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MSc Global Health 2006-2007

Anne-Marie O'Sullivan

Country: Ireland
Background: Applied Social Studies
Research Project: An exploratory study of the health needs, health service provision and barriers to health service utilization of Polish nationals, using homeless services in two Irish cities

Annette Rochford

Country: Ireland
Background: BA Sociology
Research Project: Issues for service providers working with service users in managing HIV disclosure to at risk (sex) partners in an Irish sexual health service 

Belaynesh Yifru Mulugeta

Country: Ethiopia
Background: Medicine
Research Project: Factors influencing universal salt iodization in Ethiopi

BACKGROUND: In the past in the effort made to introduce iodine in regular daily diet several foods were considered as a vehicle. Iodization of salt is the common long term and sustainable solution that will insure iodine reaches the entire population. Salt is one of the few commodities which are consumed universally through out the year irrespective of age, sex, economic status or location. It is produced in few area of the world. So iodization of salt in these few areas is possible unlike production of other food products which are produced everywhere. Technology of salt iodization is simple to operate, maintain and no adverse chemical reaction while iodization. Addition of potassium iodide to salt does not make any colour change, taste or odour to salt. The cost of iodization is very low, which is less the 5% of the retail price of salt in most countries.

OBJECTIVES: The objectives of the research is to identify factors influencing universal salt iodisation to combat iodine deficiency disorder in Ethiopia and to suggest appropriate recommendations to improve the production, availability and sustainability of iodised salt in Ethiopia.

METHODOLOGY: The sample of ten people from government institutions, non-government organisations and UN agency were in depth interviewed and the date was analysed by grounded theory of qualitative method of analysis.

RESULTS: Results showed that inadequate awareness on the part of policy makers, the salt industry and the general public of the magnitude of the problem and its alleviation through salt iodisation. Most of the country’s salt is produced in primitive ways of production which has contributed to the failure of the iodization programme in Ethiopia. There is a lack of coordination of the program between federal and regional government, salt producers and stake holders.

CONCLUSION: Information, awareness creation and education aimed at the policy and decision makers as well as the general public should be the major component of USI. Awareness creation programs should target people living in the most vulnerable areas, the salt industry and the Afar region where most of the salt is produced.

Key Words: USI, coordination, awareness, capacity building.

Clare Cantwell

Country: Ireland
Background: BSc Earth Sciences
Research Project: Children living with HIV in resource limited settings: towards effective treatment with ART

BACKGROUND: Without antiretroviral therapy (ART), children living with Human immunodeficiency virus (HIV) will not survive to adulthood. ART has become widely available in resource rich countries but in resource limited settings much work needs to be done to scale up the provision of ART for children living with HIV. Children on ART in resource limited settings face a unique set of challenges. ART is not a cure for HIV but is a potentially live saving treatment if used effectively. The aim of this research was to investigate the factors which contribute to the effectiveness of ART among children living with HIV in resource limited settings.

METHODOLOGY: The research was undertaken through a systematic review of current literature on children on ART in resource limited settings. It followed a three stage process of planning the view, conducting the review and reporting the findings. Literature was identifies through a systematic search strategy and included a review if it met predetermined inclusion criteria. Literature was critically appraised to ensure that the quality of the studies included was appropriate. Data was then extracted from the literature a synthesised in a discussion from which conclusions were drawn and recommendations made.

CONCLUSION: The study identified a wide range of factors that influence the effectiveness of ART in children living with HIV in resource limited settings. Healthcare delivery, adherence to medication, accessibility and availability of ART, early diagnosis and treatment initiation, comprehensive monitoring and follow up strategies, the provision of family centred care and social support were the main factors identified in the review. The complex nature of HIV infection is reflected in the fact that these factors are highly interdependent. It is not only a health issue; social, political and economic issues have a huge influence on the health of a child on ART.

