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

Abstract

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.

Knowledge, perceptions and experiences of trachoma among Maasai in Tanzania: Implications for prevention and control

“…All were unaware of a link between childhood infections and trichiasis, a factor that may limit uptake of interventions. This is consistent with reports from Guinea Bissau [27] and the Gambia [28]. Whilst, there was a lack of understanding of the aetiology of trachoma many recognized an association between presence of flies and increased infection.…”

“…In line with our findings other studies looking at other NTDs in other low and middle-income countries similarly found that beliefs on disease aetiology were environmental or spiritually based [29–33]. For example, a study in the Gambia revealed bad air was believed to cause trichiasis [naturalistic cause] and bad air affects eyes because ‘enemies’ in the village wish to afflict them [personalistic] [28].…”

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

“…Similar research in the Gambia 12 concluded that the lack of connection between childhood active infection and trichiasis-induced adult blindness was a major obstacle to SAFE implementation. It also postulated that traditional remedies persisted due to local perceptions of trachoma's etiology and natural history, despite observing Western medicine effecting a cure.…”

Knowledge, practices and perceptions of trachoma and its control among communities of Narok County, Kenya

“…The results of the current study show that community members have to walk for long distances in search of water and rely heavily on rainfall for supply of water. Previous studies in pastoralist communities in Turkana region Kenya [ 26 ], Gambia [ 27 ] and Northern Tanzania [ 28 ] reported large families as a major risk factor in the transmission of trachoma. This was associated with the amount of water available to each family member each day.…”

“…This belief contributes to environmental contamination leading to trachoma infection due to the attraction of flies. A study conducted in Ayod County, Sudan, [ 27 ] highlighted the importance of communities adopting the behavior of proper disposal of human waste for reduction of transmission of trachoma. A randomized controlled trial examining latrine use [ 30 ] showed that latrine provision and very high usage resulted in a decrease of flies on the face, and an associated reduction in trachoma prevalence.…”