ASTMH 2017 Poster - Understanding Perceptions and Experiences of Trachoma among the Maasai in Tanzania
- Trachoma remains the world’s leading cause of preventable blindness. Repeated conjunctival infection by Chlamydia trachomatis during childhood can trigger chronic scarring in the eyelids. The eyelids eventually roll inwards so that the eyelashes scratch the surface of the cornea and blinding corneal opacification develops.
- Control of trachoma is based on the SAFE strategy (GET 2020), Surgery for trichiasis; Antibiotic treatment to eliminate the infection; Facial cleanliness; and Environmental improvement (WHO 2012).
- The Maasai are semi-nomadic pastoralists spanning the central border of Tanzania and Kenya. Lack of health facilities and schools in their communities, and the different views about their “development” have impacted on their experiences of health programmes and services.
- WHO set a target for elimination of blinding trachoma by 2020. Despite decades of achievements in trachoma control worldwide, challenges remain in endemic communities including social issues.
- The aim of this study was to explore socio-cultural factors that may impact this disease and effective control among hyperendemic Maasai communities.
This study was situated in a larger ethnographic study of trachoma among Maasai. We used semi-structured interviews for an in-depth examination of the knowledge and understanding of the nature of trachoma. Stratified random sampling was used. Interviews were conducted in Maa. Transcripts were translated into English to conduct a framework analysis. This study was approved by the London School of Hygiene & Tropical Medicine and National Institute for Medical Research.
Interviews were carried out November- December 2016 among 15 women and 13 men ages 18-50 years. The Maasai translation for trachoma is enaoji, a term to describe a condition of eye irritation specific to the eyelids. Some mentioned white spots on the eye lids, possibly follicles. It was often reported to effect young children and some said it occurs within a few days after birth.
Causes and prevention of trachoma: Results show a poor understanding of trachoma. The causes of trachoma were attributed to pollen, dust, and smoke. When asked if facial cleanliness can prevent trachoma, responses were split between denial that it helps and “it helps” but unsure how. Water was seen as treatment and not prevention.
“We believe it happens because other people applied magic power or the patient is cursed. So we believe maybe the patient did wrong things and was cursed by his/her fellows. We believe that eyes and legs are among the most important body parts and life of the human are in his/her eyes and legs.” [45 year old male]
A link to flies was described by many participants but the mechanism was not clear. Only one participant mentioned bacteria and flies as a vector. There was little connection between childhood infection, trichiasis and related blindness.
“I think this is caused because there are those children with dead flies in their eyes and we take them to people who are able to remove those flies.” [female in her 30’s]
Treatment: Traditional medicines from plants and roots were most often used for treating inflammation. The most common was a rough leaf used to scratch the inside of the eyelid until it bleeds. Veterinary medicines for cattle were also used to treat inflammation in children. Trichiasis was seen as a normal condition that comes with aging particularly among women. All were unaware that it can be treated by surgery. Most described the use of a U-shaped iron, olputet, for epilation of eye lashes.
Mass Drug Administration: Knowledge of MDA was inconsistent. Although many thought it helped the community, they perceived it as only for children and the sick. Many reported not taking the drug and some had no recollection of the previous MDA, six months earlier.
“We just use them and the story ends there. We are not sure if they gave us drugs to stop us from getting pregnant. We had the same drugs given to us in 2015 and we used them too. And to the adult like me we took two tablets. And we feared about those drugs that maybe they are given to us purposely to stop pregnancy.” [38 year old female]
“I don’t know [how MDA helps trachoma] because people are ignorant. So some took drugs but they didn’t use them due to fear and lack of knowledge about what these drugs are for.” [36 year old female]
- Results show a poor understanding of trachoma, prevention and control measures.
- These findings can help guide approaches to SAFE in Maasai communities.
- The design of control programmes in hard to reach communities needs to be tailored based on the socio-cultural issues of those communities.
- Targeted education programmes are a critical precursor to effective control programmes.
Chadwick Trust, KU