Damien Canning

Country: Ireland
Background: BA Geography
Research Project:Substance abuse in Ireland: Irish vs. non-Irish

BACKGROUND: This study looks at the subject of substance abuse comparing the attitudes of Irish adolescents to their foreign national counterparts.
METHODOLOGY: This was an exploratory study, based on group interviews, which sought to understand the situation from the point of view of adolescents using focus group discussions as the data collection tool. It allowed the researcher to explore the issue of substance abuse in detail. Formal analysis was the process used for analysing the transcripts. 
RESULTS: Peer pressure was identifies by participants in this study as a main influence in explaining why young people start using or abusing substances. Substance abuse was seen as having a negative impact on one’s health and environment. Anti-social behaviours such as fighting or drink driving were identified as negative consequences of substance abuse. Education was depicted as been a key intervention to combating substance abuse in Ireland.
CONCLUSION: There is a clear consensus from this study that SPHE needs to be successfully implemented into schools across Ireland. On a much broader scale, it is crucial that drugs (legal or illegal) continue to be a main focus of the Irish government strategies.

Daniel McCartney

Country: Canada
Background: BSc Molecular Biology and Genetics
Research Project: The impact of migration on the sexual health of migrant men who have sex with men (MSM) in Dublin, Ireland

BACKGROUND: With a long history of emigration, Ireland has only recently experienced an unexpected and unprecedented growth of immigration due to rapid economic growth and recent European Union (EU) enlargement. Migrant men who have sex with men (MSM) are particularly vulnerable to HIV infection and other sexually transmitted infections (STIs) due to a limited availability and accessibility of services, social barriers such as stigma a marginalisation, and increased likelihood of engaging in high-risk sexual behaviours. This study examined the views and experiences of migrant MSM in Ireland to indentify the factors influencing their vulnerability to HIV and other STIs.

METHODOLOGY: Qualitative, semi-structured interviews were conducted to explore the views and experiences of migrant MSM. Purposive sampling methods were used to recruit a sample of MSM from HIV prevention and support services. The study sample included men who were born outside Ireland and migrated to Ireland aged 16 or above. The interview transcripts were subjected to thematic analysis.

RESULTS: This study involved fourteen (14) men from a wide range of countries, whose primary purpose of migrating to Ireland was for work of education. Findings indicated a number of behavioural, social, a structural factors that influence the vulnerability and increase the sexual health risk of migrant MSM. These factors are affected by the dynamic migration process, which is further complicated by the role of sexuality.

CONCLUSIONS: With the increased vulnerability of migrant MSM, a number of interventions are required to address their unique needs beyond conventional programmes for gay, bisexual mean and other MSM. With similar patterns of migration in other European countries, the issue of HIV and migration will require a cooperative effort of individual countries and multilateral agencies.

Gavin Cobb

Country: Scotland
Background: Medicine
Research Project:The management of maternal and congenital syphilis in Central Australia

METHODOLOGY: The research involved a retrospective case-note audit that was undertaken onsite in the medical records department of Alice Springs Hospital, Alice Springs, Australia. This reviewed the patient-records of all mothers who were discharged from the hospital during the dates 01/01/06 – 31/12/06 following delivery. Quantitative analysis included patient ethnicity, religion of antenatal care and residence, and maternal age. Further data was collected that examined the extent of maternal screening for syphilis during pregnancy and the management thereof in affected cases in accordance with the Centre for Disease Control (Northern Territory) “Guidelines for the Investigation and Treatment of Infants at Risk of Congenital Syphilis in the Northern Territory, July 2005”. Any affected pregnancies were also reviewed for management of infants born to these women, again in accordance with the guidelines. 
A list of all women who met in the inclusion criteria was generated by the hospital records database and these were manually accessed within the records department. Each record was evaluated individually in-line with the CDC guidelines. Evidence of serological screening for syphilis was obtained from the patient records with further cross-referencing from various hospitals a laboratory databases.
Infants who were at risk of congenital infection were identifies through the maternal records and accessed in the records department. Management of these infants was analysed in accordance with the CDC guidelines. 
All maternal (and infant where relevant) data was coded and entered onto Microsoft Excel™ spread sheets for standardisation and analysis by groupings as informed above. Paired t-testing and Chi-squared analyses were used for statistical analysis between groupings.
Ethical approval was obtained from Central Australian Human Research Ethics Committee (CAHREC) which serves the Central Australian region, and the Trinity College Faculty Research Ethics Group. Permission to enter the hospital premises and access patient notes was granted by relevant hospital management and administrative staff.

