Prevalence and associated factors of traditional eyelash epilation among patients with trachomatous trichiasis in South Ethiopia

Trachoma remains the leading infectious cause of blindness globally, with Ethiopia bearing the highest disease burden. Trachomatous trichiasis (TT), the advanced stage of trachoma, requires surgical correction to prevent irreversible blindness. However, many affected patients rely on traditional eyelash epilation as an alternative to surgery. This study aimed to assess the prevalence of traditional eyelash epilation and identify factors associated with its practice among TT patients in South Ethiopia. A community-based cross-sectional study was conducted using baseline data from a cluster randomized controlled trial carried out in selected woredas, in South Ethiopia, in 2026. A total of 464 adult TT patients were included through multistage cluster sampling across 58 kebeles. Data were collected using interviewer-administered structured questionnaires and clinical eye examination. Mixed-effects logistic regression was used to identify factors associated with traditional eyelash epilation, accounting for clustering at the kebele level. Statistical significance was declared at p < 0.05. The prevalence of traditional epilation among TT patients was 46.8% (95% CI 42.2–51.3). Each additional month of symptom duration increased the odds of traditional epilation by 7% (AOR = 1.07, 95% CI 1.04–1.10). Similarly, participants who lived more than a 30 min walk from a health facility had significantly higher odds of traditional epilation than those living within 30 min (AOR = 1.87, 95% CI 1.00–3.48). Participants with adequate knowledge about TT surgery (AOR = 0.32, 95% CI 0.16–0.62) and favourable attitudes toward TT surgery (AOR = 0.56, 95% CI 0.32–0.98) were less likely to practice epilation. Traditional epilation remains prevalent among patients with TT in South Ethiopia. Longer duration of symptoms, limited access to health facilities, and inadequate knowledge and unfavourable attitudes toward TT surgery were associated factors. Strengthening social and behavioural change communication to improve awareness and attitudes toward surgical management, along with expanding access to TT surgical services, is essential to reduce reliance on traditional epilation.