Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Origin and Transmission of Trachoma
“There are several people who do not care for our culture by eating mojojoy (Rhyncophorus palmarum beetle larva) from the pupuña palm (Bactris gasipaes) despite knowing that it produces trachoma disease.”
“To prevent trachoma, you must cover the food, wash your hands, cover the pots.”
“If families pray for protecting their children, they won’t get diseases like trachoma.”
“Ancestral medicine does not cure trachoma, when the disease starts during childhood, causes blindness; sometimes non-ancestral doctors cure the disease but in other cases they don’t.”
“Non-ancestral doctors give education and cure people when ancestral medicine doesn’t work.”
3.2. Attitudes toward Trachoma Prevention in the Community
“When you give hygiene education, some families accept it, others don’t; it’s very difficult.”
“Some people clean their children, others don’t; they learn little by little.”
“The health workers educate on hygiene, cleaning the home’ some families do it, especially women do not pay attention, some reject education.”
“The use of plant soap and foams has been lost because now commercial soap would be available.”
3.3. Hygiene Practices
“The lack of care from the mothers leads to secretions sticking to the eyelashes and become infected by that disease.”
“The mother did not bathe the child, causing trachoma and other transmissible diseases.”
“We, indigenous people, wash our faces with water, and older people combined it with crushed leaves from the forest.”
“When children are 7 years old, they already know how to wash their faces. The sisters are the ones who take care of the children; they are the ones who wash the hands, the face.”
“My husband protects our children and grandchildren through prayers against serious diseases; by doing that they protect families and children from diseases like trachoma.”
4. Discussion
4.1. Protective and Risky Practices for Trachoma
4.2. The Role of Women
4.3. The Need to Advance the Sociocultural Adaptation of the “F” Component of the SAFE Strategy
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Weekly Epidemiological Record (WER). [EN/FR]—World/ReliefWeb. 6 August 2021, Volume 96, No. 31, pp. 353–364. Available online: https://reliefweb.int/report/world/weekly-epidemiological-record-wer-6-august-2021-vol-96-no-31-pp-353-364-enfr (accessed on 22 October 2022).
- Hu, V.H.; Harding-Esch, E.M.; Burton, M.J.; Bailey, R.L.; Kadimpeul, J.; Mabey, D.C.W. Epidemiology and control of trachoma: Systematic review. Trop. Med. Int. Health 2010, 15, 673–691. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cook, J.A. Eliminating Blinding Trachoma. N. Engl. J. Med. 2008, 358, 1777–1779. [Google Scholar] [CrossRef] [PubMed]
- Bernabeu-Mestre, J.; Galiana-Sánchez, M.E.; Cremades Monerris, A. Ambiente e saúde em doença relacionada a pobreza: A epidemiologia do tracoma na Espanha, 1925–1941. Hist. Cienc. Saude Manguinhos 2013, 20, 1605–1619. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Miller, H.; Gallego, G.; Rodríguez, G. Clinical evidence of trachoma in Colombian Amerindians of the Vaupes Province. Biomedica 2010, 30, 432–439. [Google Scholar] [CrossRef] [Green Version]
- Miller, H.A.; López de Mesa, C.B.; Talero, S.L.; Meza Cárdenas, M.; Ramírez, S.P.; Moreno-Montoya, J.; Porras, A.; Trujillo-Trujillo, J. Prevalence of trachoma and associated factors in the rural area of the department of Vaupés, Colombia. PLoS ONE 2020, 15, e0229297. [Google Scholar] [CrossRef]
- Weekly Epidemiological Record (WER). [EN/FR]—World/ReliefWeb. 24 July 2020, Volume 95, No. 30, pp. 349–360. Available online: File:///C:/Users/jtrujillot/Downloads/WER9530-eng-fre.pdf (accessed on 22 October 2022).
- Plan de Desarrollo—Departamento del Vaupés 2012–2015 “Gobierno Pluricultural con Progreso Social”. Available online: http://cdim.esap.edu.co/BancoMedios/DocumentosPDF/Vaupesplandedesarrollo2012-2015.pdf (accessed on 9 July 2022).
- Registro Especial de Prestadores de Servicios de Salud. Available online: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwi8toqE0oj5AhU7ZTABHcbbCyIQFnoECBsQAw&url=https%3A%2F%2Fwww.minsalud.gov.co%2Fsites%2Frid%2FLists%2FBibliotecaDigital%2FRIDE%2FDE%2FPES%2Fcaracterizacion-registro-especial-prestadores-reps.pdf&usg=AOvVaw2CULgRvW0wH0_D1ji067eO (accessed on 9 July 2022).
