Assessment of compliance with tetracycline eye ointment treatment to accelerate the elimination of trachoma in Yobe State, Nigeria.

Background: Trachoma, a neglected tropical disease, remains a significant public health concern in many regions, particularly in sub-Saharan Africa and in Yobe State, Nigeria. One approach for elimination involves administering tetracycline eye ointment (TEO) to children <6 months of age as part of annual mass drug administration (MDA), aligning with the World Health Organization's 'A' component of the SAFE (Surgery, Antibiotics, Facial hygiene and Environmental sanitation) strategy for elimination of trachoma as a public health problem. However, suboptimal compliance rates in affected populations pose challenges, potentially serving as a reservoir for reinfection and hindering progress toward trachoma elimination. This study focuses on assessing compliance with topical TEO during MDA and explores strategies to enhance adherence in trachoma-endemic areas of Yobe State, Nigeria.

Methods: A mixed research approach was carried out involving interviews with households across 30 communities in five local government areas where TEO was administered during the 2022 round of MDA. Focus group discussions were conducted with subsets of the population who received TEO to gain insights into the underlying reasons for non-compliance and ways to improve compliance. Additionally, healthcare provider perspectives on treatment administration, compliance and community health education were explored.

Results: Findings from this study show that there is already a high level of compliance with TEO usage, however, forgetfulness due to competing domestic chores, insufficient quantity of TEO given for 6-week applications, low awareness about the impact of trachoma infection on the eyes and the stinging feeling after application, especially in children <6 months of age, are some barriers that affect TEO usage compliance. Following up with TEO recipients would remind them to use the ointment as required, while incentivizing health workers and community drug distributors to conduct follow-up visits to households, increasing awareness on the impact of trachoma on the eyes. Increasing the quantity of TEO allocation would also improve compliance.

Conclusions: Yobe State has made remarkable progress towards eliminating trachoma as a public health problem, as 12 local government areas no longer require MDA. Sustaining this momentum means ensuring high compliance among the population eligible to receive TEO to prevent any reservoir for reinfection in the state.