As progress to eliminate trachoma is made, addressing hard-to-reach communities becomes of greater significance. Areas in Tanzania, inhabited by the Maasai, remain endemic for trachoma. This study assessed the effectiveness of Mass Drug Administration (MDA) through an ethnographic study of trachoma amongst a Maasai community. The MDA experience in the context of the livelihoods of the Maasai in a changing political economy was explored using participant observation and household interviews. Factors influencing MDA effectiveness within five domains were analysed. 1) Terrain of intervention: Human movement hindered MDA, including seasonal migration, domestic chores, grazing and school. Encounters with wildlife were significant. 2) Socio-cultural factors and community agency: Norms around pregnancy led women to accept the drug but hide refusal to swallow the drug. Timing of Community Drug Distributor (CDD) visits conflicted with livestock grazing. Refusals occurred among the ilmurrani age group and older women. Mistrust significantly hindered uptake of drugs. 3) Strategies and motivation of drug distributors: Maa-speaking CDDs were critical to effective drug delivery. Maasai CDDs, whilst motivated, faced challenges of distances, encounters with wildlife and compensation. 4) Socio-materiality of technology: Decreases in side-effects over years have improved trust in the drug. Restrictions to swallowing drugs and/or water were relevant to post-partum women and the ilmurrani. 5) History and health governance: Whilst perceptions of the programme were positive, communities questioned government priorities for resources for hospitals, medicines, clean water and roads. They complained of a lack of information and involvement of community members in health care services. With elimination in sight, hard-to-reach communities are paramount as these are probably the last foci of infection. Effective delivery of MDA programmes in such communities requires a critical understanding of community experiences and responses that can inform tailored approaches to trachoma control. Application of a critical social science perspective should be embedded in planning and evaluation of all NTD programmes.

中文翻译：

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了解难以到达的社区：坦桑尼亚北部牧民马赛人对沙眼控制的当地观点和经验

随着消除沙眼的进展，解决难以到达的社区变得更加重要。坦桑尼亚马赛人居住的地区仍然是沙眼的地方病。本研究通过对马赛社区沙眼的人种学研究评估了大众药物管理局 (MDA) 的有效性。通过参与观察和家庭访谈，探讨了马赛人在不断变化的政治经济中的生计背景下的 MDA 经验。分析了五个领域内影响 MDA 有效性的因素。1)干预范围：人类活动阻碍了 MDA，包括季节性迁移、家务、放牧和上学。与野生动物的相遇意义重大。2)社会文化因素和社区能动性：怀孕期间的规范导致女性接受药物但隐藏拒绝吞服药物。社区药物经销商 (CDD) 访问的时间与放牧相冲突。拒绝发生在伊尔穆拉尼年龄组和老年妇女。不信任严重阻碍了药物的吸收。3)药品经销商的策略和动机：说 Maa 的 CDD 对于有效的药物输送至关重要。Maasai CDDs 尽管有动力，但也面临着距离、与野生动物相遇和补偿的挑战。4)技术的社会重要性：多年来副作用的减少提高了人们对药物的信任。限制吞咽药物和/或水与产后妇女和伊尔穆拉尼. 5)历史与卫生治理：虽然对该计划的看法是积极的，但社区质疑政府在医院、药品、清洁水和道路资源方面的优先事项。他们抱怨缺乏信息和社区成员参与医疗保健服务。随着消除的前景，难以到达的社区至关重要，因为这些可能是最后的感染焦点。在这些社区中有效实施 MDA 计划需要对社区经验和反应有批判性的理解，这可以为沙眼控制的定制方法提供信息。批判性社会科学观点的应用应嵌入所有 NTD 项目的规划和评估中。