Determinants of Uptake of Surgical Treatment for Trachomatous Trichiasis in North Ethiopia

Background: Surgery for trachomatous trichiasis prevents blindness. However people still decline surgery despite the availability of services in nearby health facilities. Objectives: To assess what proportion of cases of trichiasis had surgical treatment and to investigate the determinants of uptake of surgery. Methods: Eight villages in Enebse Sarmidir district of Amhara Region-Ethiopia were randomly selected and all self-reported cases of trichiasis were approached. Both operated and un-operated trichiasis cases were interviewed using structured questionnaires. Result: The study employed a case control study design with patients with untreated trichiasis being cases (135) and those operated, controls (141). The main reasons given for not having surgery were burden of household tasks, indirect cost of surgery, lack of companion and fear of surgery. Uptake of surgery was found to rise with duration of illness (Chi Square for trend = 26.62, P < 0.05). Longer walking distance (more than one hour) to the nearby health facility was a negative predictor of uptake of surgical treatment (adjusted odd ratio 0.31, 95% confidence interval 0.15-0.67). Conclusion: Behavior change communication interventions targeted on early uptake of surgery are very important. Village-based surgical service provision may be worthwhile in settings of high blinding trachoma burden.