‘If an Eye Is Washed Properly, It Means It Would See Clearly’: A Mixed Methods Study of Face Washing Knowledge, Attitudes, and Behaviors in Rural Ethiopia

Abstract

BackgroundFace cleanliness is a core component of the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements) strategy for trachoma control. Understanding knowledge, attitudes, and behaviors related to face washing may be helpful for designing effective interventions for improving facial cleanliness.MethodsIn April 2014, a mixed methods study including focus groups and a quantitative cross-sectional study was conducted in the East Gojjam zone of the Amhara region of Ethiopia. Participants were asked about face washing practices, motivations for face washing, use of soap (which may reduce bacterial load), and fly control strategies.ResultsOverall, both knowledge and reported practice of face washing was high. Participants reported they knew that washing their own face and their children’s faces daily was important for hygiene and infection control. Although participants reported high knowledge of the importance of soap for face washing, quantitative data revealed strong variations by community in the use of soap for face washing, ranging from 4.4% to 82.2% of households reporting using soap for face washing. Cost and forgetfulness were cited as barriers to the use of soap for face washing. Keeping flies from landing on children was a commonly cited motivator for regular face washing, as was trachoma prevention.ConclusionsInterventions aiming to improve facial cleanliness for trachoma prevention should focus on habit formation (to address forgetfulness) and address barriers to the use of soap, such as reducing cost. Interventions that focus solely on improving knowledge may not be effective for changing face-washing behaviors.

Prevalence of trachoma and associated factors in the rural area of the department of Vaupés, Colombia

“…Although the measurement of facial cleanliness is subjective and difficult to standardize [17], inadequate facial cleanliness and risk practices among indigenous children and caregivers in Vaupés endemic communities is evident. This situation is also influenced by the lack of resources to buy soap or forgetting to use it in cleaning routines, as reported by Kristen Aiemjoy et al in Ethiopia [18]. Considering that the non-use of soap can increase the probability of having active trachoma [19] and that there are difficulties for its permanent supply in the middle of the jungle [20], it represents a challenge for the implementation of the F component of the SAFE strategy.…”

Selecting behaviour change priorities for trachoma ‘F’ and ‘E’ interventions: A formative research study in Oromia, Ethiopia

“…Two-thirds of those washing faces used soap and almost all households had soap. Soap availability varies from community to community [27, 37, 38], but is not a major barrier to face-washing in the study setting. Whilst the available evidence in support of face washing as an effective means of trachoma control is inconclusive [12], clean faces (defined by their lack of nasal or ocular discharge [39]) and daily face washing are associated with reduced odds of C .…”

Viral species richness and composition in young children with loose or watery stool in Ethiopia

“…This study was conducted during the final annual visit of a clinical trial evaluating a water improvement intervention in the Amhara region of Ethiopia (clinicaltrials.gov NCT02373657) [16–18]. Methods for the parent trial are described in detail elsewhere [19, 20].…”