Understanding hard-to-reach communities

Local perspectives and experiences of trachoma control among the pastoralist Maasai in northern Tanzania

Bibliographic Data

ID21342600
AuthorsTara Mtuy (0000-0003-3436-0162, London School of Hygiene & Tropical Medicine, corresponding author), Kevin Bardosh (0000-0003-2973-5708, University of Washington), Jeremiah Ngondi (0000-0003-4357-4816, RTI International), Upendo Mwingira (0000-0001-6852-6402, RTI International), Janet Seeley (0000-0002-0583-5272, London School of Hygiene & Tropical Medicine), Matthew J Burton (0000-0003-1872-9169, London School of Hygiene & Tropical Medicine), Matthew Burton, Shelley Susan Lee (0000-0003-0062-7930, London School of Hygiene & Tropical Medicine), Shelley Lees
Year2021
Volume53
Issue6
Pages819-838
Publication date2021-11-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueJournal of Biosocial Science (JOURNAL)
Journal identifiersISSN: 0021-9320 • E-ISSN: 1469-7599
PublisherCambridge University Press (CUP) (PUBLISHER)
DOI10.1017/s0021932020000553
PMID32981544
OpenAlexW3088748067
LanguageEN
Citations received1
References cited38

As progress to eliminate trachoma is made, addressing hard-to-reach communities becomes of greater significance. Areas in Tanzania, inhabited by the Maasai, remain endemic for trachoma. This study assessed the effectiveness of Mass Drug Administration (MDA) through an ethnographic study of trachoma amongst a Maasai community. The MDA experience in the context of the livelihoods of the Maasai in a changing political economy was explored using participant observation and household interviews. Factors influencing MDA effectiveness within five domains were analysed. 1) Terrain of intervention : Human movement hindered MDA, including seasonal migration, domestic chores, grazing and school. Encounters with wildlife were significant. 2) Socio-cultural factors and community agency : Norms around pregnancy led women to accept the drug but hide refusal to swallow the drug. Timing of Community Drug Distributor (CDD) visits conflicted with livestock grazing. Refusals occurred among the ilmurrani age group and older women. Mistrust significantly hindered uptake of drugs. 3) Strategies and motivation of drug distributors : Maa-speaking CDDs were critical to effective drug delivery. Maasai CDDs, whilst motivated, faced challenges of distances, encounters with wildlife and compensation. 4) Socio-materiality of technology : Decreases in side-effects over years have improved trust in the drug. Restrictions to swallowing drugs and/or water were relevant to post-partum women and the ilmurrani . 5) History and health governance : Whilst perceptions of the programme were positive, communities questioned government priorities for resources for hospitals, medicines, clean water and roads. They complained of a lack of information and involvement of community members in health care services. With elimination in sight, hard-to-reach communities are paramount as these are probably the last foci of infection. Effective delivery of MDA programmes in such communities requires a critical understanding of community experiences and responses that can inform tailored approaches to trachoma control. Application of a critical social science perspective should be embedded in planning and evaluation of all NTD programmes

Agriculture · Context (archaeology) · Environmental health · Geography · Livelihood · Livestock · Maasai · Pastoralism · Socioeconomics · Sociology · Tanzania · Trachoma · Bacterial Infections and Vaccines · Medicine · Reproductive tract infections research · Syphilis Diagnosis and Treatment

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