title: Identifying Patient Perceived Barriers to Trichiasis Surgery in Kongwa District, Tanzania.
abstract: Trachomatous 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Bickley
authors.affiliation: Kongwa Trachoma Project, Kongwa, Tanzania.
authors.forename: Harran
authors.initials: H
authors.lastname: Mkocha
authors.affiliation: Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Munoz
authors.affiliation: Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Sheila
authors.identifier: 0000-0003-0818-8100
authors.initials: S
authors.lastname: West
mesh_terms: D000328:Adult; D000368:Aged; D001766:Blindness / Q000209:etiology; D016022:Case-Control Studies; D002692:Chlamydia trachomatis / Q000472:pathogenicity; D016208:Databases, Factual; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012648:Self Care; D011795:Surveys and Questionnaires; D013636:Tanzania; D014141:Trachoma / Q000150:complications*; D058457:Trichiasis / Q000209:etiology / Q000601:surgery*