title: Why do people not attend for treatment for trachomatous trichiasis in Ethiopia? A study of barriers to surgery.
abstract: 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.
  
  
  RESULTS
  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
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00522860 and NCT00522912.
authors.affiliation: The London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Saul N
authors.initials: SN
authors.lastname: Rajak
authors.forename: Esmael
authors.initials: E
authors.lastname: Habtamu
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Amir
authors.initials: A
authors.lastname: Bedri
authors.forename: Mulat
authors.initials: M
authors.lastname: Zerihun
authors.forename: Teshome
authors.initials: T
authors.lastname: Gebre
authors.forename: Clare E
authors.initials: CE
authors.lastname: Gilbert
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Burton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014141:Trachoma / Q000150:complications* / Q000453:epidemiology*; D058457:Trichiasis / Q000453:epidemiology* / Q000601:surgery*; D055815:Young Adult