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

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

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. Consort flow chart 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. Consort flow chart 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.

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