What question did this study set out to answer?

To describe a field-embedded South-South trainers-of-trainers practicum and report MDA performance in Afghanistan.

June 1, 2026International Journal of Infectious Diseases0 citationsOpen Access

Tool-in-Hand, Field-in-Flow: a field-embedded South-South trainers-of-trainers practicum for first-time trachoma mass drug administration in Afghanistan

GBGilbert Baayenda ATAgha Mohammad Abid Totakhil RORapheal Opon

Key Points

To describe a field-embedded South-South trainers-of-trainers practicum and report MDA performance in Afghanistan.
Descriptive implementation case study conducted in two phases.
Afghan ToTs participated in a live trachoma MDA campaign in Uganda, followed by training and supervision during Afghanistan's first MDA.
Aggregate data on therapeutic coverage and adverse events were summarized from the programme documentation.
373,051 out of 382,070 targeted persons were treated, achieving 97.6% therapeutic coverage.
District coverage ranged from 94.7% to 99.7% for various regions.
Mild gastrointestinal adverse events were reported, with no serious events documented.

Abstract

AbstractObjectives To describe a field-embedded South-South trainers-of-trainers (ToT) practicum for trachoma mass drug administration (MDA) and report MDA performance in Afghanistan after the practicum. Methods We conducted a descriptive implementation case study with two linked phases. In April-May 2025, Afghan ToTs joined a live trachoma MDA campaign in Moroto District, Uganda, to practise core delivery tasks using routine tools and workflows. In December 2025-January 2026, trained ToTs contributed to cascade training, microplanning, and coaching-oriented supervision during Afghanistan's first trachoma MDA in seven endemic districts, working alongside Ministry of Public Health, HealthNet TPO, provincial, and district supervisors. We summarized therapeutic coverage, adverse events reports, and supervision observations from aggregated routine programme data and campaign documentation. Results Across seven districts, 382,070 people were targeted and 373,051 were treated, giving therapeutic coverage of 97.6%. District coverage ranged from 94.7% in Asadabad to 99.7% in Khas Kunar. Supervision identified early, correctable gaps in dose-pole use and treatment recording; on-site coaching was the main corrective response. Reported adverse events were predominantly mild gastrointestinal symptoms, with no serious or clustered events documented. Conclusions A field-embedded ToT practicum was feasible and was followed by very high trachoma MDA coverage in Afghanistan. Causality cannot be inferred, but the model appears operationally promising for newly initiating trachoma programmes and warrants comparative evaluation.

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