title: Participatory evaluations of trachoma control programmes in eight countries.
abstract: OBJECTIVE
  Trachoma is a major cause of blindness. The objective of this initiative was to conduct participatory process evaluations of the trachoma control programmes receiving support from the International Trachoma Initiative in eight countries.
  
  
  METHODS
  During each 2- to 4-week evaluation we analysed information collected at the central, district and community level through interviews, focus groups, questionnaires, direct observation of trachoma control activities, and existing data.
  
  
  RESULTS
  Mapping and assessment of disease prevalence had been completed in four of eight countries. Integration of trachoma control activities into national planning and district-level service provision varied. Intersectoral partnerships to implement the SAFE strategy (i.e. surgery, antibiotics, facial cleanliness and environmental change) were well established in a few countries. In all eight countries, the number of surgeries performed annually was insufficient; and quality of surgery was rarely monitored. Mass distribution of antibiotics was carried out well in extremely resource-poor settings and good coverage was achieved, although the strategy for antibiotic distribution varied. Inadequate water and sanitation remained a major problem in all programme areas. Monitoring of programme activities was generally inadequate. The Morocco programme is an example from which lessons and processes can be learnt and adapted to other programme countries.
  
  
  CONCLUSIONS
  Significant achievements have been made in implementing the SAFE strategy. Scaling up of activities to true national coverage should be planned and implemented provided the resources can be made available. Further standardization of how to assess, implement and monitor trachoma control activities will facilitate expansion of the programme.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. hannah.kuper@lshtm.ac.uk
authors.forename: Hannah
authors.initials: H
authors.lastname: Kuper
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Solomon
authors.forename: John C
authors.initials: JC
authors.lastname: Buchan
authors.forename: Marcia
authors.initials: M
authors.lastname: Zondervan
authors.forename: David
authors.initials: D
authors.lastname: Mabey
authors.forename: Allen
authors.initials: A
authors.lastname: Foster
mesh_terms: D000349:Africa / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002648:Child; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D006920:Hygiene; D007391:International Cooperation; D009313:National Health Programs / Q000458:organization & administration / Q000592:standards; D009390:Nepal / Q000453:epidemiology; D009938:Organizations; D015397:Program Evaluation / Q000379:methods*; D014141:Trachoma / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery; D014744:Vietnam / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin