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Ryan James Bickley, Harran Mkocha, Beatriz E Munoz, Sheila K West; Barriers to accessing surgery for trachomatis trichiasis in Kongwa, Tanzania. Invest. Ophthalmol. Vis. Sci. 2016;57(12):No Pagination Specified.
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© ARVO (1962-2015); The Authors (2016-present)
Trachomatous trichiasis (TT), or inturned eyelashes as a result of repeated infection with Chlamydia trachomatis, is the leading infectious cause of preventable blindness in the world today. Though the WHO recommends surgery to correct entropion caused by trachoma, uptake of TT surgery remains low. Using a questionnaire with open- and close-ended questions, we sought to identify barriers that prevent patients with TT from receiving sight-saving surgery.
Participants were selected using an existing database of TT cases who did and did not have surgery as of August 2015. Based on previous research, we developed and pilot-tested a questionnaire on perceived barriers to accessing health care and surgical services. In-home interviews were given in participants’ native language(s) of Swahili and/or Gogo. We compared participant responses between the two groups using Fisher’s exact test. Answers to free response questions were recoded into categories before comparison. Specifically, we examined differences in reasons for and against having surgery, sources of information about TT, and suggested improvements for TT delivery to residents.
There were 167 participants (mean age of 61 years) with TT. Significantly more non-surgery participants reported not being able to afford surgery (60.3%, p<0.001), not knowing where to receive surgery (39.7%, p=0.0001), stating surgical camps were too far away (53.4%, p=0.001), not having someone to accompany and help them (75.3%, p<0.0001), and claiming they could manage TT on their own by epilating (69.9%, p<0.0001). Surgery participants were also more likely to have heard about TT from health personnel who provide trachoma services (p=0.0002). Both groups (60% and 67%) reported fear as a major obstacle. Many participants suggested that better follow-up and pre-surgery education of patients would improve surgical uptake.
Our study identifies several barriers to care as well as suggested improvements from residents with TT. Fear of surgery was a major barrier that could be addressed by better pre-surgery education of patients.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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