Exploring the neurosurgery training landscape in Pakistan: A trainee's perspective in resource-limited settings

Background

Shortage of neurosurgeons in Pakistan, one per 720,000 people, stems from a lack of trainees. Therefore, it is vital to assess the training experience, career opportunities, and satisfaction levels of neurosurgical trainees in Pakistan.

Methods

A nationwide survey was conducted, covering 22 CPSP-accredited neurosurgery training programs in Pakistan. Convenience sampling was utilized with a pilot tested questionnaire and responses were analyzed using STATA 15.

Results

The response rate was 98% (120/122) with 70.8% male and mean age of 30.4 ± 4.1 years. Training programs included teaching courses (79%) and journal club (66%); however, there was a lack of cadaver workshops (14%) and cranial model-based stimulation (22%). 67% of trainees lacked publications in indexed journals. 69% worked 50-100 h weekly, with 62% experiencing burnout due to workload and hours and a third reporting poor work-life balance. Trainees dedicated more to operating rooms (37%, 10-24 h/week) and clinics (34%, 24-48 h/week) compared to study (42%, <5 h/week) and research (64%, <5 h/week). Gender equality was rated poorly by 50%. Disparities emerged in subspecialty exposure, with over half of trainees lacking exposure to deep brain stimulation (67%), and epilepsy (75%). 52.5% of the training institutes did not offer fellowships and 64.1% of trainees planned to pursue fellowships abroad.

Conclusions

Steps need to be taken to improve working hours, gender equity, and increase simulation courses, diversify subspecialty exposure, and promote research initiatives.

Psychosocial factors influencing quality of life in patients with primary brain tumors in Pakistan: an analytical cross-sectional study

OBJECTIVE

Despite quality of life (QoL) being recognized as an important outcome in neuro-oncology, there is a lack of research from Pakistan where sociocultural differences may influence QoL. This study aimed to measure the QoL in patients with primary brain tumors (PBTs) and assess its association with mental health outcomes and social support.

RESULTS

Our study included a total of 250 patients, with a median age of 42 years (range 33-54 years). The commonest brain tumors were glioma (46.8%) and meningioma (21.2). The mean global QoL of the sample was 75.73 ± 14.9. The majority of patients had high social support (97.6%) and were not depressed (90%) or anxious (91.6%). On multivariable linear regression, global QoL was inversely associated with no or low income (beta coefficients: -8.75 to -11.84), having hypertension (-5.53), currently using a urine catheter (-13.55), having low social support (-28.16) suffering from mild (-15.31) or symptomatic (-23.84) depression, or mild anxiety (-13.22).

Complete Kawasaki disease after COVID-19 infection in an infant

Kawasaki disease is a generalized systemic vasculitis that affects blood vessels throughout the body. The aetiology of Kawasaki disease is still unknown but is thought to be related to the combined effects of the immune response, genetic susceptibility, and infections including COVID-19. In this case report, we present a seven months old male infant who presented to us with fever, swollen lips, ulcers in the mouth, enlarged tonsils, strawberry tongue, conjunctivitis and generalised non-blanchable maculopapular rash. The detailed workup fulfilled the criteria of Kawasaki disease. The COVID-19 IgM antibodies were positive. The patient was treated with IV Immunoglobulins, IV methylprednisolone and Aspirin. The repeat echocardiography on six weeks follow-up turned out normal. In conclusion, there should be a high index of suspicion of Kawasaki disease while evaluating pediatric patients with COVID-19 infection so that timely intervention can be made to prevent complications. Prospective studies are needed to evaluate the relationship between Kawasaki Disease and COVID-19 infection.

Regional Differences in Admission Rates of Emergency Patients Who Visited a Private General Hospital in the Capital City of Cambodia: A Three-Year Observational Study

BACKGROUND

Regional disparity is an imperative component of health disparity. In particular, providing emergency care that is equally available in rural areas is an essential part of reducing the urban-rural disparity. The objective of this study was to examine the worsening admission rate among Cambodian emergency patients in a rural area and determine their background characteristics that cause this decline.

