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Objective: Despite increasing availability of surgery for trachoma trichiasis, many people remain untreated. This study determined how the pattern of barriers to trichiasis surgery changes after intervention with the SAFE strategy (Surgery, Antibiotics, Face washing, Environmental improvements). Methods: Cross sectional trichiasis prevalence surveys were conducted in four areas across Ethiopia between 2002 and 2008 before and after receiving SAFE intervention. Individuals with trichiasis provided their reason as to why they were not operated and the most important barrier identified for each case. Baseline and follow-up proportions were compared under three categories: Awareness, Accessibility and Acceptability. Results: A total of 571 cases were interviewed before the intervention and another sample of 247 people participated in the post intervention assessment. The overall coverage of trichiasis surgery was 41%. Women were three times more likely to be affected than men. Indirect cost (32%), lack of awareness (28%), false beliefs (17%) and lack of escort (11%) remained the leading barriers in the follow-up assessment. The proportion of ‘Accessibility’ barriers (cost and distance) fell significantly from 49.0% [Confidence Interval (CI): 44.0%; 54.0%] down to 35% [CI: 27.2; 42.3]. The relative contribution of ‘Acceptance’ and ‘Awareness’ barriers increased though these changes were not statistically significant. Conclusion: Intervention with the SAFE strategy primarily improves accessibility to trichiasis surgery. However, acceptance and awareness related barriers standout to limit further uptake of services. Health promotion and counseling measures targeting women should be intensified in subsequent phases of SAFE. |
