Identifying Patient Perceived Barriers to Trichiasis Surgery in Kongwa District, Tanzania

Abstract

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.

Severity of Visual Field Loss at First Presentation to Glaucoma Clinics in England and Tanzania

“…These include: (i) lack of regular eye-checks 34,35 ; (ii) poverty 5 (either directly, due to lack of capacity to attend appointments, or indirectly, through a lack of education), and (iii) a lack of support 36 (both logistical and emotional). These problems are likely to be universal, but may be exacerbated in Tanzania by negative perceptions regarding surgical treatments 37,38,39 , and by its more geographically sparse population combined with fewer community-based optometriststhe primary referral route for patients in most Western countries. 40,41 The large proportion of very severe presenting cases in Tanzania may also represent the additional challenge posed by a large backlog of cases, which has built up with an aging population in combination with limited glaucoma services.…”

Piloting a trachomatous trichiasis patient case-searching approach in two localities of Sudan

“…Given that surgery uptake was close to 50%, the national program should also consider conducting a survey to understand patients’ perceived barriers to TT surgery and other reasons for refusing surgery. 14 , 15 The case-finding activity only documented suspected TT cases that were confirmed as having TT. It is therefore unknown if there were any false negatives.…”

Use of an inexpensive magnifier with light source in the diagnosis of trichiasis among community-based case finders in Nigeria

“…There have been numerous studies reporting on the barriers preventing people from accepting trichiasis surgery. [8][9][10][11][12] In the setting of this study, services were provided through outreach, thereby reducing the problem of transport for patients. In addition, the counselling guide provided to field staff may have made it easier to convince patients to accept surgery allaying their fears and other concerns about the surgery.…”