Graduation Year


Document Type




Degree Granting Department


Major Professor

Nancy Y. Romero-Daza


The goal of this study is to explore specialized and popular cultural models of trachoma, and the interaction between the trachoma elimination program and its target audience in one trachoma hyper-endemic intervention community. Eighty four million people worldwide, mainly children, are infected with active bacterial trachoma. For some, this will lead to painful and progressive corneal opacity and eventual blindness. The disease is most commonly spread by person-to-person contact or by flies, and affects very specific populations living in resource-poor areas such as rural Niger, which has one of the highest prevalence rates worldwide.

The World Health Organization formed an alliance that is working toward the goal of eliminating blinding trachoma globally by 2020 through a strategy that includes behavior change communication, drug distribution, and surgery. The elimination program has been at work in Niger since the late 1990's. Trachoma prevalence in Niger showed a dramatic reduction during the beginning of the elimination program. However, disease prevalence has again increased and, at the time of this study, was nearing pre-intervention levels.

While poverty is closely related to trachoma, the processes by which this economic state becomes translated into health impacts are complex, but rely on behaviors that are directly linked to disease transmission, prevention, and progression. From a social science perspective, these health behaviors can be studied by exploring the influence of both macro- (economics, structural, political), and micro- (cultural, cognitive, meaning-related) level factors. Cultural models are useful in examining the human relationship with infectious disease and how health-related decisions are made. These shared representations are drawn upon to negotiate well-being and disease, and are impacted by the introduction of new ideas or experiences.

This study investigates cultural models of illness and the impact of the trachoma elimination program in one high-prevalence community in rural southern Niger. Using an ethnographic approach, which includes observation, in-depth interviews, and household surveys, data were gathered describing popular representations of the program and the disease in the research community.

The main findings of this study show that the biomedical model of trachoma supported by the elimination program, amadari, has entered popular knowledge. However, this cultural model is not regularly applied to eye disease actually experienced by study households, which is seen to fit in the more general and more natural category of ciwon ido. Although the new treatments introduced for trachoma have been embraced by the intervention community, the use of the treatments has been modified to fit within popular representations of illness.