METHODS

To investigate the disparity among patients who visited Sunrise Japan Hospital (SJH), a major general private hospital in the capital, patient data from November 2016 to September 2019 were obtained from the electronic reception patient database. The primary outcome was defined as the proportion of admission patients as an indicator of illness severity. The patients' addresses were classified into 4 areas based on distance from the capital.

RESULTS

A total of 6167 patients who visited the emergency department at SJH between January 2017 and September 2019 were included in the analysis. The proportion of patients who needed to be hospitalized or transferred increased with the distance from the capital. The proportion of patients who finished consultation decreased with the distance from the capital (P<.01: Chi-square test). The results of the logistic regression analysis showed that the admission rate in rural areas was significantly higher only among males as compared to that of the capital in multivariate analyses adjusted for age, time, and season.

CONCLUSION

The admission rate of emergency patients who visited a private general hospital in Cambodia's capital city increased with distance from the capital city. To improve regional disparity among emergency patients, further research is necessary to identify the issues among emergency patients, especially those who are vulnerable.

Exploring the changes in travel behavior in a developing country amidst the COVID-19 pandemic: Insights from Metro Cebu, Philippines

This article investigates changes in travel behavior from selected urban cities in Metro Cebu, Philippines during the COVID-19 pandemic a year after the first lockdown. Different categories of community quarantine and granular lockdowns have since been imposed to curb the spread of the virus. An online survey was distributed to analyze socio-demographic characteristics and reasons for traveling in relation to weekly trip frequency before and during pandemic. These are presented and analyzed through data visualization and multinomial logistic regression. Results show that the major reason for traveling before pandemic was work-related but has since shifted to buying essentials or for leisure or recreation. Weekly trip frequencies were lesser when compared before pandemic, but several socio-demographic groups have shown otherwise. There is statistical significance for those less likely to travel when commuters are employed, self-employed or students compared to unemployed, earning PHP 10,000 or less compared to those earning above PHP 50,000, in a household size of 10 compared to all other household sizes, and those with college degree against elementary or no formal education. By determining the travel behavior of commuters when they have ample time to adjust to the new normal, their mobility needs can be best understood and consequently satisfied. Interventions in fulfilling the travel needs for those belonging to socio-demographic groups that are highly affected by the pandemic, such as the working class, blue-collar workers, and have limited financial capabilities, can also be developed when a similar outbreak in the future is imminent.

Investigating the fatal pedestrian crash occurrence in urban setup in a developing country using multiple-risk source model

Pedestrian fatalities and injuries are a major public health burden in developing countries. In the safety literature, pedestrian crashes have been modelled predominately using single equation regression models, assuming a single underlying source of risk factors. In contrast, the fatal pedestrian crash counts at a site may be an outcome of multiple sources of risk factors, such as poor road infrastructure, land use type, traffic exposures, and operational parameters, site-specific socio-demographic characteristics, as well as pedestrians' poor risk perception and dangerous crossing behavior, which may be influenced by poor road infrastructure and lack of information, etc. However, these multiple sources are generally overlooked in traditional single equation crash prediction models. In this background, this study postulates, and demonstrates empirically, that the total fatal pedestrian crash counts at the urban road network level may arise from multiple simultaneous and interdependent sources of risk factors, rather than one. Each of these sources may distinctively contribute to the total observed crash count. Intersection-level crash data obtained from the "Kolkata Police", India, is utilized to demonstrate the present modelling methodology. The three-components mixture model and a joint econometric model are developed to predict fatal pedestrian crashes. The study outcomes indicate that the multiple-source risk models perform significantly better than the single equation regression model in terms of prediction ability and goodness-of-fit measures. Moreover, while the single equation model predicts total fatal crash counts for individual sites, the multiple risk source model predicts crash count proportions contributed by each source of risk factors and predicts crashes by a particular source.

The Pattern of Help-Seeking Behavior Among Patients With Sexual Dysfunctions Attending in Psychiatry Outpatient Department in a Tertiary Care Hospital of Bangladesh

INTRODUCTION

Identifying the possible pattern of help-seeking can explain the gap between care need and actual use of care.

AIM

To know the patterns of help-seeking behavior among patients with sexual dysfunction in the context of a developing country.

