Habte Dereje, Gebre Teshome, Zerihun Mulat, Assefa Yared
Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Ophthalmic Epidemiol. 2008 Sep-Oct;15(5):328-33. doi: 10.1080/09286580801974897.
Surgery for trachomatous trichiasis prevents blindness. However people still decline surgery despite the availability of services in nearby health facilities.
To assess what proportion of cases of trichiasis had surgical treatment and to investigate the determinants of uptake of surgery.
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.
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).
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.
沙眼性倒睫手术可预防失明。然而，尽管附近医疗机构提供了手术服务，但人们仍拒绝接受手术。
评估倒睫病例接受手术治疗的比例，并调查手术接受率的决定因素。
在埃塞俄比亚阿姆哈拉州埃内布塞萨尔米迪尔区随机选择8个村庄，对所有自我报告的倒睫病例进行走访。对接受手术和未接受手术的倒睫病例均使用结构化问卷进行访谈。
该研究采用病例对照研究设计，未接受治疗的倒睫患者为病例组（135例），接受手术的患者为对照组（141例）。不接受手术的主要原因是家务负担、手术间接费用、缺乏陪伴和害怕手术。发现手术接受率随病程延长而上升（趋势卡方检验=26.62，P<0.05）。到附近医疗机构的步行距离较长（超过1小时）是手术治疗接受率的负向预测因素（调整后的比值比为0.31，95%置信区间为0.15-0.67）。
针对早期接受手术的行为改变沟通干预非常重要。在沙眼致盲负担较高的地区，提供基于村庄的手术服务可能是值得的。
