The impact of medical services on trachoma in a Gambian village: antibiotics alone are not the answer

Mabey, David; Downes, Rawlda; Downes, Barbara L.; Bailey, Robin L.; Dunn, David

doi:10.1080/02724936.1991.11747518

Cited by 14 publications

(6 citation statements)

References 5 publications

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“…None of the participants, however, appreciated the link between childhood infection and the scarring sequelae of adulthood; this lack of association may impede compliance with mass antibiotic administrations, delay treatment-seeking behavior and hinder uptake of disease control behaviors. 14 , 23 Future public health education might focus on raising awareness of eye disease in children, the concept of asymptomatic disease and explaining the natural history of trachoma to nurture understanding.…”

Section: Discussionmentioning

confidence: 99%

Health Beliefs and Perceptions of Trachoma in Communities on the Bijagos Archipelago of Guinea Bissau

Thompson

Hutchins

Baio

et al. 2015

Ophthalmic Epidemiology

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Purpose: The World Health Organization aims to eliminate blinding trachoma by 2020 using the SAFE strategy: Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement. Trachoma is hyperendemic on the remote Bijagos Archipelago of Guinea-Bissau, West Africa. Sociocultural factors remain unexplored here, despite their potential impact on disease control, particularly through the “F” and “E” aspects. By examining these, we aim to illuminate this population's unreported health beliefs, hygiene behaviors and disease perceptions. This understanding will help to optimize future public health interventions, and guide the distribution of limited healthcare resources. Methods: Two unmatched interview series were conducted 1 year apart on Bubaque Island in the Bijagos Archipelago; one in rural villages using purposive snowball sampling, the other in a semi-urban settlement, using random-cluster sampling. Interviews were conducted and recorded in Kriolu, the local dialect, by a supervised local field assistant before translation into English for conventional content analysis. Results: Trachoma was unheard of in either series, despite ongoing local trachoma research. A heterogeneous range of disease etiology and preventative measures were suggested, but the importance of hygiene was more widely reported by semi-urban interviewees. Although western medicine was well regarded, traditional practices continued, particularly in the rural populations. Conclusions: Differences in knowledge, beliefs and behaviors were apparent between the two series. Despite widespread rudimentary knowledge of disease prevention, targeted education might benefit both communities, particularly basic hygiene education for rural communities. Healthcare access should also be improved for rural populations. The impact of these measures could be assessed by future fieldwork.

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Section: Discussionmentioning

confidence: 99%

Health Beliefs and Perceptions of Trachoma in Communities on the Bijagos Archipelago of Guinea Bissau

Thompson

Hutchins

Baio

et al. 2015

Ophthalmic Epidemiology

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“…It was even reported that many of such mothers had cause to visit the local Health Centre (where the ointment was readily available) for some other health-related appointments in the course of this treatment, and yet failed to ask for the ointment in order that they might complete the treatment. 19 The lack of motivation to continue with the treatment may have stemmed from a lack of mental connection between this childhood eye infection and blindness from trichiasis later in life. Before any intervention efforts could be successful, there is a need to establish this link in people's minds, and active inflammatory trachoma, innocuous as it may appear, must be identified as a problem by the community dwellers themselves.…”

Section: Community Concepts Of Role and Their Implications For Trachomamentioning

confidence: 99%

Understanding the community perspectives of trachoma: The Gambia as a case study

Ajewole

Faal

Johnson

et al. 2001

Ophthalmic Epidemiology

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Trachoma has justifiably attracted an incredibly large amount of research interest and literature over the last several decades. Perhaps, the area which is least explored is the social aspect of the disease. Most of the major constraints to trachoma control on the global scale appear to be concerned with this aspect of the disease. Recently, a study was conducted in The Gambia with the aim of highlighting the socio-cultural determinants of trachoma. We applied qualitative methods of Focus Group Discussion and Semi-structured interview to explore the local people's concepts of the disease among two traditional ethnic groups, the Jolas and the Manjagos, in five rural communities. Our results show that there appears to be a poor understanding of the chronic nature of the active inflammatory phase of trachoma among the local people. But more importantly, there is a lack of mental connection between this childhood infection and blindness resulting from trichiasis in adults. This probably explains why it is difficult for the people in these communities to see the need for prolonged use of antibiotic eye ointment as required in the treatment of active inflammatory trachoma. Moreover, the local concepts about the cause(s) of the disease tend to compel the people to seek the traditional herbal remedies first, though there is adequate knowledge and experience among them that modern methods of treatment may produce cure, as in the case of corrective lid surgery for trichiasis. This ambivalent attitude of the people to health services appear to be a universal phenomenon in many local communities in Africa, and perhaps hinges on the local people's perspective of the disease, which varies from place to place. We conclude that for any intervention strategy to achieve the set goals of eliminating trachoma in spite of these constraints, community support and participation is essential, and in order to achieve this, the health care provider needs to have a better understanding of the community perspectives of the disease.

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“…Many active infections are asymptomatic and appear to cause little or no discomfort ( Mabey et al . 1991 ).…”

Section: Trachoma As a Diseasementioning

confidence: 99%

“…The need for provision of surgery and antibiotics is not in doubt, but on their own they are unlikely to be successful. When used rationally, antibiotics have a positive effect, but it is unrealistic to think that this can be maintained ( Mabey et al . 1991 ).…”

Section: The Transmission Of Trachomamentioning

confidence: 99%

Review of the evidence base for the ‘F’ and ‘E’ components of the SAFE strategy for trachoma control

Emerson

Cairncross

Bailey

et al. 2000

Tropical Med Int Health

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141

112

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SummaryCommunity control of trachoma as a blinding disease is based on the SAFE strategy of Surgery, Antibiotic therapy, Facial cleanliness and Environmental improvement. Surgery and antibiotic therapy currently dominate most programmes. Blindness from trachoma results from frequent infections repeated over many years, so ultimate success requires the reduction of transmission. This is only likely to be sustainable through the F and E components of SAFE. Environmental improvement with access to water, enhanced hygiene and better sanitation reduces trachoma transmission and the blinding sequelae eventually disappear. Transmission routes and factors that cause this are not known and consequently no single specific tool for F and E is in place. Evidence from intervention studies shows that the promotion of face-washing gave modest gains for intense effort and a pilot study showed that trachoma transmission was reduced in the absence of eye-seeking flies. Other studies have shown that latrines and improved access to water are associated with a lower prevalence of active trachoma. There is likely to be a long-term beneficial effect of a combination of improved water supplies, provision of latrines, facial hygiene promotion through established infrastructure and control of eye-seeking flies. Each of these interventions offers additional public health and other benefits in its own right. Further research on the routes of transmission, the role of hygiene and means of sustainable fly control should be a priority.

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The impact of medical services on trachoma in a Gambian village: antibiotics alone are not the answer

Cited by 14 publications

References 5 publications

Health Beliefs and Perceptions of Trachoma in Communities on the Bijagos Archipelago of Guinea Bissau

Health Beliefs and Perceptions of Trachoma in Communities on the Bijagos Archipelago of Guinea Bissau

Understanding the community perspectives of trachoma: The Gambia as a case study

Review of the evidence base for the ‘F’ and ‘E’ components of the SAFE strategy for trachoma control

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