METHODS

This was a cross-sectional, qualitative study using criterion sampling among the diagnosed patients of sexual dysfunction attending the psychiatry outpatient department. Based on data saturation, 18 in-depth interviews were done. For method triangulation, 1 key informant interview, 1 informal interview, and 1 focus group discussion were performed. Data were analyzed manually using the thematic analysis method.

MAIN OUTCOME MEASURE

Using an interview guideline, face to face interview was performed and the participants reported their pattern of help-seeking regarding their sexual problems.

RESULTS

The majority of the participants were male, within 20-35 years of age range, literate, and from an urban background. Premature ejaculation and female sexual interest/arousal disorder were the most common disorders. After the identification of the problems, help-seeking was done mostly from close and intimate relationships, although a few of the participants choose a self-search strategy. The complementary and alternative medicine approach was mostly used where traditional healers played a major role. The biomedical approach was the last to seek help and most of the participants visited the dermatology and venereology department. Self-help techniques and internet use were found as emerging ways to seek help.

CONCLUSION

Sex education is necessary to improve general awareness because surrounding people were found as the primary source of information. Acharjee P, Mullick MSI. The Pattern of Help-Seeking Behavior Among Patients With Sexual Dysfunctions Attending in Psychiatry Outpatient Department in a Tertiary Care Hospital of Bangladesh. Sex Med 2021;9:100381.

Coverage of IMIA-recommended Competencies by Masters in Health Informatics Degree Programs in East Africa

OBJECTIVE

The International Medical Informatics Association (IMIA) has provided recommendations on Education in Biomedical and Health Informatics (BMHI) as guidance on competencies relevant to education of BMHI specialists. However, it remains unclear how well these competencies have been adopted to guide emerging degree programs in low- and middle-income countries (LMICs). We evaluated comprehensiveness of IMIA-recommended competency coverage by Masters in Health Informatics (MSc HI) programs in East Africa.

MATERIALS AND METHODS

Two investigators independently reviewed curricula for seven accredited MSc HI university programs in the East Africa region to extract covered competencies using an instrument based on the IMIA education recommendations. Descriptive statistics were used to determine competency coverage by institution and across institutions and by IMIA-defined competency domains. Duplication of competency coverage in courses within each curriculum was also evaluated. Multivariable logistic regression was used to test whether coverage of IMIA-recommended competencies differed between institutions.

RESULTS

Cohen's Kappa for coding competencies within courses was 0.738 (95% CI, 0.713-0.764). Coverage of the 40 recommended required IMIA competencies by institutional curricula ranged from 25 (62.5%) to 39 (97.5%) (p < 0.0001), with only 18 (45%) of these competencies covered by all seven institutions. No significant variations in competency coverage were observed between the domains of information sciences (83.7%), health sciences (71.4%), and core BMHI competencies (83.5%) (p = 0.13). On average, each competency was covered by 3.06 courses in each curriculum (range 0 - 14). Curricula also contained 25 additional competencies not part of the IMIA recommendations, 15 of which were found only within the curriculum of a single institution.

DISCUSSION

There is significant variability in coverage of IMIA-recommended competencies across MSc HI curricula evaluated, with observed duplication of competency coverage within each curriculum. The additional competencies uncovered that were not part of the IMIA-recommendations were not universally shared across institutions.

CONCLUSION

The IMIA education recommendations provide a relevant, comprehensive reference guide for developing and improving health informatics degree programs within LMIC settings. Variability in competency coverage needs to be addressed for institutions within similar educational and labor regions.

Towards an Open-Source Oncology Electronic Medical Records System for Low-Resource Settings: Development of Chemotherapy Management in OpenMRS

Cancer is a major public health challenge in low and middle income countries (LMICs). In this paper, we describe work in progress to develop functionality within an open-source electronic medical records system to support safe and standardized cancer care in low-resource settings. We engaged cancer care providers from LMICs to elicit and prioritize requirement, and following a rapid application development approach we developed chemotherapy prescription and documentation functionality within OpenMRS.

Leaving Against Medical Advice From In-patients Departments Rate, Reasons and Predicting Risk Factors for Re-visiting Hospital Retrospective Cohort From a Tertiary Care Hospital

Background: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital.

Methods: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who left against medical advice by submitting a duly filled LAMA form were included. Univariate and multivariate logistic regression models with forward selection methods were employed. Revisit to hospital within 30 days; to clinic or emergency department was outcome variable for regression.

