Evaluation of barriers to surgical compliance in the treatment of trichiasis

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Abstract
Purpose: Eyelid repair surgery can preventthe effects of trichiasis leading to visual loss.Cost, transportation difficulties, and familialresponsibilities have been identified as majorbarriers to surgical compliance. We evaluated whetheroffering trichiasis surgery in the village waseffective in increasing the rate of surgicalacceptance and in decreasing perceived barriers tosurgery. Methods: In 1989, 205 women withtrichiasis were identified in Central Tanzania andwere offered free surgery along with free transport. As of 1991, only 18% of these women had undergone thesurgery. We followed-up these women 7 years laterafter village level surgery was introduced.Results: Since 1991, an additional 12% ofthe women had undergone eyelid surgery. 44% wereconducted in the village. Surgical cases since 1991reported shorter travel times to the place of surgery,similar post-surgical problems, and fewer days in thehospital. While providing benefits to the patient,increased village eye services did not increase therate of surgical acceptance. The women who declinedsurgery did not know surgery in the village wasavailable and the perceived cost and transportationdifficulties continued to be barriers. 50% of thenon-acceptors stated that there was nothing that wouldenable them to accept surgical intervention despitethe fact that 3/4 of them reported eye symptoms thatinterfered with their daily activities.Conclusions: The cost efficacy of villagelevel eye services needs to be evaluated and theawareness of these services increased.