FINDINGS AND CONCLUSION: A positive association was found between Indigenous status and maternal age with the mean age of Indigenous woman being 4 years younger that non-Indigenous women who were also more likely to undertake their antenatal care in an urban rather that a remote setting. Of the 667 women included in the study, 97 were seropositive for indicating previous or current infection. Of these, 12 were found to have active infection. All seropositive cases and cases of active infection were found in Indigenous women. A positive association was found between area of residential/antenatal care and seropositivity, with Indigenous women from remote regions and town camps more likely to be seropositive than Indigenous women from Urban areas. Interestingly, Indigenous women from urban areas were most likely not to complete their antenatal screening for syphilis which could indicate a lower risk of infection for these women. 
Syphilis screening was generally good for non-Indigenous women with 95% completing there screening, but was poor for Indigenous women. 70% of Indigenous women completed their screening, and of those who did not, 72% were due to failure of health personnel to collect serology when an opportunity was available, and 25% due to poor antenatal care attendance by the women. It was of concern that 33% of all cases of missed screening was due to failure to obtain serology at delivery, placing the child at increased risk of undiagnosed congenital syphilis obtained late in pregnancy.
Areas in which the guidelines could be improved included clarification of the terminology, inclusion of further screening and management criteria, and removal of sections that were not used or duplicated by other materials. Significant requirements for improvements in communication and documentation were identified, especially with regard to partner tracing and treatment, as were short comings in the delivery of training of health professionals regarding syphilis management. Recommendations for improvements in these areas were put forward.

Haregewoin Kiflom Desta

Country: Ethiopia
Background: Nursing
Research Project:Knowledge, attitude and practice of universal precaution among health professionals in Addis Ababa, Ethiopia

Joanne Kiniry

Country: Ireland
Background: BSc Applied Psychology
Research Project:The experience of individuals who have worked in complex emergencies, of implementing mental health and psychosocial guidelines to affected populations

Complex emergencies are challenging events that can have a detrimental effect on the mental health of individuals and the communities affected by them. Mental health and the psychosocial guidelines are available for use during the complex emergencies but there is little awareness of them. This study surveyed the experience of individuals who have worked in the implementing of mental health and psychosocial guidelines to populations affected by complex emergencies.

The experiences of participants were collected using a short questionnaire, distributed by email, which included structured and semi-structured questions.

Sixty questionnaires were distributed; however there was a low response rate with only fourteen participants responding. Only six participants returned a fully completed questionnaire.

A number of codes emerged from the analysis of the data, and from them, three main themes became apparent, these were; Awareness, Responsibilities and Capacity. The results showed that there is a lack of awareness of mental health as an issue in complex emergencies. Accordingly there was also a lack of awareness of the guidelines to tackle mental health problems. Confusion about who has responsibility for implementation was also apparent as was a lack of capacity to address the problem during complex emergencies.

In conclusion, Awareness, Responsibility and Capacity all appear to be issues in the implementation of mental health and psychosocial guidelines in complex emergencies. These issues need to be addressed before mental health and psychosocial guidelines can be introduced in complex emergencies.

Although the response rate in this study was low, the findings of this study may be used as a starting point for future research and it is recommended that in future key informant interviews or an internet based questionnaire may be appropriate methods of research.