Results: From June 2015 to May 2016 there were 429 LAMA patients, accounting for 0.7% of total admissions. Females were 223 (52%) compared to males 206 (48%). Finances were quoted as the most common reason for LAMA by 174 (41%) patients followed by domestic problems 78 (18%). Internal medicine was the service with the highest number of LAMA patients ie, 153 (36%) followed by Pediatric medicine with 73 (17%). Of the 429 patients, 147 (34%) patients revisited the hospital within 30 days. Sixty-one percent of these ‘bounced-back’ LAMA patients had worsening or persistence of same problem, or new problem/s had developed. In unadjusted bivariate logistic model, patients who were advised for follow-up during discharge against medical advice were four times more likely to revisit the hospital. Patients who were married had an increased odd of revisiting the hospital.

Conclusion: Financial reasons are the most common stated reasons to LAMA. Patients who LAMA are at a high risk of clinical worsening and ‘bouncing back.’ This is the first study from our region on in-patient LAMA rates, to our knowledge. The results can be used for planning measures to reduce LAMA rates and its consequences.

Diabetes incidence and projections from prevalence surveys in Samoa over 1978-2013

Objectives

This study estimates type 2 diabetes (T2DM) incidence in Samoans aged 25–64 years from sequential, irregularly spaced, cross-sectional population prevalence surveys.

Methods

T2DM prevalence from eight population surveys conducted over 1978–2013 (n = 12,516) was adjusted for census region, sex, and 5-year age group to the nearest previous census. Annual T2DM incidence was calculated from adjusted prevalences (by sex), using birth cohorts constructed from age-period matrices. Projections of T2DM incidence to 2020 were estimated, based on various scenarios of population weight change using Poisson regression.

Results

Over 1978–2013, T2DM incidence was estimated to increase from 1.12 to 8.44 per 1000 person-years in men and from 2.55 to 8.04 per 1000 in women. Based on regression modeling, if mean population weight was stabilized from 2013, absolute incidence reductions of 0.9 per 1000 person-years (7% lower) are predicted in 2020, compared to the current period trend in weight gain.

Conclusions

T2DM incidence can be calculated from irregularly conducted population risk factor surveys which may be useful in developing countries with limited resources.

Electronic supplementary material

The online version of this article (doi:10.1007/s00038-017-0961-x) contains supplementary material, which is available to authorized users.

Encountering a Neglected Area of a Healthcare System: A Decade of Improvement in Cancer Pain Clinical Practice in Iran

Background

With the increase in the prevalence of cancer, cancer-related issues also deserve more attention especially in developing countries where there is already limited access to high-quality healthcare. Cancer-related pain, the most common and the most annoying one, is not only a symptom but also an important subspecialty and its management is still challenging.

Objectives

To assess the level of pain and cancer pain knowledge in Iran in comparison with the whole world.

Materials and Method

A search of the literature including papers published in PubMed before March 2016 was carried out.

Results

There have been an increasing number of publications on pain since 1842 and a growing number of publications on cancer pain since 1929. There has also been remarkable growth in our understanding of cancer pain, particularly since 2010. More than one-third of studies on pain and cancer-related pain were published after 2010.

Conclusion

There is a need to be more inventive with the management of cancer-related issues, especially pain in developing countries, to maximize the quality and quantity of healthcare delivery to cancer-stricken patients. It seems that non-governmental organizations like MAHAK can play a significant role in this goal.

Are the price patterns of cardioprotective vs. unhealthy foods the same? A report from Iran

BACKGROUND

Although several studies have assessed the price of different food groups in developed countries, there is scarce evidence regarding developing countries. Also, there is no report regarding the price of cardioprotective compared with unhealthy foods. The aim of this study was to determine the trend of food cost across different food groups (cardioprotective vs. unhealthy) and to assess the association between food cost and nutritional quality of foods in Iran.

METHODS

A list of foods consumed frequently by Iranian population was provided. Nutritional quality of foods was assessed by energy density and nutrient rich foods (NRF) index. Food groups were defined according to the US Department of Agriculture (USDA) MyPlate food groups. The price of food groups was reported as kcal/price and price/serving.

