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. 2012;6(8):e1766.
doi: 10.1371/journal.pntd.0001766. Epub 2012 Aug 28.

Why do people not attend for treatment for trachomatous trichiasis in Ethiopia? A study of barriers to surgery

Saul N Rajak  1 , Esmael Habtamu, Helen A Weiss, Amir Bedri, Mulat Zerihun, Teshome Gebre, Clare E Gilbert, Paul M Emerson, Matthew J Burton
Affiliations

Why do people not attend for treatment for trachomatous trichiasis in Ethiopia? A study of barriers to surgery

Saul N Rajak et al. PLoS Negl Trop Dis. 2012.

Abstract

Background: Trachomatous trichiasis (TT) surgery is provided free or subsidised in most trachoma endemic settings. However, only 18-66% of TT patients attend for surgery. This study analyses barriers to attendance among TT patients in Ethiopia, the country with the highest prevalence of TT in the world.

Methodology/principal findings: Participants with previously un-operated TT were recruited at 17 surgical outreach campaigns in Amhara Region, Ethiopia. An interview was conducted to ascertain why they had not attended for surgery previously. A trachoma eye examination was performed by an ophthalmologist. 2591 consecutive individuals were interviewed. The most frequently cited barriers to previous attendance for surgery were lack of time (45.3%), financial constraints (42.9%) and lack of an escort (35.5% in females, 19.6% in males). Women were more likely to report a fear of surgery (7.7% vs 3.2%, p<0.001) or be unaware of how to access services (4.5% vs 1.0% p<0.001); men were more frequently asymptomatic (19.6% vs 10.1%, p<0.001). Women were also less likely to have been previously offered TT surgery than men (OR = 0.70, 95%CI 0.53-0.94).

Conclusions/significance: The major barriers to accessing surgery from the patients' perspective are the direct and indirect costs of surgery. These can to a large extent be reduced or overcome through the provision of free or low cost surgery at the community level.

Trial registration: ClinicalTrials.gov NCT00522860 and NCT00522912.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Consort flow chart 1.
Absorbable versus silk sutures for surgical treatment of trachomatous trichiasis in ethiopia: a randomised controlled trial. PLoS Med 8: e1001137.
Figure 2
Figure 2. Consort flow chart 2.
Surgery versus epilation for the treatment of minor trichiasis in ethiopia: a randomised controlled noninferiority trial. PLoS Med 8: e1001136.
See this image and copyright information in PMC

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