Julia Morrell

Country: England
Background: BA Anthropology and Geography
Research Project: Harmonisation of aid in the health sector: a case study of the implementation experience of Irish Aid in sub Saharan Africa

BACKGROUND: Current policy amongst aid agencies is to harmonise their engagement in developing countries through sector rationalisation. The aim of this study was to provide insights into the factors which support or constrain successful implementation in the health sector.

METHODOLOGY: An evaluation perspective was adopted with a qualitative case-study analysis of Irish Aid and two ‘embedded units of analysis’ Uganda and Zambia. A conceptual model was developed drawing on approaches from the literature on policy implementation and the management of change. Semi-structured interviews were conducted with 6 key informants in varying positions and perspectives in the organisation. Observation and documentary analysis provided additional and corroboratory data.

FINDINGS: The goal of sector rationalisation has been achieved but it is too soon to know if this will lead to improved aid effectiveness. 
Key factors in the implementation are firstly the situation in each country including stake-holder positions and secondly aspects within IA including strong leadership and the organisation’s commitment to shared values. However, the pace of change was probably too precipitate in terms of adequate preparation of exit strategies and achieving country ownership by Ministries of Health.
Devolved decision-making meant there was less management of the process from IA headquarters with the danger of a lack of coherence with the organisation’s strategic goals and lack of coordination of the impact of staff. 
Concerns were raised about the uncertain impact of the policy in Zambia and of the future human resource implications for Irish Aid.

CONCLUSIONS: The study described the policy context of harmonisation in the aid effectiveness agenda. In examining the steps taken by the Irish Aid it demonstrated the difficulty if implementation and the factors which need to be addressed for success. Whilst recognizing the not insignificant achievement of harmonisation, areas of concern for the future were highlighted.

Mischa Willis

Country: USA
Background: BA Social Science
Research Project: Motivations and incentives employed to prevent the “Brain Drain” of medical professionals in developing countries

BACKGROUND: The United States has 5% of the world’s population, but employs 11% of the world’s physicians, 25% of whom are international medical graduates. The number is even higher in the United Kingdom, Canada and Australia. Many of these graduates come from poor countries with high disease burdens (Kingma, 2001). Medical migration results from various “push” and “pull” factors effecting the decisions of medical professionals. It is the interplay between both forces, a reason to leave and a belief that there are chances for an improved situation elsewhere that fosters migration (Mejia, et al 1979). The economic and social impact of medical migration is profound and can cripple already weak health systems in the developing world.

AIM: This project aims to examine the effectiveness of interventions based on motivation within the context of medical migration and the “brain drain”, defined as the loss of skilled intellectual and technical labour through the movement of such labour to more favourable geographic, economic, or professional environments (Oxford, 2007).

Research Questions:

  • What specific intervention has been recommended to increase the motivation of medical professionals within the developing world?
  • What is the effectiveness of these interventions in reducing migration of medical professionals?
  • What is the evidence used as the basis of these recommendations?

METHODOLOGY: The format of a systematic review using predefined and explicit steps to minimize bias in all parts of the process including identifying relevant studies, and collecting and combining their data (Cochrane, 2006). Criteria for inclusion and exclusion were developed and only data from studies included was extracted.

FINDINGS: Seven themes were identified as main factors effecting motivation including: financial incentives, career development, continuing education, hospital infrastructure, availability of necessities, hospital management and recognition/appreciation. The frequency of the times an incentive was addressed in various studies was determined to not conclusively equate the efficiency of the intervention. There is, however, a correlation between the number of times an incentive was addressed and the level to which that particular incentive is in the academic and research consciousness.

CONCLUSION: Medical migration will not stop without interventions from the countries on both sides of the migration equation. Developing countries must assess and address the motivational push factors within their country, as well as identify the particular pull factors that are luring their medical professionals away. Developed countries need to go about the recruitment of medical professionals in an ethical way that will not debilitate the health system of countries from which they seek medical professionals. A dialogue between countries in a formal setting is needed, and both should be allowed to give input on what is fair and just in the recruitment of medical professionals.

