Abstract
Background: In the two years following the initiation of a childhood blindness project, it was recognised that many blind and low vision children who might benefit from surgical intervention were not operated. We investigated the factors associated with refusal through a survey of the parents/guardians of children referred for surgical intervention. Methods: A list of children who could benefit from surgical intervention (n=60) was compiled and a questionnaire was developed and translated into the local language. Separate in-depth interviews with a subset of parents were conducted to obtain additional information. Results: In-depth interviews were conducted with the parents of five children. The structured interviews/questionnaires were returned for 35/60 children; of the 25 other children, 14 had been operated on in the intervening period, six had left school and could not be traced, and five parents/guardians could not be questioned as they lived too far from the school or were absent at the time of the interview. A total of 38% of the parents were not willing to have surgery for their children. Gender of the child was not a factor in willingness to accept surgery, while literacy of the parents was associated with willingness to have surgery. Parents of children attending a blind school/resource centre (i.e., boarders) were more likely to agree to surgery than parents of children attending an itinerant teaching programme (a community-based effort to integrate these children into the general educational system). Most parents did not know what was involved in surgery or understand the cause of their child’s blindness. Discussion: It is crucial for health workers and teachers to discuss the advantages of surgical correction with parents on a continual basis. Special teachers need to learn more about operable eye diseases in order to give parents clear information on the cause of the disease, what can be done about it, and the cost of treatment. Particular attention should be given to parents who are illiterate. Monitoring the acceptance of surgical intervention serves as a stimulus for both teachers and parents and tends to encourage acceptance of surgical intervention.