Knowledge and associated factors towards trachoma in rural Lemo district, Southern Ethiopia, 2021

Abstract

Introduction

Trachoma is one of the Neglected Tropical diseases and the world’s leading infectious cause of preventable blindness. This preventable blindness is mainly reduced by preventive measures affiliated with pre-existing knowledge about the disease’s nature, transmission, and prevention strategies. The extracted result will be an asset for integrated future intervention, which boosts knowledge of the community, and finally, put a cornerstone in reducing the burden of the disease.

Methods

A community-based cross-sectional study in the rural Lemo district of South Ethiopia covering 552 households was conducted from 1st July–30th July 2021. We used a multistage sampling technique. Seven kebeles were selected using a simple random sampling method. Then, a systematic random sampling procedure with a five-interval size was applied to select the household.

Our study assessed the association between the outcome variable and explanatory variables using binary and multivariate logistic regressions. The adjusted odds ratio was calculated and variables with a p-value below 0.05 at the 95% confidence interval were considered statistically significant.

Results

The study found that 58.5% (95% CI: 54.2–62.9%) of participants had good knowledge regarding trachoma. Having good attitude towards trachoma (AOR: 4.68, 95% CI: 3.09–7.10), and receiving health education (AOR: 3.12, 95% CI: 2.04–4.77), were significantly associated with good knowledge of trachoma.

Conclusion

Of the study participants, 58.5% had good knowledge towards trachoma. Health education and good attitude were variables associated with good knowledge of trachoma. It is advisable to take action to make people aware of trachoma through health education about the disease’s nature, transmission, and prevention strategies.

Keywords:

• Trachoma
• prevention and control
• epidemiology
• Ethiopia

REVIEWING EDITOR:

• Joe Thomas, Institute of Health and Management, Australia

SUBJECTS:

• Community Health
• Health Education and Promotion
• Preventative Medicine
• Quality of Life

Introduction

Neglected Tropical Diseases (NTD) are one of the strategic concerns of today’s health system (World Health Organization, 2014). Trachoma is one of NTD and the world’s leading infectious cause of preventable blindness (WHO, 2014–2016). It is caused by a microorganism Chlamydia trachomatis and transmitted through direct and indirect contact with ocular or nasopharyngeal discharge from infected people and flies and fomites, respectively (Ministry of Health [MOH], 2001). Follicular and inflammatory conditions to the upper tarsal conjunctiva following repeated infection with Chlamydia trachomatis may results in scarring of the conjunctiva, causing entropion and inward turning of the eyelashes. If it is left untreated, the phenomenon leads to corneal inflammation (due to inward turning eyelashes that rub cornea) and lays scar which is responsible for vision loss (Bickley et al., 2017).

Trachoma affects communities lacking access to adequate water supply, sanitation, and health care (International Coalition for Trachoma Control, 2011; ORBIS International Ethiopia, 2012). Trachoma is account for approximately 3% of the world’s preventable blindness (Pascolini & Mariotti, 2012). A nationwide survey report in Ethiopia showed that blindness and low vision due to trachoma as 11.5% and 7.7% respectively, and 33.2% and 2% active trachoma and trachomatous trichiasis respectively in Southern Nations Nationalities and Peoples Regional State (SNNPR) (Yemane & Abebe, 2006).

World Health Organization (WHO) recommends a SAFE strategy: Surgery for trachomatous trichiasis, antibiotics distribution to treat active infection, facial cleanness, and environmental improvement to reduce transmission of the disease (Solomon, 2006). Which reduces the burden of this blinding ocular condition.

There are various non-governmental organizations like Carter center, ORBIS International, and others working in collaboration with the Ministry of Health, Ethiopia to eliminate trachoma from trachoma endemic districts of the country. However, most recent studies in different parts of the nation revealed that trachoma is a public health problem yet to be addressed (BeselamT & Solomon, 2017; Endale et al., 2019; Kassahun & Dagnachew, 2012; Metadel et al., 2015; Mustefa & Zeleke, 2020; Negash et al., 2018). In addition, Ethiopia failed to achieve the 2020 goal of trachoma elimination. However treating trachoma by antibiotics and surgery is among the strategy to control trachoma, preventive measures affiliated with pre-existing knowledge about the disease’s nature, transmission, and prevention strategies has great role of controlling the disease by sparing the community from the sequelae and other social and economic burden (Endale et al., 2019). Thus, the aim of this study was to assess knowledge and its associated factors of trachoma in rural Lemo district in Southern Ethiopia. The extracted result will be an asset for integrated future intervention, which boosts knowledge of the community, and finally, put a cornerstone in reducing the burden of the disease.

