Report of Activities from LCNTDR Travel Grant: Tara Mtuy

I am extremely grateful to have received a travel grant from LCNTDR, which allowed me to travel to London and attend courses at University College of London in March 2020.  I am doing a staff PhD in global health and development with the London School of Hygiene and Tropical Medicine and am based in Kilimanjaro, Tanzania. The grant funded my return flights to London and three intensive one-day courses on qualitative methods: (1) introduction to ethnography in healthcare, (2) introduction to rapid qualitative research and (3) introduction to rapid qualitative evaluations.  Similar courses are not available in East Africa.

My research is looking at the uptake of MDA of azithromycin for trachoma among a Maasai hyperendemic community in Tanzania.  It was a 16-month ethnographic study looking at the community’s response to control programs from a political-economy of public health perspective. This research is critical to better understand hard to reach communities as we near the end-game of trachoma elimination.  Yet employing long term qualitative research was difficult to convince academics, program planners and funders in the NTD field as they want answers sooner on how to tailor control programs for these hard to reach communities to eliminate trachoma.  The courses at UCL provided a lot of insight into how to conduct similar studies in a rapid fashion and allow for answers as per funders and program planners and policy makers’ timelines.  Although a lot of the information in the course on ethnography was not new information for me, it reconfirmed important details and allowed me space and time with other qualitative researchers and experts to talk through some of my current analysis.

In the past two year, the Tanzania government has put into law that all households have latrines.  This is an important public health measure for control of some NTDs including trachoma.  During my research in the Maasai community, I observed that an extremely low number of latrines existed in the community as Maasai practice open defecation.  Since returning to my research village in December 2019 I took note that nearly all households now have a latrine due to the new laws.  Yet from informal conversations with people in the community they are not being used but rather erected to comply with the law.  I am keen to do rapid qualitative research to better understand usage/non-usage, perceptions of latrine use and experiences of how the new policy was rolled out and enforced.  This research will provide clarity on the community response to this public health policy.  It will inform public health officials and policy makers on ways to incorporate additional public health measures (ie. education, incentives, behavior change methods) to encourage latrine use in a sustainable way.

It is important as we near the end game for elimination of NTDs that more qualitative methods are employed to understand communities as control measures are not a one size fits all in these hard to reach communities.  Use of rapid qualitative methods should be encouraged and supported by funders.  I am extremely grateful for the opportunity to travel to attend these courses which will eventually benefit NTD research and programs.