Applying the WHO SAFE Strategy for Trachoma Elimination in Yobe State: Programme Assessment

The WHO SAFE strategy comprising Surgery, Antibiotics, Facial cleanliness, and Environmental improvement represents the global framework for trachoma elimination, yet its application in conflict-affected and arid regions of north-eastern Nigeria presents distinct implementation challenges. This study assesses the application and impact of the SAFE strategy for trachoma elimination in Yobe State, North East Nigeria. A programme evaluation study will be conducted using government trachoma control data from 2018 to 2023, supplemented by semi-structured interviews with district health officers, community-directed distributors, sanitation officers, and programme partners. Key indicators including trichiasis surgical coverage, azithromycin distribution coverage rates, facial cleanliness survey results, and latrine access data will be tracked against WHO elimination thresholds. Qualitative findings will contextualise implementation successes and persistent gaps. Yobe State presents a particularly complex operating environment given security challenges, nomadic populations, and harsh arid conditions that limit sustained behaviour change for facial cleanliness and water access. This study documents implementation lessons from the Yobe context and provides evidence for programme adaptation by the State Ministry of Health and implementing partners including Helen Keller International. Recommendations will focus on integrating mobile trichiasis surgery teams, leveraging religious networks for azithromycin distribution, and incorporating trachoma SAFE activities into existing water, sanitation, and hygiene programmes. A context-sensitive SAFE strategy adaptation is indispensable for achieving trachoma elimination in the most challenging endemic districts of north-eastern Nigeria. Keywords: SAFE strategy, trachoma elimination, Yobe State, azithromycin, trichiasis surgery