A Community-based eye care intervention in Southern Egypt: Impact on trachomatous trichiasis surgical coverage
Middle East African Journal of Ophthalmology
Department of Ophthalmology, College of Medicine, King Saud University, P.O Box: 245, Riyadh, Saudi Arabia; Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa; School of Population and Public Health, University of British Columbia, Vancouver, Canada; British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia, Vancouver, Canada
Purpose: The purpose of this study was to measure the impact of a community-based intervention on uptake of trichiasis surgery in Southern Egypt. Methods: Four villages where trachoma is endemic were randomly selected in the Samalout district, Egypt. Two villages were selected for intervention (intervention villages) and two matched villages for nonintervention (nonintervention villages). The intervention model provided community information sessions, door-to-door health education, screening, and improvements in the clinical capacity of eye care providers. The intervention was evaluated through two pre - and post-intervention community-based surveys that included the prevalence of trachoma and the utilization of eye care services at local hospitals. All patients with trichiasis answered a questionnaire regarding surgical utilization and barriers. Results: In the baseline survey, the trachomatous trichiasis (TT) surgical coverage was 22.7% (38.9% males, 16.7% females) in all villages. Following the intervention, the TT surgical coverage increased to 68% in villages that received the intervention (81.5% males, 60% females). Nonintervention villages had a TT surgical coverage of 26.1% (37.5% males, 20% females). In the intervention villages, the prevalence of TT significantly decreased from 9.4% (5.7% males, 11.8% females) to 3.8% (1.9% males, 5.1% females) (P = 0.013), in 2008. In nonintervention villages, there was a slight, but insignificant decrease in TT from 10.1% (3.1% males, 14.4% females) to 8.2% (3% males, 11.5% females) (P = 0.580). The major barriers to uptake of TT surgical services were: 'Feeling no problem' (17.3%), 'fear of surgery' (12.7%) and 'cost' (12.7%). Conclusion: A community-based eye health education program with door-to-door screening significantly increased the uptake of TT surgical services. Although improvements to the delivery of surgical service are essential, they did not lead to any significant improvements in the nonintervention villages. © 2015 Middle East African Journal of Ophthalmology | Published by Wolters Kluwer - Medknow.
adult; Article; capacity building; clinical competence; community care; controlled study; cross-sectional study; Egypt; eye care; eye surgery; fear; female; health care access; health care cost; health care quality; health care utilization; health education; help seeking behavior; human; major clinical study; male; prevalence; priority journal; screening; trachoma; treatment outcome; trichiasis