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Evaluating a school-based trachoma curriculum in Tanzania

28 Nov 2008

Marcia Triunfol

Source: Health Education Research (see original article)

Citation: Evaluating a school-based trachoma curriculum in Tanzania. Lewallen S, Massae P, Tharaney M, Somba M, Geneau R, Macarthur C, Courtright P (2008). Health Educ Res; 23(6)1068-1073.

What is the point of introducing a school curriculum that advises school children to wash their faces when no clean water is available in their school? Pointless, a recent study indicates.

In many countries sub-Saharan Africa, trachoma still causes many cases of blindness. The strategy against trachoma recommended by WHO is SAFE, which includes surgery and antibiotic for treatment, and face washing and environmental hygiene for prevention.

In an attempt to make school children in Tanzania aware of the importance of having clean faces to prevent trachoma infection, Helen Keller International and the Ministry of Education and Vocational Training (MoE) in Tanzania developed a school curriculum on trachoma to be implemented in schools in a district of the Singida Region, with approximately 220,000 people of whom half are under 15 years old.

Twenty schools, located no more than 60 km away from Manyoni town and with a high prevalence of active trachoma, were selected to participate in the study. While ten schools actually received the curriculum and the training (which the authors refer to as phase I adoption of the curriculum), the other ten constituted the control group (phase II).

The study started by visiting all the schools, in order to do clinical examinations to determine how many children had clinical signs of trachoma infection. Children were randomly selected for examination.

A few weeks later, data collection on knowledge, attitudes and practices (KAP) towards trachoma was performed though a survey. Besides the school children, teachers were also surveyed to investigate their perceptions of the trachoma school-based intervention and as a way to enable the researchers to gain knowledge on the constraining factors associated with the curriculum implementation. Additionally, three months after the initial survey, schoolteachers and inspectors went through an 8-day training and familiarization with the trachoma curriculum. Trained teachers were asked to act as multipliers by disseminating the information to other non-trained teachers.

To investigate whether any significant benefit had been achieved from the implementation of the trachoma curriculum, a total of 654 children in the phase I schools and 692 in the phase II were examined one year later. The clinical examinations performed in children in the two groups showed that ocular and nasal discharges decreased in both types of school, but only phase I schools had a reduction in dirty faces over the year. In terms of the knowledge indicators, no significant difference was observed between the two types of schools.

Teachers were also interviewed after curriculum implementation and informed that using the curriculum was very difficult, either because some had not been directly trained or because the school itself did not offer the right conditions for implementation of such a curriculum. These two main issues were revealed to be the main reasons for the lack of success of the trachoma curriculum.

As for the reduction of dirty faces in children in phase I schools, the authors of the study concluded that the possibility could not be ruled out that teachers might have washed the students’ faces themselves previously to the follow-up clinical examination. If this was indeed the case, introducing a school curriculum with the aim of changing habits or attitudes when no teacher appropriate training is offered or no proper hygiene conditions are available seems to be of no avail.