Should trichiasis surgery be offered in the village? A community randomised trial of village vs. health centre-based surgery

INTRODUCTION Surgery for trachomatous trichiasis prevents blindness and is advocated by the WHO as part of the SAFE strategy for the global eliminatio n of trachoma. We conducted a randomised community trial to investigate the effect of providing surgery in villages on surgical uptake in The Gambia. METHODS 56 villages from two divisions were assigned to eight pairs of clus ters matched by geographical division and proximity. One cluster from each pair was randomly assigned to receive village-based surgery and the other c luster health centre-based surgery. Outcome measures were uptake rates and surgical results after 1 week and 3 months. The paired t-test was used to a nalyse the results. RESULTS Overall uptake was 66% in the village-based clusters and 44% in the health centre-based clusters. Subjects in the village-based surgery arm ha d significantly shorter journey times (P = 0.01) and lower costs (P = 0.002 ). The mean difference in absolute acceptance rates of surgery was 20% bett er in village-based clusters (95% CI -9 to +49%, P = 0.15), which would equ ate to an improvement of 45% (95% CI -20% to 120%) on the average acceptanc e rates of 44% in the health centre-based group. CONCLUSION These results strongly suggest better surgical uptake when surge ry is provided in patients' villages due to lower cost to the patient, time saved and less fear of the operation.