Recorded presentation

Kevin D. Frick, PhD¹, Anna J. Sanyiwa, MD, MMed², Edith M. Ngirwamungu, MD, MPH³, Gretchen A. Jacobson, MS⁴, and Peter Kilima, MD, MSc³. (1) Department of Health Policy and Management, Johns Hopkins University, 624 N. Broadway, Rm. 606, Baltimore, MD 21205, 410-614-4018, kfrick@jhsph.edu, (2) Department of Ophthalmology, Muhimbili University College of Health Sciences, P.O. Box 65001, Dar es Saalam, Tanzania, (3) International Trachoma Initiative, NSSF Building, 7th Floor, Morogoro / Bi Titi Road, P.O. Box 3545, Dar Es Salaam, Tanzania, (4) School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205

As part of an evaluation of trichiasis surgery programs, we assessed patient perceived barriers to trichiasis surgery in two trachoma-endemic districts in Tanzania in light of the national SAFE strategy being implemented for three years.

164 unoperated trichiasis patients in Dodoma Rural and Mpwapwa districts in Tanzania were interviewed regarding their socioeconomic characteristics, number of dependents, age, and barriers to surgery. To test for associations in multivariable analyses, logistic and ordered probit regression analyses adjusting for clustering by village were used.

Every respondent listed at least one barrier. All but 8.5% listed 1 of the 4 most common (each listed by at least 20% of the respondents): not having heard of surgery, lacking assistance, surgeons being unavailable, and having too many other things to do.

Unoperated trichiasis patients from Mpwapwa were significantly more likely to have heard of surgery and less likely to have listed two of the other three most common barriers. In contrast, unoperated women with trichiasis were significantly less likely to have heard of surgery and more likely to list two of other three most common barriers. Age, number of dependents, and number of food crops had mixed effects. Unoperated trichiasis patients from Mpwapwa listed significantly fewer total barriers; unoperated female trichiasis patients listed significantly more total barriers; and listing a greater number of food crops was associated with listing fewer barriers.

Those of the lowest socioeconomic status face more barriers in obtaining services aimed at a low socioeconomic status population. The unavailability of surgeons can be affected by health care workforce policy—and affects socioeconomic groups similarly.

Learning Objectives:

• To understand the barriers to obtaining trichiasis surgery faced by unoperated patients in spite of the fact that surgery is available in the villages;
• To understand how the barriers vary by sociodemgraphic characteristics.

Keywords: Access, Community-Based Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation