Determinants for refusing trachomatous trichiasis surgery among trachomatous trichiasis patients in Tembaro District, central Ethiopia; case-control study

BACKGROUND: Trachoma is a public health problem in 30 countries. Ethiopia has the highest burden of trachoma worldwide; accounting for 49% of the 136.2 million people at risk globally. In 2024, the WHO reported that almost 460, 000 people in Ethiopia required surgery to treat trachomatous trichiasis (TT). However, many people decline surgery despite the service being available. The objective of this study was identifying the determinants for refusing TT surgery among TT patients in Tembaro district, Central Ethiopia. METHODS: A community-based unmatched case-control study was conducted among TT patients in Tembaro district from March 10, 2025, to April 25, 2025. A total of 321 (95 cases and 226 controls) were included in the study. All the registered cases were selected but, 209 controls were chosen by simple random sampling from the TT surgery register to include in the study. Data collection tools were pretested at a 10% sample size before their actual use in data collection. Data were entered into EpiData version 7 and exported to SPSS version 26 for analysis. Bivariate analysis was conducted to identify candidate variables for the final model. Multivariable analysis was done to identify the determinants of TT surgery with a p-value of less than 0.05. RESULTS: High workloads [AOR (95% CI) = 14.93 (5.72, 39.00)], a previous history of epilation [AOR (95%=3.08 (1.12,7.93)], hearing rumors about TT surgery [AOR (95% CI) = 8.98 (3.24, 24.86)], a previous history of trichiasis surgery [AOR (95% CI) = 0.27 (010, 0.71)], left eye affected [AOR (95% CI) = 0.26(0.09, 0.75)], surgery takes place in a hospital [AOR (95% CI) = 0.27(0.08,0.86)], surgery takes place in a health center [AOR (95% CI = 3.08(1.22, 7.74)], travel from home to the health facility [AOR (95% CI) = 0.24(0.08, 0.76)], and volunteer to get TT surgery if food and shelter cost is covered [AOR (95% CI) = 0.27(0.12,0.62)] were the determinants for refusing TT surgery. CONCLUSION: As per the findings of this research reveals, those TT patients with high workloads, prior history of epilation, those who heard rumors, those who have history of trichiais previously, left eye affected, place where surgery is performed, distance to health facility, and volunteer to get TT surgery if food and shelter cost covered were identified as the key determinants for refusing TT surgery. TRIAL REGISTRATION: Clinical trial number: not applicable.