"If students know about trachoma, they will teach their families:" Turning to students and teachers in Amhara, Ethiopia to promote Facial cleanliness and Environmental improvement Open Access

Abstract

Objectives: Trachoma is the world's leading preventable cause of blindness with the highest known prevalence of trachoma in the Amhara region of Ethiopia. Facial cleanliness 'F' and Environmental improvement 'E' are two of the main pillars of the World Health Organization approved SAFE strategy to reduce and eliminate trachoma. This thesis aims to study the education practices regarding the 'F' and 'E' components to evaluate opportunities to improve messaging for behavior change in face washing and latrine usage.

Methods: Qualitative data was collected through focus group discussions with teachers and students grades 1-5 at primary schools in all ten zones of the Amhara region. The focus groups asked about routines, washing behaviors, latrine usage, and perceived barriers to others partaking in washing and latrine usage. Answers to these questions were analyzed for recurring and novel themes.

Results: Students, teachers, and schools face challenges in achieving education goals and activities related to face washing and latrine usage due to lack of universal water and sanitation infrastructure and teaching aids/resources. In light of these limitations, students and teachers believe that given proper training, visual aids, and information on trachoma, sanitation, and hygiene, individual and community adherence to face washing and latrine usage will increase.

Conclusions: To strengthen the 'F' and 'E' arms of the SAFE strategy in Amhara, Ethiopia, educational materials and trainings for teachers regarding trachoma, sanitation, and hygiene are recommended, with particular emphasis on providing visual aids. Continued communication and collaboration with pertinent ministries within Ethiopia to expand rural water and sanitation infrastructure would increase the population's ability to sustain trachoma reductions through regular 'F' and 'E' activities.

Table of Contents

Introduction...1 Problem...3 Purpose...4 Research Questions...5 Significance...5 Definition of Terms...6 Literature Review...7 Methodology...24 Introduction...24 Population and Sample...25 Procedures...29

Study Instruments and Data Management...30

Data Analysis...31 Ethical Considerations...35 Limitations and Delimitations...36 Results...38 Students...38 Teachers...42 Schools...44 A Deviant Set of Discussions...45 Discussion...47 Works Cited...55

Appendix 1: Visual Illustrations of the Stages of Blinding Trachoma...59

Appendix 2: FGD Guide for Teachers...60 Appendix 3: FGD Guide for students...62 Appendix 4: Demographic Form for FGD...64 Appendix 5: Research Analysis Notes...65 Appendix 6: Information Sheet...69

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	sanitation trachoma hygiene
Committee Chair / Thesis Advisor	Andes, Karen, Emory University
Committee Members	Stewart, Aisha, The Carter Center Kelly, Callahan, The Carter Center
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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