Bickley Ryan J, Mkocha Harran, Munoz Beatriz, West Sheila
Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Kongwa Trachoma Project, Kongwa, Tanzania.
PLoS Negl Trop Dis. 2017 Jan 4;11(1):e0005211. doi: 10.1371/journal.pntd.0005211. eCollection 2017 Jan.
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.
METHODOLOGY/PRINCIPAL FINDINGS: 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.
CONCLUSIONS/SIGNIFICANCE: 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.
沙眼性倒睫是由沙眼衣原体反复感染导致睫毛内翻，是全球失明的主要感染性病因。虽然手术可以矫正沙眼引起的睑内翻，但沙眼性倒睫手术的接受率仍然很低。在这项病例对照研究中，我们确定了阻碍沙眼性倒睫患者接受挽救视力手术的因素。
方法/主要发现：参与者选自截至2015年8月已接受手术（接受者）和未接受手术（非接受者）的沙眼性倒睫病例数据库。我们制定了一份家庭访谈问卷，使用开放式和封闭式问题来了解获得手术服务的感知障碍。我们比较了接受者和非接受者的回答，研究了支持和反对手术的原因、沙眼性倒睫信息来源以及改善手术服务的建议方面的差异。共访谈了167名参与者（平均年龄61岁，79.7%为女性）。与接受者相比，非接受者更有可能报告无人陪同他们去手术（75.3%对42.6%，p<0.0001），他们可以自行应对沙眼性倒睫（69.9%对31.5%，p<0.0001），并且手术营地太远（53.4%对28.7%，p = 0.001）。超过90%的接受者和非接受者都认同手术的益处。对手术的恐惧是两组提到的最大障碍。尽管有这种恐惧，但接受者比非接受者更有可能报告担心不手术会进一步丧失视力。
结论/意义：障碍包括就医问题、家庭和/或工作职责、认为自我管理就足够了以及缺乏手术相关教育。对手术的恐惧是接受者和非接受者面临的最大障碍。提高接受率需要解决如何向社区居民介绍手术的问题，包括说明治疗流程、手术结果，并强调视力丧失的风险。
