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Br J Ophthalmol 2007;91:139-142 doi:10.1136/bjo.2006.103374
  • World view

Uptake of trichiasis surgical services in Tanzania through two village-based approaches

  1. Michael Mahande1,
  2. Manisha Tharaney2,
  3. Edward Kirumbi3,
  4. Edith Ngirawamungu4,
  5. Robert Geneau1,
  6. Lisa Tapert2,
  7. Paul Courtright1
  1. 1Kilimanjaro Centre for Community Ophthalmology, Tumaini University, Moshi, Tanzania
  2. 2Helen Keller International, Dar Es Salaam, Tanzania
  3. 3Ministry of Health, Dar Es Salaam, Tanzania
  4. 4International Trachoma Initiative, Dar Es Salaam, Tanzania
  1. Correspondence to: Dr Paul Courtright Kilimanjaro Centre for Community Ophthalmology, Tumaini University, PO Box 2254, Moshi, Tanzania; pcourtright{at}kcco.net
  • Accepted 4 October 2006
  • Published Online First 18 October 2006

Abstract

Aim: To determine the effectiveness of village-based strategies (using school teachers and village leaders) to increase the use of surgical services.

Methods: A cohort study was conducted in Tanzania using two village strategies (village leader and school teachers); trichiasis surgical uptake and the factors associated with uptake were measured after 1 year.

Results: The trichiasis surgical coverage at baseline was 16.9%; 200 patients who needed surgery were identified. One year later, we were able to re-examine and interview 163 of these patients. The surgical uptake among these patients was 44.8% (95% CI 37.2% to 52.4%). Patients in the school-teacher programme had a 36.5% uptake compared with 52.1% for those in the village-leader programme. No difference was observed in uptake by age or sex. Uptake was highest among those coming from multiple-generation households and those with more household wealth. Of the 90 people who still had not had surgery, 20 (22.2%) reported seeking surgery, but failing to receive it because of barriers at the provider side.

Conclusions: Improved surgical uptake for trachomatous trichiasis was achieved by using village-based promotion efforts and surgical services at existing health clinics. Even with free surgery at health clinics, indirect costs and social support barriers limit utilisation by the most vulnerable, the poorest and those living in single-generation households. Problems at the provider level also create barriers for patients who need surgery.

Footnotes

  • Published Online First 18 October 2006

  • Funding: This study was carried out through the generous support of the International Trachoma Initiative and Helen Keller International.

  • Comopeting interests: None declared.

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