Methods

Study design and period

A community-based cross-sectional study was conducted in the rural Lemo district, Southern Ethiopia, from 1st July to 30th July 2021.

Study area

The study was conducted in Lemo district, Hadiya Zone, Southern Ethiopia. The district is 230 kilometers away from Addis Ababa, the capital city of Ethiopia. According to the 2020 district administration statistics, there are 33 rural and 3 urban kebeles (sub-districts) within the Lemo district. Its projected total population is 183,912, with 90,971 men and 92,941 women. The district has one comprehensive specialized hospital that offers services including eye care. The hospital also serves as referral sight for the 7 nearby health centers, 33 health posts, and 17 private clinics.

Study population

All household (HH) heads of children aged 1–9 years and exist in rural Lemo district, Hadiya zone, South Ethiopia.

Study participants

All selected HH heads of children aged 1–9 years in rural Lemo district, Hadiya Zone, Southern Ethiopia.

Eligibility criteria

All HH heads of children aged 1–9 years as family member/s were included. However, HH heads who are mentally ill, in serious sickness, and have hearing problems were excluded.

Sample size determination

The sample size needed to assess knowledge towards trachoma is determined by using a single population proportion formula on the following assumption.

Level of significance (α): 5% (with a confidence level of 95%), Marginal error: 5%, P: 0.666 (16)

The Z-value of 1.96 was used at 95% CI (n: sample size, P: proportion, d: marginal error). $$n=\frac{{{(Z}_{a/2})}^2*P(1-P)}{d^2}$$ $$n=\frac{{\left(1.96\right)}^2*0.666*0.334}{{0.05}^2}$$ $$n=342$$

The total sample size (n) with a 10% non-response rate and 1.5 design effect becomes 565.

Sampling technique and procedure

In this study, a multistage sampling technique was applied. Seven sub-districts that include 2636 HH were selected randomly out of 33 rural kebeles. A proportional allocation of sample size was done based on the number of HH within each kebele. Every household within the Kebele of choice was assigned a unique identification code. Finally, the households were selected using a systematic random sampling approach. Every 5th HH was selected to contact the study participants for this study.

Dependent variable

Knowledge of trachoma.

Independent variables

Socio-demographic variables: age, sex, educational status, occupation, marital status, family size, number of under ten children, and average family monthly income

Environmental factors: time to fetch water from its source, amount of water, source of energy for cooking, and water source

Other factors: health education, attitude towards trachoma, preventive practice

Operational definitions

• Good Knowledge: An individual who scored a median score of six or above from nine knowledge-based questions (Gebretnsae et al., 2020).

• Good attitude: The nine attitude measuring questions were computed and individuals scored median value of seven or above was termed as having good attitude (Gebretnsae et al., 2020).

• Facial cleanliness: An absence of ocular and nasal discharge and flies on the eye at the time of examination (Delea et al., 2018; Stocks et al., 2014).

• Ocular discharge: The presence of any discharge or sleeping sign around and/or in the eye at the time of examination (Stocks et al., 2014).

• Nasal discharge: The presence of any discharge seen in the nose at the time of examination (Stocks et al., 2014).

• Fly on the eye: The presence of at least one fly contact with the eyelid margin during eye observation (Golovaty et al., 2009).

• Time to a water source: A round trip time taken to fetch/collect water from the source (Stocks et al., 2014).

• Adequate/amount of water: Using about 20 liters of water per person per day for domestic and personal hygiene (Tadesse et al., 2017).

• Cleanliness of compound: The absence of faces, animal dung, or/and domestic wastes in the residential compound.

• Health education: Acquiring education about trachoma and trachoma prevention practice at least once in the previous two years.

• Utilization of waste disposal pit: The presence of discarded unwanted agricultural and domestic products in the pits or the presence of ashes (a burned sign of waste).

• Cleanliness of latrine: The absence of human excreta, and any unwanted trash on the floor of the latrine.

• Latrine utilization: Using the latrine for excretion purposes of feces and urine (Koyra et al., 2017).

• Kebele: Lower level Governmental administration tier in the country.

Data collection tool and procedure

The questionnaire was adapted from various literature on knowledge, attitude, and associated factors towards trachoma. Two ophthalmic nurses and three integrated eye care workers (IECW) collected data using a Hadiyisa and Amharic version of the questionnaire, which had been translated by a language expert from the English version. Then, it was retranslated to the English version for consistency. It contains socio-demography, knowledge, attitudes, and other factors related to trachoma.

