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

<div><p>Background</p><p>Trachomatous trichiasis (TT), inturned eyelashes from repeated infection with <i>Chlamydia trachomatis</i>, 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.</p><p>Methodology/Principal Findings</p><p>Participants 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.</p><p>Conclusions/Significance</p><p>Barriers 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.</p></div

Participation and disposition of 231 trichiasis cases eligible to be in the study.

<p>Participation and disposition of 231 trichiasis cases eligible to be in the study.</p

Suggested improvements to surgical care delivery, compared between acceptors and non-acceptors.

<p>Suggested improvements to surgical care delivery, compared between acceptors and non-acceptors.</p

Questionnaire For trichiasis cases: background items.

<p>Questionnaire For trichiasis cases: background items.</p

The perceived “general” benefits of having surgery, compared between acceptors and non-acceptors of surgery when asked using closed-ended questions.

<p>The perceived “general” benefits of having surgery, compared between acceptors and non-acceptors of surgery when asked using closed-ended questions.</p

Characteristics of acceptors and non-acceptors of surgery.

<p>Characteristics of acceptors and non-acceptors of surgery.</p

The “general” perceived barriers, compared between acceptors and non-acceptors of surgery when asked in closed-ended questions.

<p>The “general” perceived barriers, compared between acceptors and non-acceptors of surgery when asked in closed-ended questions.</p

Questionnaire for trichiasis cases: items about factors that are perceived barriers or enablers to trichiasis surgery for community residents.

<p>Questionnaire for trichiasis cases: items about factors that are perceived barriers or enablers to trichiasis surgery for community residents.</p

Among non-acceptors of surgery, the comparison of perceived “general” versus personal barriers to surgery.

<p>Among non-acceptors of surgery, the comparison of perceived “general” versus personal barriers to surgery.</p

Questionnaire for trichiasis cases: items about factors that are perceived barriers or enablers to trichiasis surgery for the respondent in particular.

<p>Questionnaire for trichiasis cases: items about factors that are perceived barriers or enablers to trichiasis surgery for the respondent in particular.</p