Nicola Boyle

Country: Ireland
Background: Nursing
Research Project: Advanced nursing practice in HIV, international experiences and lessons for an Irish context

OBJECTIVES: This paper aims to explore the literature and previous experiences and challenges of ANPs specialising in HIV/Sexual Health in order to facilitate future HIV ANPS in Ireland.

BACKGROUND: The role of HIV ANPs has been identified as result of health care reforms and an increase in service demands. This has been augmented by the changing disease pattern of HIV, from being a life threatening illness to a chronic disease. However the intricacies of the role need to be clarified and defined.

METHODOLOGY: A review of the literature was carried out to explore past experiences of this role. A qualitative descriptive approach was used to interview ANPs specialising in HIV/Sexual Health in Australia, Ireland, the UK and the USA.

RESULTS: The role of the HIVANP is diverse and multi-faceted. The array of titles and scope of practice at national and international levels are confusing. ANPs experience high levels of job satisfaction however also experience many challenges to their role. These challenges were primarily driven by the ambiguity that still surrounds the role.

CONCLUSION: The role of the ANP is complex, diverse, demanding and evolving. The importance of a clearly defined role is the key to the success of future HIV ANPs. Setting up of a framework to support current and future ANPs specialising in HIV on a national and international level with policies to inform ANPs and lead to a harmonised structured approach to the role.

Oliver Malokota

Country: Zambia
Background: Medicine
Research Project: The impact of Highly Active Antiretroviral Therapy (HAART) project on health service delivery at Monze Mission Hospital, Zambia

BACKGROUND: This chapter discusses the magnitude of HIV/AIDS in sub-Saharan Africa and the impact it has had. It further lays out the demand for Antiretroviral therapy and the interventions, hitherto. It stress that human resource for health is imperative if health systems are to be strengthened. It concludes by describing the project site for this study which is in Monze, Zambia.
This chapter reviews the limitations to scaling up antiretroviral programmes and recognises the critical role Human Resource for Health plays. It also discusses the choice of delivery strategies and how they affect quality, coverage, cost, sustainability and equity. It concludes by demonstrating how effective interventions have been implemented in other places.

METHODOLOGY: This chapter provides an overview of study design, and a rationale for the use of various approaches, methods and tools. A rationale for case selection is presented followed by information relating to sample identification and recruitment procedures. The ethical considerations are also outlined. The approach to data analysis is described and a pre-structured case outline is presented. This chapter concludes by stating the methods of validation and reliability.

FINDINGS: A description of the sentiments and experiences of key informants and clients of the HAART project and the hospital is accounted in this chapter. The chapter is expressed with generous excerpts from interviews on workload, impact of the project on human resource and health service delivery.

DISCUSSION: This chapter highlights the evolution of human resource, workload and health services from inception of the HAART project. Factors that led to frustration and a compromise in quality of services is carefully discussed. It ends with lessons learnt about the manner in which HAART project was implemented and invaluable recommendations and limitations for this research. A concise and succinct account of desirable effects of the HAART project and its impact on human resource, and the quality of hospital services in relation to the adopted implementation approach concludes this research.

Rebecca McSorley

Country: USA
Background: Pre Medicine
Research Project: Examination of the Irish Government’s policies and responses with respect to tuberculosis in foreign-born individuals

Tuberculosis incidence in Ireland had been falling for many years, but since 2001 this trend has been replaced with a slight year-on-year increase. Almost simultaneous with this change in TB trend, immigration has increased, notable from the 2004 European Union Accession States. Many of these states not only have higher annual incident rates of TB than Ireland, but also high prevalence of drug resistance in their tuberculosis cases. From the late 1990’s it appears that the incidence rate of TB in Irish-born individuals has been decreasing, while that in the foreign-born has been on the increase. With the ease of immigration between EU countries, it possible that not only TB, but also drug resistant cases could spread in the Republic of Ireland.

