Case–control study of determinants of corrective upper eyelid surgery refusals among trachomatous trichiasis patients in Ethiopia

Abstract

Background: Repeated infection with Chlamydia trachomatis causes trachomatous trichiasis (TT). Surgery is the main and preferred method of treatment. However, many people decline surgery despite the availability of free services in nearby health facilities. Aims: To identify the determinants of surgery refusal among TT patients in Ethiopia. Methods: This community-based, case–control study was conducted among 338 cases and 338 controls from 5 October to 17 December 2018. Using systematic random sampling, we selected people who had been operated on (controls) and those who refused surgery (cases) from registration documents and used a pre-tested, interviewer-administered, structured questionnaire for data collection. We used SPSS version 23 to analyse the data and used multivariate logistic regression to identify the determinants. Results: Having witnessed a poor surgical outcome [adjusted odds ratio (aOR): 3.51, 95% CI: 1.94–6.35] and lack of knowledge about TT (aOR: 1.77, 95% CI: 1.18–2.65) increased the refusal rate for surgery. Having trust in the surgeon (aOR: 0.26, 95% CI: 0.15–0.45), knowledge about eyelid surgery (aOR: 0.32, 95% CI: 0.16–0.64), long duration of trichiasis (aOR: 0.50, 95% CI: 0.31–0.79), decision-making via discussion with the family (aOR: 0.29, 95% CI: 0.13–0.64), frequent epilation (aOR: 0.31, 95% CI: 0.17–0.60), and receiving personal advice (aOR: 0.11, 95% CI: 0.04–0.28) reduced refusal rates. Conclusion: Refusing to have TT surgery was significantly related to knowledge about upper eyelid surgery, past surgical outcomes, decision-making capacity, and personal influences. Improved systems for upper eyelid surgery should be established in Ethiopia to better manage, and reduce unfavourable, surgical outcomes, and reduce surgery refusal.