaboration with water and sanitation agencies and community-based trichiasis surgery are still needed in order to eliminate trachoma by the year 2020.
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Affiliation(s)
- Caleb Mpyet
- a Department of Ophthalmology , Jos University Teaching Hospital , Jos , Nigeria.,b Sightsavers , Kaduna , Nigeria.,c Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Nasiru Muhammad
- d Ophthalmology Unit, Surgery Department , Usmanu Dan Fodiyo University , Sokoto , Nigeria
| | - Mohammed Dantani Adamu
- d Ophthalmology Unit, Surgery Department , Usmanu Dan Fodiyo University , Sokoto , Nigeria
| | | | | | | | - Joel Alada
- a Department of Ophthalmology , Jos University Teaching Hospital , Jos , Nigeria.,h Department of Ophthalmology , Jos University Teaching Hospital , Jos , Nigeria
| | | | | | | | - Nicholas Olobio
- j National Trachoma Control Program, Department of Public Health , Federal Ministry of Health , Abuja , Nigeria
| | | | | | | | | | - Sophie Boisson
- l Department of Public Health, the Environment and Social Determinants of Health , World Health Organization , Geneva , Switzerland
| | | | | | | | | | - Bruce A Gordon
- l Department of Public Health, the Environment and Social Determinants of Health , World Health Organization , Geneva , Switzerland
| | - Anthony W Solomon
- n Clinical Research Department , London School of Hygiene & Tropical Medicine , London , United Kingdom.,o London Centre for Neglected Tropical Disease Research , London , United Kingdom.,p Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Amer K, Müller A, Abdelhafiz HM, Al-Khatib T, Bakhtiari A, Boisson S, El Arab GE, Gad H, Gordon BA, Madian A, Mahanna AT, Mokhtar S, Safa OH, Samy M, Shalaby M, Taha ZA, Willis R, Yacoub A, Mamdouh AR, Younis AK, Zoheir MBE, Courtright P, Solomon AW. Prevalence of trachoma in four marakez of Elmenia and Bani Suef Governorates, Egypt. Ophthalmic Epidemiol 2019; 25:70-78. [PMID: 30806536 PMCID: PMC6444193 DOI: 10.1080/09286586.2018.1446536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE In 2015, to determine where interventions are needed to eliminate trachoma as a public health problem from Egypt, we initiated population-based prevalence surveys using the Global Trachoma Mapping Project platform in four suspected-endemic marakez (districts; singular: markaz) of the governorates of Elmenia and Bani Suef. METHODS In each markaz, 30 households were selected in each of 25 villages. Certified graders examined a total of 3682 children aged 1-9 years in 2993 households, noting the presence or absence of trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI) in each eye. A total of 5582 adults aged ≥15 years living in the same households were examined for trachomatous trichiasis (TT). Household-level access to water and sanitation was recorded. RESULTS Three of four marakez had age-adjusted TF prevalence estimates in 1-9-year olds of >10%; the other markaz had a TF prevalence estimate of 5-9.9%. Estimates of the age- and gender-adjusted prevalence of unmanaged TT in adults ranged from 0.7% to 2.3%. Household-level access to water and sanitation was high. (We did not, however, measure use of water or sanitation facilities.) Conclusions: Each of the four marakez surveyed has trachoma as a public health problem, with a need for implementation of the SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) strategy. Further mapping is also required to determine the need for interventions in other areas of Egypt.
