Comm Eye Health Vol. 18 No. 53 2005 pp 80. Published online 01 March 2005.

Enhancing the SAFE strategy through collaboration, participation, accountability and sustainability

William Astle, Boateng Wiafe, April Ingram, Mike Mwanga, Colin Glassco

Alberta Children’s Hospital, Canada in collaboration with Lusaka Eye Hospital, Zambia.

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The purpose of our project was to determine the prevalence of trachoma, and to measure the impact of implementing the SAFE strategy for controlling trachoma in the Gwembe District of southern Zambia. Implementation of the strategy was enhanced by ensuring local input and cooperation at every stage of development. Direct involvement at the village, community and government levels strengthened the commitment to the project, thereby promoting accountability and responsibility for its success.

New, clean water wells were drilled under local supervision for each identified village. All levels of government were aware of the project and approved each well and drilling location. All people living near the wells were screened for trachoma, and then treated with antibiotic if required. Education on personal and environmental hygiene was provided by trained volunteers. Patients affected by significant trichiasis and corneal scarring received surgery, locally if possible. Attempts were made to control fly populations by cleaning villages, penning livestock and digging latrines; this was done in consultation with local villagers and government officials. Data was collected on all variables normally associated with trachoma as well as variables relating to demographics, water quality, environment and hygiene.

Trachoma prevalence in southern Zambia
Trachoma prevalence in southern Zambia

In total, 26 wells throughout the valley were drilled. While the total population of the valley area is approximately 60,000 people in an area of 3,600 km2, the total sample population totalled 3,892 people, with 54% under 16 years of age. The overall prevalence of trachoma in the area was 45% in 2001; however, prevalence was 52% within the subset of children under 16 years. Two years of intervention has reduced the overall prevalence of trachoma to 6.5%, representing 9% in the child subset, and 3.8% among adults. The drop in prevalence is likely to be due to the interventions but there could also be other explanations.

Problems identified from baseline were: lack of water wells close to the communities; poor personal and environmental hygiene; and lack of awareness of the potential dangers of trachoma infection.

It is common in trachoma projects to encounter a high number of patients who do not return for follow-up, yet we had only 4% lost to follow-up in our study, due to the diligence of our staff. This loss percentage is considered quite low in studies of this magnitude.

Continued monitoring will be required for long-term sustainability of our trachoma control project in this area of Zambia. While it is possible to control trachoma if the appropriate risk factors are addressed, an approach including collaboration and active participation at both local and federal levels will increase the long-term success of such a project.