Why do patients in Tanzania refuse trachoma surgery?

Why do patients in Tanzania refuse trachoma surgery?

Trachomatous trichiasis, caused by the chlamydia bacteria, is one of the leading causes of preventable blindness worldwide. This disease is common in areas of the world that lack access to health care and clean water. While a simple and free surgery can spare the patient’s vision, multiple studies indicate that many patients refuse surgery.

In a new study published by PLOS Neglected Tropical Diseases, Dr. Emily Gower of Gillings School of Global Public Health at the University of North Carolina and her colleagues held two focus groups in Tanzania’s Mtwara and Masasi districts with patients and Community Health Workers (CHWs) to figure out why individuals would refuse free corrective surgery. Roughly 75 percent of participants were middle-aged or elderly women who are traditionally charged with most of the household tasks and unable to spend time being incapacitated after surgery. About one-third of CHWs and patients noted that surgery was declined due to the belief that the surgery requires a six-month post-op recovery.

However, the recovery time is quite short. Patients can remove their bandages the morning after surgery and can farm within a few days while stitches are still in place.

Once the researchers realized the main reasons for declining surgery were based on misconceptions of trichiasis and the surgery, they created a frequently asked questions sheet and gave it to the CHWs. Reports from the field indicated that this FAQ sheet reduced the number of refusals and increased health worker knowledge about the procedure, although no formal comparison of refusal rates was performed.

“We’ve found important misinformation exists that limits people from deciding to undergo trichiasis surgery,” the researchers note. “Our findings are applicable not only to trichiasis surgery programs, but to a broad range of health-related activities implemented at the community level, particularly in developing country settings where access to medical information is limited. And, while the rural communities we studied are closely knit, our findings highlight the fact that stronger support systems are needed to ensure surgical services for those most in need.”




Gupta KM, Harding JC, Othman MS, Merbs SL, Gower EW (2018) Why do patients refuse trichiasis surgery? Lessons and an education initiative from Mtwara Region, Tanzania. PLOS Neglected Tropical Diseases 12(6): e0006464. https://doi.org/10.1371/journal.pntd.0006464

Image Credit:
“Entropion and trichiasis secondary to trachoma,” Otis Historical Archives Nat’l Museum of Health & Medicine, (Wikimedia Commons, CC BY 2.0)


Avren Keating is a Publications Assistant for PLOS Neglected Tropical Diseases. They received their MFA in Creative Writing from Mills College. You can contact them at akeating@plos.org.

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