This study was undertaken in order to determine the effectiveness of the Irish TB policy in light of the current tuberculosis pandemic, more specifically with respect to individuals from the EU 10. Specific interest was given to immigrants’ barriers to health care in Ireland. Qualitative methods using semi-structured, in-depth interviews based on phenomenological principles. The participants interviewed represented a variety of sub-specialities within TB.

There was a strong feeling that the Irish Government lacked political commitment towards elimination of TB, demonstrated through the lack of national policy and inadequate resources. Streamlining of health service protocols as well as adequately resourcing existing specialties such as public health and laboratories would be of great benefit. The barriers for foreign-born individuals ranged from communication to lack of social support structures to misperceptions surrounding TB. All of this is in the backdrop of both the immigrants and the general populaces’ lack of TB awareness.

Recommendations include the appointment of a small governing body with an annual budget to streamline TB protocols and direct resources where they are needed most. These resource provisions should be made to fund specialized TB units, public health case managers, improve laboratory facilities and provide voluntary screening units. All of this should be done while implementing a mass of TB awareness campaign.

Rebecca Morris

Country: England
Background: BSc Psychology
Research Project: A formative evaluation of the TB Photovoice Project, Thailand

Tuberculosis (TB) kills over 1.6 million people per year and predominantly affects lower income countries and within those countries the poorest are disproportionately affected. The TB Photovoice (TBPV), Thailand project, based in Chiang Mai, Thailand, uses photography as a medium to produce social action through dialogue by people affected by TB. It aims to increase a facilitate dialogue about TB and HIV/AIDS in local communities in order to strengthen and better understand community-defined TB and HIV/AIDS issues. The researcher conducted a formative evaluation of the project at the end of the first year of implementation using individual interviews with key stakeholders and a focus group with the project participants. The evaluation found that the greatest impact was on the participants by empowering individuals through building skills in photography and writing as well as well as enabling a support network between the participants. There has been an unexpected impact in the form of income generation for the participants. The partner organisations of the project have also been impacted by it through being involved in events with TBPV that have established the partnerships and brought together organisations working in the same field. There were a number of adaptations made from the original Photovoice model in the implementation of TBPV. The project had taken longer to implement than planned and so had limited impact in the wider community. The project was considered a novel effective way of engaging individuals affected by TB. The project now must increase awareness of TB in the local community and identify the issues on which to advocate.

Sarah O'Neill

This research compares and contrasts a selective review of literature pertaining to development workers working to address GBV, with case studies with returned development workers (N=2) who have experiences in the field addressing GBV. The review focused on mental health, occupational stress, traumatic experiences and working with GBV, among development workers and related populations. There was a limited amount of research available, much of which was identified treats development workers as implementers of policy, there has been little focuses on the experiences of workers on assignments to establish evidence based screening, training and support. Research has established that development workers can be considered a group at risk of developing psychological distress as a result of their work, the focus now must be how to support and prepare them for their work, to limit the risk of negative consequences.

The case studies used that Critical Incidents Technique to identify skills; characteristics and abilities development workers have found useful achieving their goals of work in the filed. It is hoped this information could inform employee screening, pre-deployment training, and support on assignment and upon return. Results of the case studies show procedural skills were exclusively identified by participants.

Susan Bradley

Country: England
Research Project: Mid-Level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system

BACKGROUND: Malawi has a chronic shortage of human resources for health. This has a significant impact on maternal health, with mortality rates among the highest in the world. Mid-level cadres of health worker provide the bulk of emergency obstetric and neonatal care. Whilst there have been several studies addressing retention factors for medical doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce.

METHODOLOGY: This exploratory qualitative study took place over a 2-week period in four rural Christian Health Association of Malawi hospitals. The study population were mid-level providers of emergency obstetric and neonatal care. Focus group discussions took place with nursing and medical cadres. Semi-structured interviews with key human resource, training and administrative personnel were used to provide context and background. Data were analysed using a framework analysis.

