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Fighting trachoma in Zambia

`Alexis Barnes August 12, 2016
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There isn’t much to the town of Namwala itself – an assortment of mobile phone “talk time” sellers and wholesale farmer feed stores. But it’s 20 minutes outside of town before you arrive at Kalundu Primary School, which hosted the first facial cleanliness for trachoma elimination pilot in southern province. Students donned heart and star-shaped molds of glycerin soap hanging from strings for one month to reinforce hand washing and facial cleanliness.

“The first day it was hard to teach!” said grade one teacher, Mukena Fortress. “They were so excited to use the soap necklaces that they kept wanting to go use the latrine.”

Fortress demonstrated how to use the necklace, bringing a bucket into her 47 student-filled classroom to teach proper hand washing.

Seven-year-old Misika likes the shape of the soap.

“Our soap is like a heart,” she said. I like always having it to wash.”

Kalundu Primary School is located in Namwala district in southern province, a region in Zambia where trachoma prevalence reaches 37%. Trachoma, an eye infection caused by the Chlamydia trachomatis bacterium, is a major cause of blindness especially in areas with limited access to water and sanitation. Repeated infections lead to scarring of eye tissue. When this scarring happens, the eyelid eventually turns in on itself and eyelashes continuously scratch at the cornea, which may eventually lead to blindness. The infection can be spread by bacteria on hands and the legs of flies, and the common sharing of cloths to wipe the face, especially of children. It is responsible for three percent of global blindness.

An example of an infected eye with eyelashes turning inward. This scratching of the cornea can lead to blindness.

An example of an infected eye with eyelashes turning inward. This scratching of the cornea can lead to blindness.

In partnership with the Ministry of Health, Ministry of Education, Sightsavers, and Manoff Group, Akros is working to eliminate the infection with new surveillance data additions, mass drug administrations and a particular focus on facial cleanliness (“F”) and environmental improvements (“E”) in conjunction with the United Kingdom Department for International Development’s (DFID) SAFE program. SAFE is using surgery, antibiotics, facial cleanliness and environmental control to eliminate trachoma in Zambia’s southern province.

Besides the important of personal hygiene, Namwala is home to more cattle than people and with animals come flies, which made it a perfect home for the pilot.

With a mantra of “No Flies, Happy Eyes”, Akros is working to reduce one of the main methods of infection transmission through a multifaceted communications approach utilizing mass media, new environmental health technician (EHT) trainings, targeted messaging and school initiatives to increase hygiene.

Part of the social and behavior change strategy for the Sightsavers Trachoma Elimination project includes identifying ways to ensure that families keep children’s faces clean and free of secretions all day using soap and water. Because many older children (age 4-10) are often in school or independent during the day, and not always directly under the care of their parents, the project will reach these children through the school-based CLTS program, coupling face washing with hand washing in schools.

“Aiming at young children, especially the grade ones, will really make it stick,” said Kalundu head teacher Anderson Zulu. “In socio-economic settings such as here, it will even make students more excited to go to school. They have something that is theirs, that they are proud of.”

Molds used for making soap bracelets.

Molds used for making soap bracelets.

Zulu met with parents and the parent teacher association before starting the pilot in order to ensure understanding. Because most Zambians in the province have learned of trachoma, parents were open and happy about the new project, said the head teacher.

To make the necklaces, glycerin soap was melted in the microwave or on the stove briefly then poured into molds or ice cube trays. While the soap was still liquid, strings were placed in the molds and the soap hardened. The necklaces can also work as “hall passes” or created as key chains. The point is to trigger good hygiene behavior.

“We teach hygiene, but this time the students were really excited about it,” said Fortress. “I think it can last and it is easy to make. I hope every school and student can have one.”


About Alexis Barnes

Alexis Barnes is a communications and advocacy Global Health Corps fellow at Akros. Previously a NYC-based journalist, she has interests in development, sanitation issues and human rights.


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