Table 4.

Barriers to Surgery

Authors	Study Description	Surgical Uptake	Barriers
Courtright, 199440	Design: Prospective cohort Location: Malawi Number of participants: 29 Follow up period: 9-12 months	37.9%	•Far distance from main road •Not knowing another woman who had received surgery •Unilateral TT •Not widowed
West et al, 1994 (1)136; Oliva et al, 1997 (2)98,a	Design: Prospective cohort Location: Tanzania Number of participants: 200 Follow up period: (1) 2 years and (2) 7 years	18% at 2 years 27.4% at 7 years	•Lack of symptoms •Lack of time •Additional costs •Lack of escort •Children at home •Transport difficulties •Lack of money •Don't want surgery •Poor knowledge about service •Clinic failures (patient attended)
Bowman et al, 200024	Design: Paired cluster randomized trial of (A)Health centre based surgery (B)Village based surgery Location: Gambia Number of participants: 158 Follow up period: one year	(A) 44% (B) 66% (RR, 1.49; 95% CI, 1.11–2.01; p = 0.009)	•Cost •Distance
Rabiu and Abiose, 2001102	Design: Cross-sectional Location: Nigeria Number of participants: 101 Follow up period: cross-sectional study	90% (of people with TT had not sought treatment)	•Cost •Lack of symptoms •Distance •Lack of escort
Bowman et al, 200222	Design: Prospective cohort Location: Gambia Number of participants: 148 Follow up period: 12 months	23%	•Mild symptoms •Previous bad surgical experience •Fear •Happy to epilate •Using traditional eye medicines •Family opposition •Too expensive •Lack of time •Lack of escort •Do not know how to access surgery •Seasonal income •Geographic •Heard radio broadcast
Mahande et al, 200787	Design: Prospective cohort of villages with trachoma education provide by: (A)Village leaders (B)School teachers Location: Tanzania Number of participants: 225 Follow up period: 1 year	44.8% overall (A) 52.1% (B) 36.5% in villages served by school teacher education (RR, 1.4; 95% CI, 0.9–2.1; p = 0.006)	•Unilateral TT •Surgical provision failure •Less effective TT surgery education program •Geographic •Clinic failures (patient attended)
Habte et al, 200861a	Design: Case-Control Location: Ethiopia Number of participants: 135 cases, 141 controls Follow up period: n/a	n/a	•Burden of household chores •Indirect costs of surgery •Fear of surgery •Concerns about surgical outcome •Mild symptoms

95% CI = 95% confidence interval; RR = rate ratio; TT = trachomatous trichiasis.

^aSame study population in both studies.