Data regarding the availability of latrines, cleanliness of latrines, cleanliness of childrens’ face, availability and utilization of waste disposal pit, presence of hand washing facilities, and cleanliness of the compound were collected by observation. An assessment of way of cleaning the child’s face was made as a part of preventive practice for adults.

Data quality control

Training was given to data collectors and supervisors for two days to make them familiar with their tasks. The principal investigator and supervisor had checked out the completeness, accuracy, and clarity of collected data on daily basis throughout the data collection period. A pre-test was performed on 5% of participants who were not selected for the study and were from other Kebeles (in Masibira Kebele, 30 households). To check reliability of the questions, Cronbach’s Alpha was calculated for knowledge and attitude and got 0.93 and 0.81, respectively.

Data processing and analysis

Once the data were collected using Kobo toolbox, cleaning and exporting the data into excel was followed for minimizing errors, and incompleteness. Finally, the data were exported to SPSS version 26 (statistical packages for social science) for analysis. Variables were presented as different tables and summaries. A binary and multivariate logistic regression was run to assess the strength of the association between each independent variable and the outcome variable. Hosmer and Lemeshow‘s goodness of fit test was applied and the result of p-value became 0.453.

No evidence of multi-collinearity was found with variance inflation factors that were less than one point five for all independent variables. Crude Odds Ratio (COR), Adjusted Odds Ratio (AOR), and a 95% Confidence Interval (CI) of 0.05 were used to interpret the results of the final multivariable regression tables for assessing the strength of the association between the outcome and independent variables.

Ethical consideration

We found ethical clearance from the Institutional Review Board (IRB) at the University of Gondar (UoG), College of Medicine and Health Sciences (CMHS). Participants gave informed verbal consent after we exchanged formal correspondence with the district administration in Lemo. The study was conducted in accordance with the Declaration of Helsinki. All responders had the option to not participate, discontinue their involvement, and we avoided personal identification

Results

Socio-demographic characteristics of study participants

The mean age of the study participants was 38.7, with a range of 20–66 years. Among 552 eligible study participants, more than half 55.8% (308) were female. Almost all 94.2% (520) of the study participants were married (Table 1).

Table 1. Socio-demographic characteristics of study participants in rural Lemo district community, South Ethiopia, 2021 (n = 552).

Variables	Category	Percent	Frequency
Age in years
	20–30	25.0%	138
	31–37	26.6%	147
	38–45	25.2%	139
	46–66	23.2%	128
Sex
	Male	44.2%	244
	Female	55.8%	308
Marital status
	Currently unmarried	5.8%	32
	Currently married	94.2%	520
Educational status
	Can’t read and write	12.0%	66
	Read and write	15.4%	85
	Primary education	54.5%	301
	Secondary education and above	18.1%	100
Occupation
	Housewife	23.9%	132
	Farmer	47.8%	264
	Merchant	15.8%	87
	Daily labor	7.2%	40
	Government employee	5.3%	29
Family size
	≤5	45.7%	252
	>5	54.3%	300
Number of under ten children
	1	21.4%	118
	2	49.1%	271
	3	26.3%	145
	≥4	3.2%	18
Average family monthly income (in Ethiopian Birr)
	500–2000	25.9%	143
	2001–3000	32.2%	178
	3001–4000	20.5%	113
	4001–7000	21.4%	118

Knowledge of trachoma of the study participants

Most (85.5%) of respondents heard about trachoma. About half (58.2%) knew that trachoma can be transmitted from one person to others and answered correctly that trachoma was transmitted by dirty fingers (30.6%), files (46.2%), and using contaminated towels (24.6%). Majority 456 (82.6%) of respondents accept trachoma as a treatable condition and three-fourth 421 (76.3%) of the respondents believes that trachoma could result blindness.

Of the eligible study subjects, 323 (58.5%) (95% CI: 54.2–62.9%) had good knowledge towards trachoma (Table 2).

Table 2. Knowledge of the study participants towards trachoma, Lemo district, South Ethiopia, 2021 (n = 552).

