Pattern of Barriers to Trichiasis Surgery Before and After SAFE Intervention

Assegid Aga Roba

Objective: Despite increasing availability of surgery for trachoma trichiasis, many people remain untreated for various reasons. We determined how the pattern of barriers to trichiasis surgery changes after intervention with the SAFE strategy (Surgery, Antibiotics, Face washing, Environmental improvements).

Methods: Cross sectional trichiasis prevalence surveys were conducted in four trachoma areas across Ethiopia, between 2002 and 2008, before and after receiving the whole SAFE intervention. Individuals identified with trichiasis during these surveys were asked why they were not operated. Baseline and follow-up proportions were compared after selecting the most important barrier under hierarchical categories of awareness, accessibility and acceptability.

Results: A total of 571 and 247 cases were interviewed before and after the intervention. Coverage of TT surgery was low (41%). Indirect cost of surgery (30%), lack of awareness (28%), false believes (16%) and lack of escort (11%) remained the leading barriers in the follow-up assessment. The proportion of 'Awareness' related barriers increased from 12.7% [Confidence Interval (CI): 9.6 - 16.3] to 27.6% [CI: 21.6 - 35.2]. The contribution of Access (cost and distance) barriers fell significantly from 52.6% [CI: 47.7 - 57.7] to 35% [CI: 28.3 - 42.7]. Proportion of barriers related to acceptance (believes, escort, fear) showed no significant change before (34.7%) and after (37.4%) the intervention.

Conclusion: Whereas SAFE intervention improves accessibility to trichiasis surgery, awareness and acceptance related barriers standout to limit uptake of services. Health education and promotion activities with preoperative counseling services are essential to mitigate barriers to trichiasis surgery in SAFE program areas.