- Úsuga, C.R.C. Sistemas médicos tradicionales en la Amazonia nororiental: Salud y saberes alternativos. Iatreia 2011, 24, 5–15. [Google Scholar]
- Guevara, G.J. En Busca de un Modelo de Salud Para los Pueblos Indígenas: La Experiencia del Vaupes, 1st ed.; Banco de Ideas Publicitarias: Mitú-Vaupés, Colombia, 2003; pp. 1–91. [Google Scholar]
- Nuevos Elementos Para la Reflexión Metodológica en Sociología. Del Debate Cuantitativo/Cualitativo al dato Complejo. Available online: http://estadisticamigable.blogspot.com/2011/04/nuevos-elementos-para-la-reflexion.html (accessed on 23 October 2022).
- Forero, D.A.; Chaparro, P.E.; Vallejo, A.F.; Benavides, Y.; Gutiérrez, J.B.; Arévalo-Herrera, M.; Herrera, S. Knowledge, attitudes and practices of malaria in Colombia. Malar. J. 2014, 13, 165. [Google Scholar] [CrossRef] [Green Version]
- Singla, N.; Sharma, P.P.; Singla, R.; Jain, R.C. Survey of knowledge, attitudes and practices for tuberculosis among general practitioners in Delhi, India. Int. J. Tuberc. Lung Dis. 1998, 2, 384–389. [Google Scholar]
- Carrillo-Bonilla, L.M.; Trujillo, J.J.; Alvarez-Salas, L.; Vélez-Bernal, I.D. Study of knowledge, attitudes, and practices related to leishmaniasis: Evidence of government neglect in the Colombian Darién. Cad Saude Publica 2014, 30, 2134–2144. [Google Scholar] [CrossRef] [Green Version]
- Tang, K.C.; Davis, A. Critical factors in the determination of focus group size. Fam. Pract. 1995, 12, 474–475. [Google Scholar] [CrossRef]
- Carlsen, B.; Glenton, C. What about N? A methodological study of sample-size reporting in focus group studies. BMC Med. Res. Methodol. 2011, 11, 26. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Prieto Rodríguez, M.A.; March Cerdá, J.C. Paso a paso en el diseño de un estudio mediante grupos focales. Aten Primaria 2002, 29, 366–373. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Debus, M. Manual Para Excelencia en la Investigación Mediante Grupos Focales; HealthCom: Washington, DC, USA, 1994; p. 97. Available online: https://pesquisa.bvsalud.org/portal/resource/pt/pah-24739 (accessed on 23 October 2022).
- Östlund, U.; Kidd, L.; Wengström, Y.; Rowa-Dewar, N. Combining qualitative and quantitative research within mixed method research designs: A methodological review. Int. J. Nurs. Stud. 2011, 48, 369–383. [Google Scholar] [CrossRef] [Green Version]
- Malterud, K. Qualitative research: Standards, challenges, and guidelines. Lancet 2001, 358, 483–488. [Google Scholar] [CrossRef] [PubMed]
- Al-Busaidi, Z.Q. Qualitative Research and its Uses in Health Care. Sultan. Qaboos. Univ. Med. J. 2008, 8, 11–19. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087733/ (accessed on 21 July 2018). [PubMed]
- Czerniewska, A.; Versteeg, A.; Shafi, O.; Dumessa, G.; Aga, M.A.; Last, A.; MacLeod, D.; Sarah, V.; Dodson, S.; Negussu, N.; et al. Comparison of face washing and face wiping methods for trachoma control: A pilot study. Am. J. Trop. Med. Hyg. 2020, 102, 740–743. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Greenland, K.; White, S.; Sommers, K.; Biran, A.; Burton, M.J.; Sarah, V.; Alemayehu, W. Selecting behaviour change priorities for trachoma “F” and “E” interventions: A formative research study in Oromia, Ethiopia. PLoS Negl. Trop. Dis. 2019, 13, e0007784. [Google Scholar] [CrossRef] [Green Version]
