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

Rajak, SN; Habtamu, E; Weiss, HA; Bedri, A; Zerihun, M; Gebre, T; Gilbert, CE; Emerson, PM; Burton, MJ; (2012) Why do people not attend for treatment for trachomatous trichiasis in ethiopia? A study of barriers to surgery. PLoS neglected tropical diseases, 6 (8). e1766. ISSN 1935-2727 DOI: https://doi.org/10.1371/journal.pntd.0001766

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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.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: Tropical Epidemiology Group
The International Centre for Evidence in Disability
International Centre for Eye Health
Centre for Global Non-Communicable Diseases (NCDs)
Neglected Tropical Diseases Network
PubMed ID: 22953007
Web of Science ID: 308497100013
URI: http://researchonline.lshtm.ac.uk/id/eprint/230679


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