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BackgroundTrachomatous trichiasis (TT), inturned eyelashes from repeated infection with Chlamydia trachomatis, is the leading infectious cause of blindness in the world. Though surgery will correct entropion caused by trachoma, uptake of TT surgery remains low. In this case-control study, we identify barriers that prevent TT patients from receiving sight-saving surgery.Methodology/Principal FindingsParticipants were selected from a database of TT cases who did (acceptors) and did not (non-acceptors) have surgery as of August 2015. We developed an in-home interview questionnaire, using open and closed-ended questions on perceived barriers to accessing surgical services. We compared responses between the acceptors and non-acceptors, examining differences in reasons for and against surgery, sources of TT information, and suggestions for improving surgical delivery. 167 participants (mean age 61 years, 79.7% females) were interviewed. Compared to acceptors, non-acceptors were more likely to report they had no one to accompany them to surgery (75.3% vs. 42.6%, p<0.0001), they could manage TT on their own (69.9% vs. 31.5%, p<0.0001), and the surgery camp was too far (53.4% vs. 28.7%, p = 0.001). Over 90% of both acceptors and non-acceptors agreed on the benefits of having surgery. Fear of surgery was the biggest barrier stated by both groups. Despite this fear, acceptors were more likely than non-acceptors to also report fear of losing further vision without surgery.Conclusions/SignificanceBarriers included access issues, familial and/or work responsibilities, the perception that self-management was sufficient, and lack of education about surgery. Fear of surgery was the biggest barrier facing both acceptors and non-acceptors. Increasing uptake will require addressing how surgery is presented to community residents, including outlining treatment logistics, surgical outcomes, and stressing the risk of vision loss.

» Surfing is safe: the risk of injury ranges from 0.26 to 0.90 injuries per surfer per year, 0.06 to 3.5 injuries per 1,000 days of surfing, and 1.1 to 13.0 injuries per 1,000 hours of surfing.» The most common acute surfing injuries are lacerations, contusions, and sprains; the head and the neck as well as the lower extremities are the locations that are affected most.» The most common mechanism of injury is striking a surfer’s own board or that of another surfer.» A pathology that is unique to surfers is surfer’s myelopathy; bites and/or stings by sea life and infections caused by marine life also occur in surfers.

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