- Aragie, S.; Tadesse, W.; Dagnew, A.; Hailu, D.; Dubie, M.; Wittberg, D.M.; Melo, J.; Haile, M.; Zeru, T.; Freeman, M.; et al. Changing hygiene behaviours: A cluster-randomized trial, Ethiopia. Bull. World Health Organ. 2021, 99, 762–772A. [Google Scholar] [CrossRef]
- Chen, X.; Munoz, B.; Wolle, M.A.; Woods, G.; Odonkor, M.; Naufal, F.; Mkocha, H.; West, S.K. Environmental factors and hygiene behaviors associated with facial cleanliness and trachoma in Kongwa, Tanzania. PLoS Negl. Trop. Dis. 2021, 15, e0009902. [Google Scholar] [CrossRef]
- Chen, X.; Munoz, B.; Mkocha, H.; Wolle, M.A.; West, S.K. Children as messengers of health knowledge? Impact of health promotion and water infrastructure in schools on facial cleanliness and trachoma in the community. PLoS Negl. Trop. Dis. 2021, 15, e0009119. [Google Scholar] [CrossRef]
- Cromwell, E.A.; Courtright, P.; King, J.D.; Rotondo, L.A.; Ngondi, J.; Emerson, P.M. The excess burden of trachomatous trichiasis in women: A systematic review and meta-analysis. Trans. R. Soc. Trop. Med. Hyg. 2009, 103, 985–992. [Google Scholar] [CrossRef] [PubMed]
- Guevara, J. Introduccion a la atencion primaria con participacion comunitaria en el VaupesT—Introduction to primary care with community participation in Vaupes. LILACS 1987, 72, lil-86393. Available online: https://pesquisa.bvsalud.org/portal/resource/pt/lil-86393?lang=es (accessed on 27 October 2022).
- Mtuy, T.B.; Burton, M.J.; Mwingira, U.; Ngondi, J.M.; Seeley, J.; Lees, S. Knowledge, perceptions and experiences of trachoma among Maasai in Tanzania: Implications for prevention and control. PLoS Negl. Trop. Dis. 2019, 13, e0007508. [Google Scholar] [CrossRef]
- Tsang, K.; de Wildt, G.; Mwingira, U.; Mtuy, T.B. Implementing trachoma control programs in marginalised populations in Tanzania: A qualitative study exploring the experiences and perspectives of key stakeholders. PLoS Negl. Trop. Dis. 2021, 15, e0009727. [Google Scholar] [CrossRef]
- Peake, R.M.; Jackson, D.; Lea, J.; Usher, K. Investigating the processes used to develop and evaluate the effectiveness of health education resources for adult Indigenous people: A literature review. Contemp. Nurse 2019, 55, 421–449. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bonfil Batalla, G. Lo Propio y lo Ajeno: Una Aproximación al Problema del Control Cultural. RMCPYS. 9 December 2019, Volume 27. Available online: https://www.revistas.unam.mx/index.php/rmcpys/article/view/72329 (accessed on 27 October 2022).
- Guillermo Bonfil Batalla. La Teoría del Control Cultural en el Estudio de Procesos Étnicos. Anu. Antropológico 1998, 86, 13–53. [Google Scholar]
- Ministerio de Cultura. Política de Patrimonio Cultural Inmaterial 2011. Available online: http://www.mincultura.gov.co/areas/patrimonio/publicaciones/Documents/C-ConvenciónypolíticadesalvaguardadelPCI.pdf (accessed on 9 July 2022).
