National approaches to trichiasis surgical follow-up, outcome assessment and surgeon audit in trachoma-endemic countries in Africa

Abstract

BackgroundPoor outcomes of trichiasis surgery, including postoperative trichiasis, are common in many trachoma-endemic countries in Africa. To improve outcomes, WHO recommends regular follow-up and outcome assessment of surgical cases plus audit of trichiasis surgeons.AimsTo assess national approaches to trichiasis surgical follow-up, outcome assessment and audit, and identify national targets for good surgical outcome (defined as the percentage of patients undergoing surgery for trichiasis remaining free of post-operative trichiasis for a defined interval after surgery).MethodsA cross-sectional survey was carried out between May and July 2018, involving all 29 known-trachoma-endemic countries in Africa. An emailed questionnaire was used to collect information on national targets for surgical outcomes, policies, monitoring and strategies to address underperformance by surgeons.ResultsAll national programmes provided information; 2 of the 29 had not yet implemented trichiasis surgery as part of their trachoma elimination programme. Findings from 27 countries are therefore reported. Only four countries reported having a national policy for trichiasis surgery follow-up and outcome assessment and only two had a national policy for conducting audits of trichiasis surgeons. Only 9 of the 27 countries had a cut-off point at which poorly performing surgeons would be instructed to discontinue surgery until retraining or other interventions had been undertaken.DiscussionTo address the challenge of post-operative trichiasis and other poor outcomes, national trachoma programmes should create and implement policies and systems to follow up patients, assess surgical outcomes and monitor the performance of individual surgeons through post-surgical audits.

A secondary analysis to determine countries and districts eligible for documented full geographic coverage for trichiasis case finding and outreaches

“…Mwangi et al., 16 in their four-country study, attributed the inability to achieve TT elimination prevalence targets despite FGC interventions in a district to failure by case finders to reach all target households, gaps in case finder capacity to correctly identify trichiasis cases, misdiagnosis of TT, refusal of patients to be examined or to attend outreach and poor documentation of case finding and outreaches.…”

The Gambia has eliminated trachoma as a public health problem: Challenges and successes

“…The unexpected finding of a large proportion of surgical cases having poor outcomes, in particular for specific surgeons, meant that the surgical programme had to be redesigned in order to ensure that good quality became a focus within the program. Poor quality trichiasis surgery threatens surgical uptake throughout trachoma-endemic countries and review of outcomes through surgeon audits [ 14 ] is critical for success. It also requires quarterly nationwide monitoring and evaluation visits by supervising ophthalmologist.…”

Patient perceived barriers to surgical follow-up: Study of 6-month post-operative trichiasis surgery follow-up in Tanzania

“…The preferred practice pattern for TT surgery specifies follow-up at 3-6 months to determine adverse outcomes [14]. In this cohort study, we examined patient perceived barriers and enabling factors to their attending 6-month follow-up after TT surgery in a district of Tanzania where surgical cases were reminded by CHWs to present for surgical follow-up at a central location in each village.…”