Defending the Right to Sight Preventing Trachoma

• Program Overview
• Objectives
• Strategies & Interventions
• Results

PROGRAM OVERVIEW

Koulikoro, Mali. It is 1 PM at the community health center and the sun beats down relentlessly. Mahawa has been waiting to see a doctor since 10 AM. She suspects that her son has a trachoma infection. Brema’s eye began oozing a yellow discharge two days ago. Mahawa is worried about blindness, a common affliction in Mali. Two hours later, despite the trachoma diagnosis, Mahawa feels relieved. The prescribed antibiotic will quickly heal Brema’s infected eye. Mahawa’s search for medical treatment for her son’s symptoms exemplifies the behavioral change Mali’s Right to Sight campaign has begun to achieve.

Trachoma is a contagious eye infection easily spread through close personal contact or by flies after contact with an infected person. According to the International Trachoma Initiative, 39.9% of Mali’s population is actively infected with this disease. Trachiasis is a complication of chronic, untreated infection in adults. Trachoma is the world’s leading cause of blindness. Hyper-endemic in Mali, the disease is so common that blindness is often accepted as a fact of life. Yet trachoma is easily cured with antibiotics, and the suffering it causes is avoidable. Using a strategic communication approach, the Center for Communication Programs (JHU/CCP) made strides in preventing blindness through an innovative trachoma campaign.

OBJECTIVES

Beginning in 2002, JHU/CCP assisted Mali’s National Blindness Control Program conduct a two-year trachoma prevention effort. The program’s objectives included:

• Increasing knowledge of trachoma transmission, prevention and treatment;
• Increasing face-washing of children to prevent infection; and,
• Increasing use of clinical services to treat early and late stage infections.

The target audience was parents and caretakers of children under age twelve in the Kayes and Koulikoro regions. Secondary audiences included health workers, community and political leaders. A comparison of surveys conducted before and after the program found increases in caretaker awareness about trachoma; perception that the disease is serious, and knowledge of prevention and treatment.

STRATEGIES & INTERVENTIONS

In order to reach large audiences at low cost, the program developed two radio pieces: a 20-minute radio magazine and a 2-minute infomercial. “Edutainment” approaches, such as a trachoma song contest, also proved very popular. Radio stations aired the winning tunes repeatedly, to the delight of their composers. CBOs broadcast lively debates on community radio, attacking widespread misconceptions about the disease. An abundance of pamphlets, comic books and promotional items were given out. These materials reinforced person-to-person contact and reiterated key messages.

Other materials targeted important secondary audiences. First, a 15-minute video introduced community leaders to the campaign and urged them to get involved. Second, a trachoma curriculum, trainings and counseling cards prepared health care providers to answer common questions and to treat infections properly.

Campaign messages used the SAFE approach to trachoma prevention--Surgery, Antibiotics, Face Washing and Clean Environment—developed by WHO. Messages reached communities through radio programs and community events. A host of partners—radio stations, NGOs, CBOs, administrative and community authorities, schools, health and social service providers—distributed campaign materials and broadcast radio programs. By joining together with a variety of other organizations, the program succeeded in reaching a very wide audience.

RESULTS

The campaign’s impact was measured qualitatively, using in-depth interviews; and quantitatively, using baseline surveys. Some 1,284 mothers participated in the baseline and 1,069 in the follow-up surveys. Striking differences emerged between mothers who had been exposed to the program and those who had not, for example:

Mothers who were exposed to the program were…

• Significantly more likely to have heard of trachoma
• More likely to believe trachoma is easy to treat
• More likely to know effective trachoma treatments (antibiotic ointment, eye drops)
• Less likely to mention treatment from traditional healers
• More likely to seek advice from a medical specialist—hospital, health center, dispensary, private clinic or doctor, or pharmacy

The program’s impact is also reflected in the clear dose response effect: the higher the exposure, the better the outcomes (Insert Figure 3). Thus, mothers who were exposed to three or more program components had a greater response than those with lower exposure. Even very low exposure to the message, however, produced substantially superior outcomes than no exposure at all.

Behavior change theories suggest that individuals move through a series of stages before they make changes in actual practice. Multiple communication interventions are required before a person achieves a desired behavior. The program’s positive impact on intermediate outcomes, awareness, attitudes, and intentions, suggests that the audience has begun moving in the desired direction.