Health Education for Early Trachoma Prevention

2017 - 2019 Tigray Region, Ethiopia

“When we work with children in their early years, we can create opportunities for healthy development for them that will last for the rest of their lives.” Sarah Wilner, Co-Founder, Early Starters International

Ethiopia has the highest burden of trachoma globally, with 65 million people at risk of infection in 2022. Caused by the bacteria Chlamydia trachomatis, the disease spreads through contact with facial discharge of an infected person via eye-seeking flies, touch, and sharing of cloths. Highly prevalent in rural communities as a result of limited sanitation and clean water, young children (ages 1-9) are particularly vulnerable to the disease, alongside their caretakers, often women due to frequent contact. Despite repeated infections at a young age being a cause of blindness in adulthood, trachoma prevention activities often miss out this pivotal age, in part due to a lack of structured curriculum for pre-school children in Ethiopia. Therefore, in partnership with  Early 

Given the high risk young children are at of contracting the disease, combined with Early Starters International and Light for the World Ethiopia, NALA developed and implemented an early childhood trachoma prevention project, with the aim of influencing health hygiene behaviors from the start.  

Piloted in the Tigray in 2013, due to the high prevalence of trachoma in the region, the project targeted both schools and households, with a target population of children under the age of 7. Guided by the core principles of creating an emotional connection, active learning, and problem based solving, the project employed unique and engaging methodologies to encourage the internalization of trachoma-related issues in young children. Through personalized hand and face charts reflecting current cleanliness states, routine mirror checks, a fictional friend and confidante Toto who through forgetful behaviors required the guidance of children, as well as the use of songs and games, the project was exciting for both children and the school community, and encourage the establishment of good hygiene practices for trachoma prevention. 

Monitoring and evaluation was included as a key element of the project, with visits conducted following each of the 5 training rounds, recording the utilization of methodologies, additional initiatives led by school staff, changes in students behaviors, and changes to WASH facilities. Highlights included school community purchases of mirrors for each classroom and the distribution of soap for students to take home; improved usage of latrines and reduction in the number of children arriving to school with dirty faces; positioning of hand washing facilities outside latrines and a schedule for regular latrine cleaning; and parent-teacher association (PTA) engagement including message continuity in the community. 

Overall, the project proved a huge success, offering an impactful model for disease prevention in the most at-risk population for trachoma. Meet Toto today and see our project materials. 

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