Controlling Blinding Trachoma in the Egyptian Delta: Integrating Clinical, Epidemiological and Anthropological Understandings

Abstract

Trachoma is a leading cause of preventable blindness in the world. The disease is hyperendemic in rural Egypt, where more than 75% of children show signs of having had at least one episode of infectious trachoma during the first year of life. Earlier anthropological and epidemiological observations suggested that trachoma prevalence would decrease if children had their faces washed with soap and water at least once each day. We conducted a community-based intervention to increase face washing in order to control trachoma. In this paper we describe the overall design of this intervention trial and discuss how we integrated anthropological methods and ethnographic data into the design of this successful multi-disciplinary, cross-cultural project to prevent trachoma.

Acknowledgements

This work was supported by grants from the Edna McConnell Clark Foundation and by NIH grant EY.00427. The views expressed in this paper are those of the authors. We thank our fellow team members who participated in the fieldwork for this project, Dr Ahmed Osman, Dr Anita Fábos and Ms Martha Diase. Mr Nasr Elmanadilli coordinated the logistics for this study. We are grateful to Dr Moyhi El-din Said for his advice and guidance and to Dr Fred Dunn for his general consultation on this project and his comments during the development of the KAP instrument. Dr Walter Hauck provided statistical consultation and Ms Lauren Gee managed the study databases. Earlier versions of some of this material were presented at the 1991 meeting of the American Public Health Association and at the 1991 and 1992 meetings of the American Anthropological Association.

Notes

Notes

[1] In Egypt the word for village (Qareeya) denotes a relatively large administrative unit. Our work is actually carried out in communities known as hamlets (’isba). For convenience, and for consistency with earlier reports of our research, we call the communities in which we worked ‘villages’ and the larger administrative divisions ‘mother-villages’.

[2] The village names used in this article are fictional, but consistent with names reported in the literature for villages studied by our group in the past.

[3] One of the anonymous reviewers for this journal noted that this paper moves between ‘hard core science on the one hand and qualitative anthropological methodology on the other’, and suggested that we adopt a single voice in presenting this material. We do not do this because what this paper is demonstrating—an experiment in integrating three forms of research (clinical, epidemiological and ethnographic)—means that adopting a single voice would do damage to the description of the project. The reality of this kind of collaboration is, we believe, that there will be multiple voices. Adopting a single voice about what happened would mislead the reader.

[4] There are a number of additional questions that can be explored concerning the results obtained in this study. These include questions about the wider meaning of face washing, soap use and eye disease, and questions about gender relations and the interaction of the intervention with the moral and social worlds in the village. Also questions about the long term effect of the intervention, the wider relevance of blindness in social life and differences between the treatment of eye disease between rural and urban areas. Most of these questions were beyond the scope of this study's design. However, a number of them are addressed in other publications by our research team (see, e.g. Lane 1987; Lane & Millar 1987; Courtright 1988; Mikhail et al. 1989; Courtright et al. 1991; Lane et al. 1993).

[5] Because not all data were collected on all individuals, the sample sizes for the analyses that follow vary. In addition, in some instances data are missing for particular questions. However, except for the behavioral observations, where the sample size is 90 children, the results reported here generally derive from samples of 900 or more individuals.

[6] The following questions concerning the efficacy of specific intervention techniques are important. But, such a comparative evaluation was not part of our study design and resources were not available for doing so. While important for the design of future studies, we do not have the data to answer them now.