Graduate Student Funding
Rollins School of Public Health, Master in Public Health
New fellowship showcases collaboration between IDN, LGS, and The Carter Center.
Nicole Devereaux spent the summer of 2015 working with The Carter Center Ethiopia office collecting and analyzing data for sanitation and hygiene education. Nicole’s research contributed to The Carter Center’s study of Behavior Change Communications for Education (BCCE) aimed at eliminating trachoma by 2020.
Trachoma is a bacterial eye infection found in poor, isolated communities lacking basic hygiene, clean water, and adequate sanitation. It is easily spread from person to person through eye-seeking flies, hands, and clothes. Repeated infection leads to scarring and inward turning of the eyelid — a very painful condition called trichiasis — eventually causing blindness if left untreated. Trachoma can be found in over 50 countries, most in Africa and the Middle East, and a few countries in the Americas and Asia. Globally, 232 million people are at risk for trachoma, and over 4 million are at immediate risk for blindness from trichiasis. Through its Trachoma Control Program established in 1998, The Carter Center has a trachoma target elimination date of 2020. Ethiopia still has the highest known prevalence of trachoma in the world, and the Amhara Regional National State has the highest known prevalence within Ethiopia.
In February 2015, The Carter Center’s Trachoma Control Program piloted a study in the Amhara Regional National State of Ethiopia to evaluate opportunities for the program to better address facial cleanliness and environmental improvement. The goal of the study was to provide insights and understanding about the barriers and challenges people in the region face in regards to latrine use and facial cleanliness. In June 2015, Nicole joined the study team in Ethiopia for final data collection and analysis. The study surveyed households in all 10 zones of the Amhara region and conducted focus group discussions with teachers, students, community leaders, women’s health group leaders, and health workers. The study’s findings are contributing to the revision of education materials for primary schools.
Photo: Sekota, Amhara Region, Ethiopia
Nicole’s findings included the following:
- Trachoma is not covered in the region’s primary school curriculum before grade five and hygiene and sanitation instruction are limited.
- Traditional community beliefs about smoke, dust, and crying as causes of trachoma paired with potentially harmful treatments of trachoma, including eyelash plucking and cutting of the eyelid, confirm the need for a comprehensive educational approach to facial cleanliness and environmental improvement.
- While the act of face washing is reported as part of daily routines at the household level, many people cited they do not always wash their face daily due to too much work and fatigue at the end of the day.
- Stigma towards being “too clean,” especially for women – an idea described most often among women’s group members suggesting that overly clean women were not performing their household, and potentially marital duties as they should be - was also uncovered in the data analysis.
- Additional barriers to face washing include infrastructure issues such as availability of soap and water.
- The study also found that there is broad understanding about the health benefits of using latrines and regular face washing.
Photo: Sekota Zuria, Outside School Compound
Outcomes from her research:
Preliminary findings were presented to colleagues at The Carter Center office in Ethiopia in August 2015. Information about teachers’ needs for training and materials were presented at a workshop for education officials, teachers, principals, and health care workers at the end of July 2015 in Sekota Town in the Amhara region. This workshop had two purposes: 1) to show the burden of trachoma and the need from the teachers for new materials specific to trachoma, sanitation, and hygiene; 2) to get feedback and buy-in on some of the grade specific lesson plans being developed.
Materials created with The Carter Center assistance are currently used as a co-curricular guide, or as a supplement to the official curriculum. However, the lessons need to be included in the official curriculum in order to ensure that they are regularly taught, a desire expressed by many teachers expressed during the focus groups. Including information about neglected tropical diseases (NTDs) in the official curriculum would be a big step towards the elimination of NTDs and the hygiene and sanitation behaviors that play into their transmission.
The education approach cannot address the infrastructure needs for hygiene and sanitation behaviors to take place. The school education component relies on the existence and upkeep of a latrine within households and a constant supply and availability of clean water.
Photo: Sekota Zuria 4th grade
The revision and development of co-curricular materials is in process. Developing appropriate visual aids to accompany the lessons has proved to be a key part of the design process. A final approval and translation process took place in December 2015. The integration of the research analysis and education material development process helped to ensure that all misconceptions and barriers found in the research are addressed in the education materials.
Monitoring and evaluation tools for the revised teaching materials are also underway. The process for collecting baseline sanitation and hygiene data at the school, and community level requires conversations with all stakeholders involved at every level. The workshop previously mentioned made a first attempt to engage government and school officials from different levels into thinking through the data collection stream as well as the measures for the data to be collected. Pilot testing of all tools is currently underway in the Amhara Region as of March 2016.
Photo: Study team at Lalibela churches