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National approaches to trichiasis surgical follow-up, outcome assessment and surgeon audit in trachoma-endemic countries in Africa
  1. Grace Mwangi1,
  2. Paul Courtright2,
  3. Anthony W Solomon3
  1. 1Department of Surgery, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
  2. 2Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Observatory, South Africa
  3. 3Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
  1. Correspondence to Grace Mwangi, Department of Surgery, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa; grace.mwangi{at}


Background Poor outcomes of trichiasis surgery, including postoperative trichiasis, are common in many trachoma-endemic countries in Africa. To improve outcomes, WHO recommends regular follow-up and outcome assessment of surgical cases plus audit of trichiasis surgeons.

Aims To assess national approaches to trichiasis surgical follow-up, outcome assessment and audit, and identify national targets for good surgical outcome (defined as the percentage of patients undergoing surgery for trichiasis remaining free of post-operative trichiasis for a defined interval after surgery).

Methods A cross-sectional survey was carried out between May and July 2018, involving all 29 known-trachoma-endemic countries in Africa. An emailed questionnaire was used to collect information on national targets for surgical outcomes, policies, monitoring and strategies to address underperformance by surgeons.

Results All national programmes provided information; 2 of the 29 had not yet implemented trichiasis surgery as part of their trachoma elimination programme. Findings from 27 countries are therefore reported. Only four countries reported having a national policy for trichiasis surgery follow-up and outcome assessment and only two had a national policy for conducting audits of trichiasis surgeons. Only 9 of the 27 countries had a cut-off point at which poorly performing surgeons would be instructed to discontinue surgery until retraining or other interventions had been undertaken.

Discussion To address the challenge of post-operative trichiasis and other poor outcomes, national trachoma programmes should create and implement policies and systems to follow up patients, assess surgical outcomes and monitor the performance of individual surgeons through post-surgical audits.

  • Eye (Globe)
  • Public health

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  • Correction notice This paper has been corrected since it was published online. Figure 1 has been replaced.

  • Twitter @anthonywsolomon and @courtright_paul.

  • Acknowledgements We thank the national trachoma programme coordinators who participated in this study. We are also grateful to Alexei Mikhailov for producing Figure 1.

  • Contributors GM, PC and AWS contributed to the design and implementation of the study, analysis of the results and writing of the manuscript.

  • Funding This study was part of a Master of Public Health course funded by the Queen Elizabeth Diamond Jubilee Trust.

  • Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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