Aspects Evaluated | KAP Survey | Focus Groups 5 | |||
---|---|---|---|---|---|
n1 | % | n1 | % | ||
Participants over 18 years old | 357 | 100 | 21 | 100 | |
Participating indigenous | 357 | 100 | 21 | 100 | |
Participating men | 260 | 72.8 | 13 | 61.9 | |
Participating women | 97 | 27.2 | 8 | 38.1 | |
Ethnicities represented 2 | 29 | 69.0 | 14 | 33.3 | |
Communities represented 3 | 160 | 72.7 | 14 | 6.4 | |
Sedentary settlement pattern | 334 | 93.6 | 19 | 90.5 | |
Roles within the family | Mother | 88 | 24.6 | - | - |
Father | 208 | 58.3 | - | - | |
Other | 61 | 17.1 | - | - | |
Role in the community 4 | Payé-Cumú | 61 | 17.1 | - | - |
Community leader | 125 | 35.0 | - | - | |
Teacher | 28 | 7.8 | - | - | |
Health promoter | 25 | 7.0 | - | - | |
No leadership role | 155 | 43.4 | - | - |
Aspects Evaluated | Sex of Respondent | p 4 | |||||
---|---|---|---|---|---|---|---|
Male n = 260 | Female n = 97 | Total n = 357 | |||||
n1 | % 2 | n 1 | % 2 | n1 | % 2 | ||
Origin and transmission of trachoma | 393 | 126 | 519 | ||||
Other (dirty water, contaminated food or air, river water, and other) | 80 | 30.8 | 22 | 22.7 | 102 | 28.6 | 0.132 |
Lack of cleanliness in the face and eyes 3 | 77 | 29.6 | 24 | 24.7 | 101 | 28.3 | 0.462 |
Did not know | 61 | 23.5 | 24 | 24.7 | 85 | 23.8 | 0.670 |
Due to a lack of cleanliness 3 (body) | 47 | 18.1 | 13 | 13.4 | 60 | 16.8 | 0.353 |
Passes from one person to another 3 | 40 | 15.4 | 16 | 16.5 | 56 | 15.7 | 0.697 |
Due to flies 3 | 39 | 15.0 | 11 | 11.3 | 50 | 14.0 | 0.438 |
Due to garbage 3 | 32 | 12.3 | 8 | 8.2 | 40 | 11.2 | 0.323 |
Did not answer | 10 | 3.8 | 7 | 7.2 | 17 | 4.8 | 0.183 |
Ancient resource elements (spirit and evil) 3 | 7 | 2.7 | 1 | 1.0 | 8 | 2.2 | 0.345 |
The cleanliness concept is associated with the following:3 | 316 | 109 | 425 | ||||
Bathing one or more times per day | 171 | 65.8 | 69 | 71.1 | 240 | 67.2 | 0.462 |
Use of commercial soap | 56 | 21.5 | 21 | 21.6 | 77 | 21.6 | 0.937 |
Other | 31 | 11.9 | 11 | 11.3 | 42 | 11.8 | 0.824 |
Did not answer | 19 | 7.3 | 5 | 5.2 | 24 | 6.7 | - |
Ancestral methods for obtaining soap from plants | 19 | 7.3 | 2 | 2.1 | 21 | 5.9 | 0.055 |
With prayers or ancestral medicine | 20 | 7.7 | 1 | 1.0 | 21 | 5.9 | 0.015 |
Trachoma prevention and treatment | 386 | 115 | 501 | ||||
Taking medicine 3 | 108 | 41.5 | 35 | 36.1 | 143 | 40.1 | 0.525 |
Following the recommendations of ancestral medicine 3 | 94 | 36.2 | 23 | 23.7 | 117 | 32.8 | 0.045 |
Consulting health workers (non-ancestral) 3 | 70 | 26.9 | 17 | 17.5 | 87 | 24.4 | 0.099 |
With good personal hygiene measures 3 | 58 | 22.3 | 16 | 16.5 | 74 | 20.7 | 0.306 |
Did not know | 38 | 14.6 | 14 | 14.4 | 52 | 14.6 | 0.905 |
Did not answer | 10 | 3.8 | 8 | 8.2 | 18 | 5.0 | - |
Other | 6 | 2.3 | 2 | 2.1 | 8 | 2.2 | 0.935 |
Cannot be prevented | 1 | 0.4 | 0 | 0.0 | 1 | 0.3 | - |
It does not produce anything | 1 | 0.4 | 0 | 0.0 | 1 | 0.3 | - |
Aspects Evaluated | Sex of the Respondent | p 3 | |||||
---|---|---|---|---|---|---|---|
Male n = 260 | Female n = 97 | Total n = 357 | |||||
n 1 | % 2 | n 1 | % 2 | n 1 | % 2 | ||
How would you help the community? 4 | 481 | 169 | 650 | ||||
Informing the health workers (non-ancestral) | 126 | 48.5 | 36 | 37.1 | 162 | 45.4 | 0.036 |
Keeping the faces of children, young people, and adults clean | 116 | 44.6 | 36 | 37.1 | 152 | 42.6 | 0.150 |
Taking medication | 77 | 29.6 | 27 | 27.8 | 104 | 29.1 | 0.660 |