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Affiliation(s)
- Khaled Amer
- a Ministry of Health and Population , Cairo , Egypt
| | - Andreas Müller
- b Centre for Eye Research , University of Melbourne , Melbourne , Australia
| | | | | | | | - Sophie Boisson
- f Department of Public Health, the Environment and Social Determinants of Health , World Health Organization , Geneva , Switzerland
| | | | - Hema Gad
- h Health Office , Deir Mawass , Egypt
| | - Bruce A Gordon
- f Department of Public Health, the Environment and Social Determinants of Health , World Health Organization , Geneva , Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Courtright
- n Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Anthony W Solomon
- o Clinical Research Department , London School of Hygiene & Tropical Medicine , London , UK.,p Department of Control of Neglected Tropical Diseases , World Health Organization , Geneva , Switzerland
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Mpyet C, Muhammad N, Adamu MD, Umar MM, Tafida A, Ogoshi C, Maidaura A, Isiyaku S, William A, Willis R, Bakhtiari A, Olobio N, Solomon AW, for the Global Trachoma Mapping Project. Prevalence of Trachoma in Four Local Government Areas of Jigawa State, Nigeria. Ophthalmic Epidemiol 2018; 25:86-92. [PMID: 30806552 PMCID: PMC6444196 DOI: 10.1080/09286586.2018.1467468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/17/2018] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the prevalence of trachoma and water and sanitation coverage in four local government areas (LGAs) of Jigawa State, Nigeria: Birnin Kudu, Buji, Dutse and Kiyawa. METHODOLOGY A population-based cross-sectional survey was conducted in each LGA using Global Trachoma Mapping Project (GTMP) protocols. From each LGA, 25 villages were selected using probability-proportional-to-population size sampling; in each village, 25 households were selected using the random walk technique. All residents aged ≥1 year in selected households were examined by GTMP-certified graders for trachomatous inflammation - follicular (TF) and trichiasis, defined according to the WHO simplified trachoma grading scheme definitions. Water, sanitation and hygiene data were also collected through questioning and direct observation. RESULTS In 2458 households of four LGAs, 10,669 residents were enumerated. A total of 9779 people (92% of residents) were examined, with slightly more females examined (5012; 51%) than men. In children aged 1-9 years, the age-adjusted prevalence of TF ranged from 5.1% (95% CI 2.5-9.0%) in Birnin Kudu to 12.8% (95% CI 7.6-19.4%) in Kiyawa, while the age- and gender-adjusted trichiasis prevalence in persons aged ≥15 years ranged from 1.9% (95% CI 1.4-2.5%) in Birnin Kudu to 3.1% (95% CI 2.2-4.0) in Dutse. Access to improved water sources was above 80% in all LGAs surveyed but access to improved sanitation facilities was low, ranging from 23% in Buji to 50% in Kiyawa. CONCLUSION Trachoma is a public health problem in all four LGAs surveyed. The full SAFE strategy needs to be implemented to achieve trachoma elimination.
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Affiliation(s)
- Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria
- Sightsavers, Kaduna, Nigeria
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Nasiru Muhammad
- Ophthalmology Unit, Surgery Department, Usmanu Danfodiyo University, Sokoto, Nigeria
| | | | | | | | | | | | | | | | | | | | | | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
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Dodson S, Heggen A, Solomon AW, Sarah V, Woods G, Wohlgemuth L. Behavioural change interventions for sustained trachoma elimination. Bull World Health Organ 2018; 96:723-725. [PMID: 30455520 PMCID: PMC6238993 DOI: 10.2471/blt.18.212514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sarity Dodson
- The Fred Hollows Foundation, 52 Barry St Carlton VIC 3053, Sydney, Australia
| | - Anne Heggen
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Delea MG, Sclar GD, Woreta M, Haardörfer R, Nagel CL, Caruso BA, Dreibelbis R, Gobezayehu AG, Clasen TF, Freeman MC. Collective Efficacy: Development and Validation of a Measurement Scale for Use in Public Health and Development Programmes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2139. [PMID: 30274212 PMCID: PMC6211028 DOI: 10.3390/ijerph15102139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 02/04/2023]
Abstract
Impact evaluations of water, sanitation, and hygiene interventions have demonstrated lower than expected health gains, in some cases due to low uptake and sustained adoption of interventions at a community level. These findings represent common challenges for public health and development programmes relying on collective action. One possible explanation may be low collective efficacy (CE)-perceptions regarding a group's ability to execute actions related to a common goal. The purpose of this study was to develop and validate a metric to assess factors related to CE. We conducted this research within a cluster-randomised sanitation and hygiene trial in Amhara, Ethiopia. Exploratory and confirmatory factor analyses were carried out to examine underlying structures of CE for men and women in rural Ethiopia. We produced three CE scales: one each for men and women that allow for examinations of gender-specific mechanisms through which CE operates, and one 26-item CE scale that can be used across genders. All scales demonstrated high construct validity. CE factor scores were significantly higher for men than women, even among household-level male-female dyads. These CE scales will allow implementers to better design and target community-level interventions, and examine the role of CE in the effectiveness of community-based programming.
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Affiliation(s)
- Maryann G Delea
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Gloria D Sclar
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Mulat Woreta
- Emory Ethiopia, Bahir Dar, Addis Ababa, Ethiopia.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Bethany A Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Robert Dreibelbis
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | | | - Thomas F Clasen
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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