RESULTS

Although a positive association between different types of nutrient rich foods, nutrient content of foods and food price was observed, there was an inverse relationship between food price and energy density. The kcal/price of "oils" was less than "whole grains" and "refined grains". "Sugar, sweets and beverages" and "beans and legumes" food groups had equal kcal/price media. Among healthy foods for cardiovascular system, nuts had the highest price/serving. On the other hand, among unhealthy foods for cardiovascular system, processed meat had the highest price/serving. The price/serving of healthy oils was similar to saturated and trans fatty acids rich oils. Also, the price/serving of low-fat (healthy) vs. high fat (unhealthy) dairy was not different. Similar finding was observed for white meat vs. red meat.

CONCLUSION

Our findings revealed that the pattern of food price in Iran is different from developed countries. Also, we found that Iranians can consume a cardioprotective diet without any economic pressure.

Addressing geriatric oral health concerns through national oral health policy in India

There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world's elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries.

Eligibility assessment for intravenous thrombolytic therapy in acute ischemic stroke patients; evaluating barriers for implementation

Background:

Intravenous thrombolysis is an approved treatment method for patients with acute ischemic stroke (AIS) and is recommended by multiple guidelines. However, it seems that it is less frequently used in the developing countries compared to the developed countries.

Objectives:

The purpose of this study was to estimate the percentage of patients with AIS, eligible for intravenous thrombolytic therapy, at the main referral center in Northwest Iran and to determine the main barriers for implementation of this method.

Patients and Methods:

Over one year, 647 patients who were admitted to the emergency department and met the Cincinnati Stroke Scale were enrolled into the study. The center to which patients were admitted, is a tertiary university hospital that has the required infrastructure for thrombolytic therapy in AIS. Factors recorded were neurological examinations and time between onset of symptoms and hospital arrival, hospital arrival and performance of brain computed tomography (CT) scanning, and hospital arrival to complete the investigations. Patients eligible for intravenous thrombolytic therapy were identified according to the American Heart Association (AHA) guidelines.

Results:

Mean time interval between hospital arrival and completion of brain CT scanning was 91 minutes (range: 20–378 minutes) and mean time from hospital arrival to completion of investigations was 150 minutes (range: 30–540 minutes). A total of 159 (31.3%) patients arrived at hospital within 3 hours of the onset of symptoms (early enough for intravenous thrombolytic therapy). However, 81.7% (130/159) of these patients missed thrombolytic therapy due to delayed performance of brain CT scanning and laboratory tests and 38.3% (61/159) had contraindications. The remaining 16 patients (10% of those who arrived within 3 hours and 3.1% of all cases) were eligible for thrombolytic therapy.

Conclusions:

The major barriers for thrombolytic therapy for patients with AIS in this setting were delays in the provision of in-hospital services, like initial patient assessment, CT scans or laboratory studies. These results were in contrast with previous reports.

Understanding the investigators: a qualitative study investigating the barriers and enablers to the implementation of local investigator-initiated clinical trials in Ethiopia

OBJECTIVES

Clinical trials provide 'gold standard' evidence for policy, but insufficient locally relevant trials are conducted in low-income and middle-income countries. Local investigator-initiated trials could generate highly relevant data for national governments, but information is lacking on how to facilitate them. We aimed to identify barriers and enablers to investigator-initiated trials in Ethiopia to inform and direct capacity strengthening initiatives.

DESIGN

Exploratory, qualitative study comprising of in-depth interviews (n=7) and focus group discussions (n=3).

SETTING

Fieldwork took place in Ethiopia during March 2011.

PARTICIPANTS

Local health researchers with previous experiences of clinical trials or stakeholders with an interest in trials were recruited through snowball sampling (n=20).

OUTCOME MEASURES

Detailed discussion notes were analysed using thematic coding analysis and key themes were identified.

RESULTS

All participants perceived investigator-initiated trials as important for generating local evidence. System and organisational barriers included: limited funding allocation, weak regulatory and administrative systems, few learning opportunities, limited human and material capacity and poor incentives for conducting research. Operational hurdles were symptomatic of these barriers. Lack of awareness, confidence and motivation to undertake trials were important individual barriers. Training, knowledge sharing and experience exchange were key enablers to trial conduct and collaboration was unanimously regarded as important for improving capacity.

