Stakeholder’s perception on the slow progress towards trachoma elimination and suggested recommendations for future intervention: An interpretive qualitative study in Bugna District, Northeast Ethiopia

Abstract Background: Trachoma is a common neglected tropical disease and it was earmarked for elimination at the end of 2020 using SAFE (surgery, antibiotics, facial cleanness, and environmental improvement) strategy. Ethiopia is the most affected country of the globe in which trachoma remains rampant in many rural parts. For instance, in the North and South Wollo Zones of the Amhara region, the prevalence of active trachoma among children aged 1–9years was 21.6%. In the same region, but in Gazegibela district of Wagehemra Zone, the prevalence of active trachoma among children aged 1–9years was 52.4%. The aim of this study was to explore perceptions of stakeholders on the contributors of SAFE strategy failure despite the Ethiopian government and partner organizations implementation of the SAFE strategy to control trachoma from 2006 to 2020 and as well to describe the recommendation of the stakeholders for future intervention in Bugna District, Ethiopia. Methods: The study design is an interpretive generic qualitative design and the study setting was Bugna district, Northeast Ethiopia. The study participants were sampled purposively from the district health care leaders, public health professionals, Health Extension Workers (HEWs) and kebelle leaders (lowest level community leaders). The included participants were 28Health Extension Workers, 16kebelle leaders, 2district level health office leaders, 2district level trachoma officers, and 5district level public health staffs. An in-depth interview (n=18) and Focus Group Discussion (n=7) were held to explore the participants' perception. Both the in-depth interview and Focus Group Discussion (FGD) sessions were audio-taped, and the interview lasted one to two hours, and the FGD lasted two to three hours. The data analysis framework was an inductive thematic analysis. Results: The study participants (stakeholders) lived in 16kebelles (sub-districts) of the Bugna District. The age of health extension workers ranged from 23-35years, with a mean age of 31years. Participants' opinions were categorized into two broad themes; contributors for ineffectiveness of SAFE strategy in controlling trachoma in Bugna District, and suggested recommendations to reduce the prevalence of trachomatous inflammation­-follicular(TF) below 5% and prevalence of trachomatous trichiasis (TT) below 0.2%. The two broad themes classified further in to four sub-themes of contributors for the ineffectiveness of SAFE strategy to control trachoma below 5%, and six sub-themes of the recommendations to reduce the prevalence of TF below 5% and TT below 0.2% in Bugna District post-2020. Conclusions: Despite various interventions implemented to control trachoma in many parts of Ethiopia by the minister of health and many nongovernmental organizations like the Carter Center, the prevalence of trachoma (TF) was above 5% by October 2020, and the GET2020 in Ethiopia were not effective. The Bugna District had the highest prevalence of trachoma in the North Wollo Zone in 2020 and continued post-GET2020. The stakeholders forwarded their recommendations to eliminate trachoma by 2030.