Variables	Category	Percent	Numbers
Knowledge towards trachoma
	Good	58.5%	323
	Poor	41.5%	229
Heard about trachoma disease
	Yes	85.5%	472
	No	14.5%	80
Knew trachoma can be transmitted from one person to others
	Yes	58.2%	321
	No	41.8%	231
Knew trachoma can be transmitted by contaminated fingers
	Yes	30.6%	169
	No	69.4%	383
Knew trachoma can be transmitted by contaminated towels
	Yes	24.6%	136
	No	75.4%	416
Knew trachoma can be transmitted by fly
	Yes	46.2%	255
	No	53.8%	297
Knew trachoma as a preventable disease
	Yes	84.2%	465
	No	15.8%	87
Knew trachoma prevented by washing face
	Yes	81.5%	450
	No	18.5%	102
Knew trachoma prevented by washing hands with soap
	Yes	78.3%	432
	No	21.7%	120
Knew trachoma prevent by using a latrine
	Yes	51.3%	283
	No	48.7%	269
Knew trachoma prevent by not using a common towel
	Yes	35.3%	195
	No	64.7%	357
Knew trachoma can prevent by improving environmental sanitization
	Yes	72.3%	399
	No	27.7%	153
Knew trachoma as a treatable condition
	Yes	82.6%	456
	No	17.4%	96
Knew trachoma lead to blindness
	Yes	76.3%	421
	No	23.7%	131

Environmental factors of knowledge towards trachoma

From the 552 total participants, the vast majority 521 (94.4%) reported public pipe as their main source of water, almost all the study participants, 525 (95.1%) used less than 20 liters of water per person per day. The energy source of above ninety-seven percent (537) of the study participants was firewood (Table 3).

Table 3. Environmental factors in the study of knowledge towards trachoma in rural Lemo district community, Lemo district, South Ethiopia, 2021 (n = 552).

Variables	Category	Percent	Frequency
Source of water
	Public pipe water	94.4%	521
	Spring water	5.6%	31
Time taken to fetch water from its source
	≤30 min	31.7%	175
	>30 min	68.3%	377
Amount of water used per person per day
	≤20 litre	95.1%	525
	>20 litre	4.9%	27
Source of energy to cook food
Electricity
	Yes	3.3%	18
	No	96.7%	534
Wood
	Yes	97.3%	537
	No	2.7%	15

Factors associated with knowledge of trachoma among study participants

From bi-variable logistic regression analysis; age, educational status, occupation, family size, number of under 10 children, average family monthly income, preventive practice, history of health education, attitude towards trachoma, and use of electricity as an energy source for cooking were selected and fit into a multivariable logistic regression. On multivariable logistic regression analysis, history of health education and attitude towards trachoma was found to be statistically significantly associated with knowledge of trachoma.

The odds of good knowledge of trachoma were 3.12 times (AOR = 3.12 (95% CI: 2.04–4.77)) higher in study subjects who got health education about trachoma as compared to those who had not took health education about trachoma. In addition, the study participants who had good attitude towards trachoma were 4.68 times (AOR = 4.68 (95% CI: 3.09–7.10)) more likely to have good knowledge of trachoma than those who had poor attitude towards trachoma (Table 4).

Table 4. Factors associated with knowledge towards trachoma among study participants of rural Lemo district community, Lemo district, South Ethiopia, 2021 (n = 323).

