Presentation on theme: "Is access to the SAFE strategy equal for men and women?"— Presentation transcript:
1 Is access to the SAFE strategy equal for men and women? Paul Courtright, DrPHKilimanjaro Centre for Community OphthalmologyTumaini University/KCMC, Moshi, Tanzania
2 “…state of being easy to approach or enter…” Access“…state of being easy to approach or enter…”Accessible“…easily approached or entered…”
3 Burden of blindness in the population (all surveys)
4 Findings from systematic review Age-adjusted odds of blindness in women compared to menAfrica: ( )Asia: ( )Industrialised: ( )Overall: ( )Abou-Gareeb et al. Gender and blindness: a meta-analysis of population-based prevalence surveys. Ophthal Epidem. 2001;8:39-56.
5 Analysis of potential reasons for gender disparity: Longer life expectancy in womenWomen live longer and blindness is associated with increasing age.However, age-specific rates of blindness show female excess in most age groups.Different risk for acquiring eye diseasesHigher incidence of cataract among womenHigher incidence of trachomatous trichiasis among womenUnequal utilisation of eye care services
6 Cataract Surgical Coverage Lewallen & Courtright. Gender & use of cataract surgical services in developing countries. Bull WHO. 2002;80:300-3
7 Does trachoma need to be considered a gendered health issue?
8 ObservationsIn many (not all) settings, females have higher prevalence of active diseaseWomen account for 60-85% of trichiasis cases (2-3 times higher than men)Blindness due to trachoma about 3 times higher in women compared to men.
9 Trachomatous trichiasis in Menia governorate, Egypt
10 Trachoma as a cause of vision loss and blindness in Ethiopia
11 Why do women bear an excess burden of blindness due to trachoma? Are girls more likely to acquire active disease (infection) compared to boys?Do girls have more persistent infection compared to boys?Are their biologic reasons for the differences?Could the differences be due to gender roles which facilitate transmission?Are there differences in the utilisation of surgical services for trichiasis?
12 Is access to the SAFE strategy equal for men and women? SurgeryAntibioticsFace washing & environmental changes
13 Is access to Surgery equal for men and women? Burden of need primarily for womenMeasurable?Need baseline data to know burden by sexNeed to monitor separately for men and womenCurrent evidence:Yes….if….….there are community-based efforts to encourage/enable use of trichiasis surgical services
14 Sr. Kileo examining for trichiasis in Ormelili village
15 Barriers to use of eye care services are different for men & women Cost of using service (access to financial resources)distance to services (ability to travel and need for assistance)knowledge of service (awareness and literacy)perceived “value” (social support)fear of a poor outcome (cosmesis)
16 Masai woman with combined trichiasis & cataract surgery
17 Is access to Antibiotics equal for men and women? Access depends upon distribution mechanismMass vs. targetedManagement with other NTD?Access depends on community characteristicsWhen promotion inadequate: can be sex-specific non-acceptanceGender roles constructed by culture & religion
18 Is access to Antibiotics equal for men and women? Measurable?Need coverage data reported by sexCurrent evidence lackingSupposition that poor coverage due to providers rather than recipients
19 Who will bear the burden of the cost of antibiotic treatment? Tanzania willingness to pay (WTP) study showed:>1/3 of respondents would not be willing to pay for antibioticThose at higher risk of trachoma were willing to pay less for future treatmentFemale-headed households unwilling to pay (=-0.7)Maternal education predictive of willing to pay
20 Is access to F & E equal for men and women? When water is scarce, who decides how it is used?Who is responsible for ensuring facial cleanliness?
21 Understanding access to F & E requires: Understanding decision making at the community and the household levelGender roles in enabling (or disabling) community developmentUnderstanding how changes occur
22 Some reasons our health education efforts fail Messages are not addressed to the right audienceMedia used for knowledge transfer used not appropriate for audience or messageOver-reliance upon single strategiesWomen often not “enabled” to make behavioral or infrastructure changes
23 Potential areas of research What is needed to scale up trichiasis surgery (remembering that 60-80% of surgical need is among women)?What factors contribute to low antibiotic coverage—and what is needed to ensure high coverage?Can community-directed strategies for improving F & E reduce the burden of trachoma in communities (and how do we enable women to adopt these strategies?)