RESULTS: Participants confirmed the difficulties of their working conditions and the clear commitment they have to serving the rural Malawian population. The main factors impacting on retention and performance were insufficient financial remuneration, limited opportunities for career development and further education (particularly for clinical officers), and inadequate or non-existent human resources management systems. The lack of performance-related rewards and recognition were perceived to be particularly de-motivating.

CONCLUSION: Mid-level cadres are being used to stem Africa’s brain drain. It is in the interests of both governmental and CHAM to protect their investment in these workers. For optimal performance and quality of care they need to be supported and properly motivated. A structured system of continuing professional development and functioning human resources management would show commitment to these cadres and support them as professionals. Action needs to be taken to prevent staff leaving the health sector for less stressful, more financially rewarding alternatives.

Tsegaye Bedane Fulassa

Country: Ethiopia
Background: Public Health
Research Project: Determinants of community participation on Fand E components of safe strategy for Trachoma control in Hulet Eju Enese Woreda/District, East Gojam zone of the Amhara Regional State, North Western Ethiopia

WHO has adopted a resolution to eliminate blinding trachoma by the year 2020 (WHO, 1997). To accomplish this ambitious goal, WHO recommends the use of the SAFE strategy for countries implementing trachoma control programs. This multi-faceted approach includes surgery for trichiasis cases, antibiotics to treat the community pool of infection, facial cleanliness to reduce transmission, and environmental improvement to reduce transmission from sources such as flies (Bailey and Leitman, 2001; Kuper et al., 2003).

The prevalence of Blindness in Ethiopia was found to be 1.6%. These were 1.2 million blind and about 2.8 million people will low vision in the country. The main causes of blindness and low vision in Ethiopia are cataract, trachoma, other corneal opacities, refractive errors and glaucoma. Trachoma is the second leading infectious cause of blindness (11.5%) in the country (Federal Ministry of Health Ethiopia, 2006b).

The trachoma control programme does not just fight disease; it fights the conditions that perpetuate disease: poverty, poor sanitation, lack of knowledge, and hopelessness.
In Ethiopia, active trachoma and trachomatous trichiasis (TT) are concentrated in the regions of the country with high population density; namely the Amhara, Oromia, and SNNP regional states (Federal Ministry of Health Ethiopia, 2006a).

There are so many challenges faced in the trachoma control program: the huge size of the country, wide scattering of households, lack of communication, few unevenly distributed and de-motivated human resources, inadequate budget for eye care, shortage of facilities/infrastructure, lack of basic equipment/instruments, inadequate ophthalmic research, weak inter and intra-sectored collaboration and coordination and there are many other health problems in trachoma control program (Federal Ministry of Health Ethiopia, 2006b). Nevertheless there are considerable grounds for optimism for the scaling of activities, with greater public sector involvement; the strategic trachoma plan has been revised to take this into account. Government commitment to implement of the SAFE strategy is strong (WHO 2006).

Active community participation in the F and E components of SAFE strategy is crucial in the sustainable prevention and control of trachoma. This study designed to access the practice of environmental sanitation in relation to trachoma and to examine the knowledge/attitude, belief and practice of face washing and environmental sanitation of the communities in the targeted Woreda.

For this purpose, a community based cross-sectional study was designed that employed both qualitative and quantitative research. One hundred household heads were interviewed using a semi-structured, translated (in to local language – Amharic) and pre-tested/standardized questionnaire and five focus groups (of eight to ten participants). Discussions were conducted among community leaders, representatives of women associates, religious leaders, community volunteers, and health extension workers.

This study revealed that the community has brought behavioural change in the prevention of trachoma control by being actively participated in facial cleanliness and environmental improvement. The study result showed that 65% of the household heads respondents explained that the distance to a source of water is less than 30 minutes. 85% of the households had latrines. Regarding facial cleanliness, 80% washed children’s faces two or more times a day and 85% of the respondents had information about trachoma. In addition, the result from focus group discussions revealed that trachoma is their public health problem and discussed that they have problems in the implementation of trachoma control program due to their low socio-economic status.