Variable	Knowledge towards trachoma		COR(95%CI) AOR(95%CI)
	Good (# and %) Poor (# and %)
Age in years
20–30	89 (64.5%)	49 (35.5%)	2.12 (1.29–3.47)*	1.78 (0.85–3.75)
31–37	85 (57.8%)	62 (42.2%)	1.60 (0.99–2.58)	1.55 (0.79–3.04)
38–45	90 (64.7%)	49 (35.3%)	2.14 (1.31–3.51)*	1.41 (0.74–2.72)
46–66	59 (46.1%)	69 (53.9%)	1	1
Sex
Male	142 (58.2%)	102 (41.8%)	1.02 (0.72–1.44)
Female	181 (58.8%)	127 (41.2%)	1
Marital status
Currently married	307(59.0%)	213(41.0%)	1.44 (0.70–2.94)
Currently unmarried	16 (50.0%)	16 (50.0%)	1
Educational status
Can’t read and write	29 (9.0%)	37 (91.0%)	1	1
Read and write	43 (50.6%)	42 (49.4%)	1.30 (0.68–2.49)	0.84 (0.38–1.86)
Primary education	178 (59.1%)	123 (40.9%)	1.84 (1.07–3.16)	0.95 (0.45–2.01)
Secondary education and above	73 (73.0%)	27 (27.0%)	3.45 (1.78–6.65)**	1.03 (0.41–2.57)
Occupation
Farmer	140 (53.0%)	124 (47.0%)	1	1
Housewife	79 (59.8%)	53 (40.2%)	1.32 (0.86–2.01)	0.78 (0.45–1.36)
Government employee	25 (86.2%)	4 (13.8%)	5.53 (1.87–16.34)*	1.73 (0.49–6.10)
Merchant	61 (70.1%)	26 (29.9%)	2.07 (1.23–3.49)*	0.87 (0.44–1.72)
Daily labour	18 (45.0%)	22 (55.0%)	0.72 (0.37–1.41)	0.61 (0.26–1.42)
Family size
≤5	157 (62.3%)	95 (37.7%)	1	1
>5	166 (55.3%)	134 (44.7%)	1.33 (0.94–1.87)	1.11 (0.68–1.81)
Number of under ten children
1	73 (61.9%)	45 (38.1%)	1.62 (0.59–4.39)**	0.72 (0.22–2.34)
2	166 (61.3%)	105 (38.7%)	1.58 (0.60–4.11)**	0.87 (0.29–2.61)
3	75 (51.7%)	70 (48.3%)	1.07 (0.40–2.85)**	0.73 (0.24–2.22)
4	9 (50.0%)	9 (50.0%)	1	1
Average family monthly income in ETB
500–2000	65 (45.5%)	78 (54.5%)	1	1
2001–3000	108 (60.7%)	70 (39.3%)	1.85 (1.18–2.89)*	1.66 (0.98–2.82)
3001–4000	68 (60.2%)	45 (39.8%)	1.81 (1.10–2.99)	1.10 (0.59–2.05)
4001–7000	82 (69.5%)	36 (30.5%)	2.73 (1.63–4.56)**	1.40 (0.72–2.75)
Preventive practice
Poor	71 (39.9%)	107 (60.1%)	1	1
Good	252 (67.4%)	122 (32.6%)	3.11 (2.15–4.50)**	1.44 (0.90–2.29)
Health education
No	91 (38.1%)	148 (61.9%)	1	1
Yes	232 (74.1%)	81 (25.9%)	4.65 (3.23–6.70)**	3.12 (2.04–4.77)**
Attitude
Poor	96 (36.5%)	167 (63.5%)	1	1
Good	227 (78.5%)	62 (21.5%)	6.36 (4.37–9.28)**	4.68 (3.09–7.10)**
Source of water
Public pipe water	308 (59.1%)	213 (40.9%)	1
Spring water	15 (48.4%)	16 (51.6%)	0.64 (0.31–1.34)
Time taken to fetch water from its source
≤30 min	106 (60.6%)	69 (39.4%)	1
>30 min	217 (57.6%)	160 (42.4%)	0.88 (0.61–1.27)
Amount of water used per person per day
≤20 litre	309 (58.9%)	216 (41.1%)	1
>20 litre	14 (51.9%)	13 (48.1%)	0.75 (0.34–1.63)
Use electricity for cooking
No	307 (57.5%)	227 (42.5%)	1	1
Yes	16 (88.9%)	2 (11.1%)	5.91 (1.34–25.98)	0.25 (0.49–13.31)
Use wood for cooking
No	10 (66.7%)	5 (33.3%)	1.43 (0.48–4.24)
Yes	313 (58.3%)	224 (41.7%)	1

*: p-value <0.05, **: p-value <0.001, #: Number, ETB: Ethiopian Birr.

Discussion

An analytic cross-sectional study was conducted to evaluate knowledge towards trachoma and associated variables. The study results showed that 58.5% (95% CI: 54.2–62.9%) of the participants got good knowledge regarding trachoma. Among the study participants (58.2%) Knew trachoma can be transmitted from one person to others, (30.6%) mentioned contaminated fingers as a way of transmission for trachoma, (76.3%) stated that trachoma leads to blindness.

The level of good knowledge of trachoma in our study was higher than those conducted in Arba Minch (23.2%) (Churko et al., 2021) and Tigray (51%) (Gebretnsae et al., 2020), Ethiopia. This occurrence of discrepancy may be due to the large time difference in time of the studies conducted and sample size difference. The above two studies were conducted earlier than this one. This makes the result from these studies not consider the effect of the recent intervention and the difference in study area may also has possible effect resulting from difference in health intervention activity to control trachoma.

