Stakeholder’s perspective on the slow progress towards elimination of trachoma as a public health problem, and suggested recommendations for future intervention improvements: A pilot case study in Bugna district, 2020, Northeast Ethiopia

Background: Blinding Trachoma is considered a neglected tropical disease and earmarked for global elimination as a public health problem by 2020 using the advocated World Health Organization's (WHO) recommendation, SAFE (surgery, antibiotics, facial cleanness, and environmental change) strategy. In Sub-Saharan Africa, Trachoma is a leading cause of preventable blindness, and Ethiopia is the most affected and bears the highest burden. In many rural parts of Ethiopia, Trachoma continues to be rampant. In the North and South Wollo zones of the Amhara region, the overall prevalence of active Trachoma among children aged 1–9 was 21.6%. In the Gazegibela district of Wagehemra zone, Amhara region, among children aged 1–9 years, 52.4% were positive for active Trachoma. This study aimed to explore the determinates of SAFE strategy failure when WHO and MoH implement a SAFE strategy to control Trachoma from 2006 until 2020 and reconsider the recommendation of stakeholders in Bugna district, Ethiopia. Methods: The design used in this study is an exploratory case study to highlight the determinants of SAFE strategy failure. The data were collected in Bugna district, Northeast Ethiopia. The study data were collected from Health Extension Workers (HEWs) and kebele leaders. We employed an in-depth interview and Focus Group Discussion (FGD) to gain access to the participants' experiences and conducted an inductive qualitative content analysis. The study population includes 28 health extension workers, 16 kebele leaders, 2 district health office leaders, 2 district trachoma officers, and 5 district health officers. Both the interview and FGD sessions were audio-taped, and an interview lasted one to two hours, but the FGD lasted two to three hours. Result: The study subjects live in 16 kebeles (sub-districts) of the Bugna district. The age of health extension workers ranged from 23 to 35 years old, with a mean age of 30.57 years (SD±2.68). Participants' opinions were categorized into two major categories; determinants for failing in controlling Trachoma in the Bugna district and forwarded recommendations to reduce the prevalence of trachomatous inflammation-follicular(TF) below 5%, and the prevalence of trachomatous trichiasis (TT) below 0.2%. In these two major categories, four themes were identified as determinants for failing to control Trachoma below 5% in the Bugna district in 2020, while six themes were deduced as recommendations to reduce the prevalence of TF below 5% and TT below 0.2% in Bugna district post-2020.Conclusion: Many organizations like The Carter center played a great deal and still investing their time, money, and knowledge to control TF below 5% and TT below 0.2% as per WHO recommendation through global elimination of Trachoma by 2020 (GET2020).