Flies as possible vectors of inflammatory trachoma transmission in a Brazilian municipality

Modeling the "F" in "SAFE": The dynamic game of facial cleanliness in trachoma prevention

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.

Perceptions and practices of community members relating to trachoma in Africa: a qualitative systematic review

OBJECTIVE

The objective of this review was to synthesize the perceptions and practices of community members relating to trachoma in Africa.

INTRODUCTION

Trachoma is the leading cause of blindness worldwide, and Africa is the worst-affected continent. Synthesized evidence relating to the disease has focused on various aspects including epidemiology, control, health education, facial cleanliness, interventions for trachomatous trichiasis, and the burden of trachoma on women. Currently, systematic reviews on perceptions and practices relating to trachoma are lacking despite the existence of primary studies. Filling this knowledge gap is critical for decision-making for effective community uptake of interventions.

INCLUSION CRITERIA

Qualitative studies on the perceptions and practices relating to trachoma in both health care and community settings in Africa were considered for inclusion. Studies with participants 14 years or older were considered, regardless of gender, health status, religion, or ethnicity. Perceptions included beliefs, perspectives, views, knowledge, and thoughts relating to trachoma. Practices included regular actions relating to trachoma, such as treatment and prevention behaviors.

METHODS

A search for studies in English was conducted in MEDLINE, CINAHL, Embase, PsycINFO, Sociological Abstracts, BioMed Central, Current Contents, Cochrane Library, and Google Scholar in May 2019 and updated in October 2021. Unpublished studies were searched in MedNar, Index to Thesis, ProQuest Dissertations and Theses Global, World Health Organization, and individual governments' commissioned trachoma reports. Two independent reviewers were involved in study selection, critical appraisal, and data extraction using the JBI tools. Data were synthesized using the JBI meta-aggregative approach.

RESULTS

Seven studies were included in this review. Participants were people either with or without trachoma. A total of 90 findings were extracted, from which 10 categories were produced and three synthesized findings derived from the categories. The synthesized findings are: understanding and awareness of trachoma influences perceptions of treatment and preventive methods; beliefs and behaviors influence treatment options; economic constraints, socio-cultural beliefs, and risk perceptions influence prevention behaviors and practices.

CONCLUSION

Various perceptions and practices relating to trachoma exist among community members in Africa. These perceptions and practices are influenced by knowledge, cultural beliefs, economic factors, and environmental factors. The findings suggest the need for decision-makers in policy and practice to consider and include these perceptions and practices when designing interventions to combat trachoma in endemic countries. However, due to the limited number of included studies and their methodological weaknesses, more high-quality studies are needed to have a deeper and broader view on these perceptions and practices.