The level of good knowledge was also higher than studies held across Africa; Kenya (47.2%) (Tidwell et al., 2019), Cameroon (38.2%) (Baneke, 2012), and Nigeria (18.5%) (Gboeloh & Kingsley, 2017). Socio-economic differences in the studies, differences in health care programs that boost the knowledge towards trachoma might have a role in creating this discrepancy. The health extension package applied in Ethiopia was recognized as transformational program (even in international level) in improving the primary health care. Since personal and environmental hygiene is from the packages included and health education with ongoing monitoring and follow up is way of intervention, it creates great opportunity to boost knowledge of the community regarding trachoma

Exclusively, the level of good knowledge regarding trachoma was lower as compared to the study from Oromia, Ethiopia (66.6%) (Abera & Waqjira, 2021). This might be contributed by the implementation of an eye care project aim of increasing knowledge in the previous study area (Oromia) and the difference in sample size.

The Level of knowledge in the current study was also lower than in studies across the world; Kenya (71%) (Ng’etich et al., 2015), and Vietnam (65.2%) (Khandekar et al., 2004). which will be contributed by the socio-economic difference of the studies group, and the difference in health intervention in boosting the knowledge of trachoma.

An important finding of this study was that good attitude towards trachoma was significantly associated with good knowledge regarding trachoma. Those who had a good attitude had a positive view to explore trachoma source of infection, transmission modalities, and prevention strategies. It is crucial to implement future interventions that will improve community attitude towards prevention to reduce the burden of this disease (Negash et al., 2018; Solomon, 2006).

A health education program can improve cultural perception by mitigating misunderstandings and encourages the community to know about trachoma. We found out that participants who had received health education had good trachoma knowledge. Investing in health education could be an effective strategy to reduce the burden of trachoma in the community (Abera & Waqjira, 2021).

Limitations

It would be helpful to conduct longitudinal studies in the coming years to have an inclusive outcome, since our study was a cross-sectional assessment of the outcome variable, and cannot consider the time change of the potential variable. Hence, using structured quantitative questionnaires makes us unable to glean all information we need, it is better to use more inclusive tool by comprising qualitative element.

The adopted questionnaire (from different publications) challenges the measurement of different variables, it is advisable to use standard questionnaire that ease the measurement process of the study. In addition, our study was limited to one district due to resource constraint, so studies on a larger scale are anticipated in the future.

Conclusion

According to this study, good knowledge of trachoma was 323 (58.5%). Health education, and having good attitude towards trachoma have significant association with good knowledge towards trachoma. It is advisable to take action to make people aware of trachoma through health education about the disease’s nature, transmission, and prevention strategies. Finally, this study will help to initiate and facilitate successful public intervention to prevent this blinding ocular disease.

Ethical approval

Ethical approval was obtained from Gondar University Ethical review board and consent also taken from each participants based on Helsinki declarations.

Authors contributions

Mikias Mered Tilahun: Proposal and result write up, design, conception, data collection and analysis. Biruk Lelisa Eticha: Manuscript preparations, design, conception, editing and interpretation of the data. Mulunesh Girma Shobiso: Editing, conception, and design. Merkineh Markos Lorato: Editing, conception, and design.

Acknowledgements

All the respected bodies were acknowledged (University of Gondar, department of Optometry, all the authors, and all the participants).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All the data are available and incorporated within the manuscript.

Additional information

Notes on contributors

Mikias Mered Tilahun

Mikias Mered Tilahun (BSc, MSc in Clinical Optometry), Nationality: Ethiopian, Place of work: Gondar, Ethiopia, Sex: male, Lecturer at University of Gondar.

Biruk Lelisa Eticha

Biruk Lelisa Eticha (BSc, MSc in Clinical Optometry), Date of birth: 03 May 1994, Nationality: Ethiopian, Place of work: Gondar, Ethiopia, Sex: male, Address: Phone No, [phone]; Email [email protected] & [email protected]; Cofounder and member of University of Gondar Agape Family Charity Association. Currently working as Lecturer at University of Gondar.

Mulunesh Girma Shobiso

Mulunesh Girma Shobiso (BSc, MSc in Clinical Optometry), Nationality: Ethiopian, Place of work: Gondar, Ethiopia, Sex: male, senior clinical Optometrist at Nigest Eleni Mohamed Comprehensive Hospital.

Merkineh Markos Lorato

Merkineh Markos Lorato (BSc, MSc in Clinical Optometry), Nationality: Ethiopian, Place of work: Gondar, Ethiopia, Sex: male, Lecturer at University of Gondar.