CONCLUSIONS

Barriers to trial conduct were found at individual, operational, organisational and system levels. These findings indicate that to increase locally led trial conduct in Ethiopia, system wide changes are needed to create a more receptive and enabling research environment. Crucially, the creation of research networks between potential trial groups could provide much needed practical collaborative support through sharing of financial and project management burdens, knowledge and resources. These findings could have important implications for capacity-strengthening initiatives but further research is needed before the results can be generalised more widely.

Patients' awareness of their rights: insight from a developing country

BACKGROUND

Considering the effect of human right observance on patients' satisfaction from the treatment process, in Iran the Patient Rights Charter (PRC) was developed by the Ministry of Health and Medical Education (MOHME) in 2001 and enforced to all hospitals across the country. The purpose of the current study was to evaluate patients' awareness of their rights based on PRC in two tertiary teaching hospitals affiliated with Shiraz University of Medical Sciences (SUMS) in Iran.

METHODS

Current study was a cross-sectional descriptive and analytical survey. The research sample consisted of 200 inpatients and data were gathered through questionnaires filled out during the interview. The rate of awareness of patients was measured on a Likert scale ranging from 1 to 4. Validity and reliability of the questionnaire were confirmed. Data were analysed by descriptive and analytical statistics.

RESULTS

In 30.5% of cases, the total awareness of patients was weak, in 59.4% was moderate, and in 10.1% of them was good. The most awareness was about trust and assurance to confidentiality of treatment team, and the least was about providing sufficient information about treatment options and their complications. There was a significant relationship between educational level and the place of residency with patients' awareness (P<0.001).

CONCLUSION

Total awareness of patients from their rights was medium. Although compared to similar studies this rate was not unsatisfactory, attempts should be made to improve it. Health care organizations are to deliver PRC to patients and make sure they have proper information about their rights. Assuring observance of patients' rights requires not only informing healthcare policy makers and providers, but also educating citizens about what they must expect from their governments and health care providers. This will consequently improve the quality of services. Establishment of Patient Right Committee for supervision and monitoring of informing and observance of patients' rights is also recommended.

Patterns and predictors of non-use of family planning methods in Ethiopian women: a panel survey

PURPOSE

Family planning (FP) is a key global health issue for achieving millennium development goals by 2015. The aim of this study was to identify predictors of changes in FP practice before and after interventions among Ethiopian women of reproductive age in a rural area.

METHODS

This study used a panel survey to identify predictors that placed women at greater risk for non-use of FP methods. The sample consisted of 407 women aged 19-49 years old living in a rural community of Ethiopia who completed both a baseline and follow-up survey. Trained local enumerators conducted face-to-face interviews during home visits. Patterns of FP practice were categorized into four groups: FP use at both baseline and follow-up; use at baseline but non-use at follow-up; non-use at baseline but use at follow-up; non-use at both baseline and follow-up. Logistic regression and classification and regression tree analyses were used.

RESULTS

In a binary logistic regression, women over 35 years old with a negative attitude towards FP and resided in the Sibu area were less likely to start FP practice. Women over 35 years who were in poor health and resided in Sibu were less likely to continue FP practice. For the decision tree, age was the primary node for FP non-users at baseline while area of residence was the primary node for FP users at baseline.

CONCLUSION

Age, health status, attitude towards FP, and area of residence are the primary considerations when developing FP interventions for Ethiopian women in a resource-limited rural area.

Trachoma in an omani village - a health care study

This paper reports the findings of a study carried out on 289 families in rural Oman, to assess the knowledge of trachoma in a defined community, identify the determinants of continued transmission and endemicity of the disease, and to assess the effect of health education provided by medical students.The study identified the prevalence of illiteracy, large family size and overcrowding as potential risk factors. Lack of knowledge in a significant number of families about causes, prevention and transmission of trachoma led to practices that promoted the spread of the disease.We found that episodic health education by medical students did not have any lasting impact on the community. Between families who had received such health education and those who had not, there were few significant differences regarding misconceptions about the disease and undesirable practices.The findings of this study concerning deficiency in knowledge, misconceptions and incorrect practices about trachoma are being utilised to plan a subsequent health education programme for the villagers.