Informing the Cumú/Payé | 36 | 13.8 | 14 | 14.4 | 50 | 14.0 | 0.941 |
Keeping the home clean to avoid flies | 32 | 12.3 | 11 | 11.3 | 43 | 12.0 | 0.755 |
Accepting the medical brigade | 23 | 8.8 | 16 | 16.5 | 39 | 10.9 | 0.046 |
Participating in workshops or meetings on trachoma | 24 | 9.2 | 12 | 12.4 | 36 | 10.1 | 0.413 |
Collaborating in the care of trichiasis-operated patients | 20 | 7.7 | 8 | 8.2 | 28 | 7.8 | 0.901 |
Keeping towels, rags, and toiletries clean | 14 | 5.4 | 6 | 6.2 | 20 | 5.6 | 0.802 |
Did not answer | 13 | 5.0 | 3 | 3.1 | 16 | 4.5 | - |
Teaching others the importance of washing the face | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | - |
Hygiene Practices | Sex of the Respondent | p 3 | |||||
---|---|---|---|---|---|---|---|
Male n = 260 | Female n = 97 | Total n = 357 | |||||
n 1 | % 2 | n 1 | % 2 | n 1 | % 2 | ||
Sharing clothes to dry the body after bathing | |||||||
Yes | 142 | 54.6 | 46 | 47.4 | 188 | 52.7 | 0.226 |
No | 118 | 45.4 | 51 | 52.6 | 169 | 47.3 | |
Daily frequency of washing the face of healthy children | |||||||
Many times | 154 | 59.2 | 67 | 69.1 | 221 | 61.9 | 0.116 |
Few times | 86 | 33.1 | 21 | 21.6 | 107 | 30.0 | |
Never | 7 | 2.7 | 2 | 2.1 | 9 | 2.5 | |
No answer | 13 | 5.0 | 7 | 7.2 | 20 | 5.6 | |
Daily frequency of washing the face of children when they have nasal or conjunctival discharge | |||||||
Many times | 238 | 91.5 | 88 | 90.7 | 326 | 91.3 | 0.931 4 |
Few times | 11 | 4.2 | 3 | 3.1 | 14 | 3.9 | |
Never | 7 | 2.7 | 2 | 2.1 | 9 | 2.5 | |
No answer | 4 | 1.5 | 4 | 4.1 | 8 | 2.2 | |
Elements for cleaning children’s nose and eyes 5 | |||||||
With a rag towel or clothing in use | 173 | 66.5 | 63 | 64.9 | 236 | 66.1 | 0.965 |
With water | 127 | 48.8 | 48 | 49.5 | 175 | 49.0 | 0.828 |
With hands or fingers | 36 | 13.8 | 5 | 5.2 | 41 | 11.5 | 0.023 |
No answer | 11 | 4.2 | 8 | 8.2 | 19 | 5.3 | |
Other | 8 | 3.1 | 4 | 4.1 | 12 | 3.4 | 0.610 |
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Trujillo-Trujillo, J.; Meza-Cárdenas, M.; Sánchez, S.B.; Zamora, S.M.; Porras, A.; López de Mesa, C.B.; Bernal Parra, L.M.; Bernal Lizarazú, M.C.; Miller, H.; Silva, J.C. Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department. Int. J. Environ. Res. Public Health 2023, 20, 4632. https://doi.org/10.3390/ijerph20054632
Trujillo-Trujillo J, Meza-Cárdenas M, Sánchez SB, Zamora SM, Porras A, López de Mesa CB, Bernal Parra LM, Bernal Lizarazú MC, Miller H, Silva JC. Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department. International Journal of Environmental Research and Public Health. 2023; 20(5):4632. https://doi.org/10.3390/ijerph20054632
Chicago/Turabian StyleTrujillo-Trujillo, Julián, Mónica Meza-Cárdenas, Sol Beatriz Sánchez, Sara Milena Zamora, Alexandra Porras, Clara Beatriz López de Mesa, Luz Mery Bernal Parra, María Consuelo Bernal Lizarazú, Hollman Miller, and Juan Carlos Silva. 2023. "Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department" International Journal of Environmental Research and Public Health 20, no. 5: 4632. https://doi.org/10.3390/ijerph20054632
APA StyleTrujillo-Trujillo, J., Meza-Cárdenas, M., Sánchez, S. B., Zamora, S. M., Porras, A., López de Mesa, C. B., Bernal Parra, L. M., Bernal Lizarazú, M. C., Miller, H., & Silva, J. C. (2023). Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department. International Journal of Environmental Research and Public Health, 20(5), 4632. https://doi.org/10.3390/ijerph20054632