Why Do People Not Attend for Treatment for Trachomatous Trichiasis in Ethiopia? A Study of Barriers to Surgery

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. © 2012 rajak et al.