How health workers are gathering data to fight trachoma in conflict areas

Earlier this year, the Ministry of Health in Sudan invited eye health workers from Somalia and Libya to attend a training session as part of the Tropical Data programme.

Trachoma is thought to be endemic in both Libya and Somalia. Yet to find out how widespread the disease is, and begin the important work to control the spread of infection, endemic areas must first be mapped to gather data. Once the surveying is complete, the results can be used by national trachoma programmes to plan any work to eliminate the disease, usually using the SAFE approach (surgery, antibiotics, facial cleanliness and environmental improvement). But the first step is to train the people in country how to conduct surveys.

Because of security issues in Libya and Somalia, the Ministry of Health in Sudan worked with national trachoma coordinator Dr Bilghis and her colleague Dr Tawfik (from Yemen) to organise and host a Tropical Data training session (with support from the World Health Organization).

What did the training cover?

The workshop was based on Tropical Data’s training curriculum, which teaches graders (ophthalmologists and eye health workers) and recorders (people with eye health or data management backgrounds) the skills needed to carry out the trachoma surveys. This includes examining people in their homes and gathering information on sanitation and hygiene, in relation to their living conditions.

During the training, graders spent the first two days learning how to spot and grade the different stages of trachoma. This included practice in the field, as well as a test in which trainees examined the same 50 children as the trainer, then compared results. While the graders examined people for trachoma, the recorders spent their first two days learning about different data collection forms and elements of sanitation and hygiene, and practised entering data onto smartphones. The second half of the training focused on team training and the practicalities of carrying out house-to-house surveys.

Why was the training important?

Until now, we have not had much engagement with Libya and Somalia: when working with countries, particularly for the first time, it is beneficial to be able to discuss survey planning and other important details face-to-face ahead of supporting surveys.

For Somalian staff, the training meant they could increase their number of qualified teams before restarting their surveys in April 2019. The training also provided a refresher for previous participants, ensuring the data they collect is high quality and can be used to influence health programmes if any SAFE interventions are needed.

Unfortunately, the Libyan staff have had to postpone their surveys because of a resurgence of conflict in the country, but all the mapping elements are now in place to begin once the situation is secure enough. Once mapping begins, it will be the first ever standardised trachoma prevalence survey work to be conducted in south Libya, enabling the country to confirm if SAFE interventions are needed.

It was truly inspiring to witness the Libyan trainees’ persistence and their drive to continue delivering services and outreach, even though the current situation they must operate in is extremely difficult.

What’s more, anti-government protests had broken out in Sudan in the month before the training, causing insecurity across the country. Thankfully, the sessions were not affected, aside from communication and connectivity difficulties. However, the situation required additional work to ensure everything was safely planned and carried out.

The training enabled us to come together and build stronger partnerships with the two countries, and to strengthen in-country health systems by providing training for trainers. For example, one of the recorders from Libya was also trained as a trainer, and we also gave a trainer from Somalia a refresher course, meaning they can now return home and train others.

It also created a unique opportunity for the trainees to share their experiences and hear more about the conditions in which other staff have to work.

What can trachoma elimination programmes learn from this training?

The Tropical Data initiative has now helped 37 countries to carry out trachoma surveys in more than 1,000 districts. The project promotes a standardised approach to ensure the data collected is high quality, which means programmes can rely on it to plan their national trachoma programme work. The training in Sudan has shown that progress can be achieved, even in difficult environments, by taking a different approach or being flexible. The training has also highlighted the importance of collaboration and partnership in the fight against trachoma and other neglected tropical diseases.

Cristina Jimenez
Cristina is Sightsavers’ Tropical Data Programme Manager, and is based in the UK.