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


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.

SUBMITTER: Rajak SN 

PROVIDER: S-EPMC3429389 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Publications

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

Rajak Saul N SN   Habtamu Esmael E   Weiss Helen A HA   Bedri Amir A   Zerihun Mulat M   Gebre Teshome T   Gilbert Clare E CE   Emerson Paul M PM   Burton Matthew J MJ  

PLoS neglected tropical diseases 20120828 8


<h4>Background</h4>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.<h4>Methodology/principal findings</h4>Participants with previously un-operated TT were recruited at 17 surgical outreach campaigns in Amhara Region, Ethiopia. An interview was conducted to  ...[more]

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