title: Uptake of trichiasis surgical services in Tanzania through two village-based approaches.
abstract: OBJECTIVE
  To determine the effectiveness of village-based strategies (using school teachers and village leaders) to increase the use of surgical services.
  
  
  METHODS
  A cohort study was conducted in Tanzania using two village strategies (village leader and school teachers); trichiasis surgical uptake and the factors associated with uptake were measured after 1 year.
  
  
  RESULTS
  The trichiasis surgical coverage at baseline was 16.9%; 200 patients who needed surgery were identified. One year later, we were able to re-examine and interview 163 of these patients. The surgical uptake among these patients was 44.8% (95% CI 37.2% to 52.4%). Patients in the school-teacher programme had a 36.5% uptake compared with 52.1% for those in the village-leader programme. No difference was observed in uptake by age or sex. Uptake was highest among those coming from multiple-generation households and those with more household wealth. Of the 90 people who still had not had surgery, 20 (22.2%) reported seeking surgery, but failing to receive it because of barriers at the provider side.
  
  
  CONCLUSIONS
  Improved surgical uptake for trachomatous trichiasis was achieved by using village-based promotion efforts and surgical services at existing health clinics. Even with free surgery at health clinics, indirect costs and social support barriers limit utilisation by the most vulnerable, the poorest and those living in single-generation households. Problems at the provider level also create barriers for patients who need surgery.
authors.affiliation: Kilimanjaro Centre for Community Ophthalmology, Tumaini University, PO Box 2254, Moshi, Tanzania.
authors.forename: Michael
authors.initials: M
authors.lastname: Mahande
authors.forename: Manisha
authors.initials: M
authors.lastname: Tharaney
authors.forename: Edward
authors.initials: E
authors.lastname: Kirumbi
authors.forename: Edith
authors.initials: E
authors.lastname: Ngirawamungu
authors.forename: Robert
authors.initials: R
authors.lastname: Geneau
authors.forename: Lisa
authors.initials: L
authors.lastname: Tapert
authors.forename: Paul
authors.initials: P
authors.lastname: Courtright
mesh_terms: D000328:Adult; D000368:Aged; D001766:Blindness / Q000382:microbiology / Q000517:prevention & control; D003153:Community Health Services / Q000458:organization & administration; D003906:Developing Countries; D005140:Eyelashes; D005141:Eyelid Diseases / Q000382:microbiology / Q000601:surgery*; D005178:Faculty; D005260:Female; D006201:Hair Diseases / Q000382:microbiology / Q000601:surgery*; D006293:Health Promotion / Q000458:organization & administration; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007857:Leadership; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D019035:Rural Health Services / Q000458:organization & administration; D012959:Socioeconomic Factors; D013636:Tanzania; D014141:Trachoma / Q000150:complications / Q000601:surgery*