Factors associated with health worker adoption of facial and environmental hygiene promotion in the 'SAFE strategy' for trachoma elimination in Western Province, Zambia.

Background: Trachoma is responsible for the blindness or visual impairment of about 1.9 million people and causes about 1.4% of all blindness worldwide. In Zambia, trachoma is endemic and Western Province is one of the most affected provinces. The SAFE (surgery, antibiotics, facial cleanliness and environmental improvement) strategy is recommended for elimination of trachoma. In many settings, interventions particularly for facial cleanliness and environmental improvement are sub-optimally adopted due to lack of prioritization and inadequate funding of intervention activities. This study sought to establish the level of, and factors associated with adoption of facial and environmental hygiene promotion in the SAFE strategy among health workers in Western Province, Zambia.

Methodology/principal findings: This was a cross-sectional study involving 24 health facilities selected from three districts using stratified random sampling. A total of 388 health workers comprising environmental health officers, community health assistants and community health workers were randomly selected. Adoption of facial and environmental hygiene promotion was self-reported, defined as participation in community distribution of information, education and communication (IEC) materials or community demonstrations of correct hand and face washing methods or both, within the past six months. Multiple logistic regression was used to identify the factors associated with adoption using STATA Version 15. The study was conducted in March and April 2023. Adoption of facial and environmental hygiene promotion was low at 47.68%. Having readily available transport (AOR = 3.06. 95% CI = [1.38, 6.80]), perceiving the intervention as relevant for trachoma prevention (AOR = 7.78, 95% CI = [4.38, 13.82]), having been trained in F and E (AOR = 2.17, 95% CI = [1.24, 3.78]) and availability of information, education and communication materials (AOR = 3.04, 95% CI = [1.69, 5.46]) were associated with higher odds of adoption of facial and environmental hygiene promotion among health workers.

Conclusion/significance: There was low adoption of facial and environmental hygiene promotion among health workers influenced by training, transport availability, IEC material availability and perceived relevance and complexity of the intervention. To increase adoption of facial and environmental hygiene promotion, program implementers must ensure that they consider the identified factors in the planning of the intervention activities.