The Impact of Knowledge and Attitudes on Access to Eye-Care Services in Cambodia

Quality of Refractive Error Care in Cambodia: An Unannounced Standardized Patient Study

PURPOSE

Quality-of-care in refractive error services is essential, as it directly affects vision outcomes, wellbeing, educational attainment, and workforce participation. In Cambodia, uncorrected refractive error is a leading cause of mild and moderate vision impairment in adults. We evaluated the quality of refractive error care in Cambodia by estimating the proportion of prescribed and dispensed spectacles appropriate for people's refractive error needs and factors associated with spectacle quality.

METHODS

A cross-sectional protocol was employed with 18 Khmer-speaking adult participants observing testing procedures in 156 optical services across six provinces in 2022. A total of 496 dispensed spectacles were assessed against spectacle quality indicators.

RESULTS

The analysis revealed that 35.1% of dispensed spectacles were of optimal quality. The most common error observed in sub-optimal spectacles was the presence of horizontal prism outside of tolerance limits. The study also found that 44.0% of emmetrope visits involved unnecessary prescription spectacle recommendations, and 18.3% of written prescriptions did not correspond with dispensed spectacles. Sex differences were observed, with men predominantly providing refractive error care and women more likely to be unnecessarily recommended prescription spectacles.

CONCLUSION

The findings highlight the importance of prioritizing quality-of-care in refractive error services. A key recommendation is to consider regulatory mechanisms to ensure optical services employ appropriately qualified staff. Additionally, efforts should be made to eliminate unnecessary prescriptions -- especially for emmetropes and females -- standardize written prescriptions, ensure consistent pupil distance measurements, reduce reliance on autorefraction, and address the gender imbalance in the refractive error workforce.

Knowledge of cataracts and eye care utilization among adults aged 50 and above in rural Western China

Background

Cataracts are highly prevalent in rural China, but patient utilization of eye care services is low. Cataract knowledge is regarded as an important factor in eye care utilization. Few studies, however, have been conducted to measure the level of cataract knowledge and its relationship with eye care utilization among older adults in rural China. Hence, we described cataract knowledge and investigated the relationships between cataract knowledge and eye care utilization among adults (≥50 years) in rural Western China.

Methods

A large community-based cross-sectional study was conducted from October to December 2020 among adults aged 50 years and older in 73 rural villages in Qingcheng County, Western China. The participants underwent an eye examination at their village clinic to determine whether they had cataracts. Participants also answered a questionnaire about cataracts, eye care utilization status, and sociodemographic characteristics. The collected data underwent descriptive and multiple logistic regression analyses.

Results

The eye examinations revealed that 45.15% (675/1,495) of participants had cataracts in at least one eye, yet 90.67% (612/675) were left untreated. The average score achieved by participants about cataract knowledge was 4.91 points (total score was eight points). Correct knowledge about cataracts was positively associated with cataract screening and cataract surgery. Elders with better cataract knowledge were 2.21 times more likely to undergo cataract screening (OR, 2.21; 95% CI, 1.54-3.16) and 5.61 times more likely to undergo cataract surgery (OR, 5.61; 95% CI, 2.87-10.98). More than half had three fundamental misconceptions about how cataracts should be treated, how much they should cost, and when they should be treated. Participants who did not have these misconceptions were more likely to receive cataract screening by 1.21-2.02 times and cataract surgery by 1.76-3.48 times.

Conclusion

There are misunderstandings about cataract treatment methods, treatment costs and timing in the sample areas. A better understanding of cataracts was significantly positively associated with cataract screening and cataract surgery. Health education on cataracts and regular eye examinations are needed to improve eye care utilization in rural China.

Survey of Refractive Errors in Secondary School and Refractive Errors Based- School Screening in Vietnam

BACKGROUND: School-based visual acuity screening activities calculate the rates of students with possible refractive errors (REs). School staff informs the results of the children’s parents and the need for an in-depth examination to assist students with RE. AIM: The study aimed to identify the prevalence of REs among secondary students and REs based school screening in some provinces in Vietnam. METHODS: There are 4838 secondary students participating in the survey. All of them were screened for visual acuity by trained school staff including teachers and nurses. Then, a sub-sample of 1404 students was randomly selected for examination by ophthalmologists. There is a set of criteria to identify cases of low vision. We compared the school staff’s visual acuity screening results with ophthalmologists’ results to identify the difference in visual screening methods. RESULTS: The proportion of students with untreated eye problems and that of students with an uncorrected refractive error are currently quite high (at, respectively, 18.5% and 24.6%), especially in urban areas in Da Nang and Hai Duong provinces. Two of three children with RE have not received the appropriate correction. The results of visual acuity screenings were conducted by school staff in the target area have a sensitivity of 60.9% and a specificity of 93.8%. CONCLUSIONS: This indicates that efforts toward detecting students with RE need investments to mitigate the current issues in secondary school. The results suggest that school staffs including teachers and nurses need to be trained with better knowledge and skills in performing screening to improve their screening performance.

Knowledge, attitudes and practices towards refractive error amongst students

Background: Uncorrected refractive error is one of the leading causes of visual impairment. Understanding of the barriers to spectacle usage and attitudes of students towards spectacle use and management strategies can help improve population knowledge and develop school-based programmes to address refractive error.Aim: This study aimed to determine the knowledge, attitudes and practices of university students towards refractive error.Setting: A large university in South Africa.Methods: A quantitative descriptive study was performed via a validated self-administered questionnaire. The survey included questions regarding the knowledge of the participants current status of vision, knowledge on causes of poor vision, accessibility of eye healthcare facilities and attitudes towards spectacle use.Results: Knowledge of participants with respect to the cause of poor vision amongst their peers revealed 63% (n = 189) reporting that digital devices are the major cause of poor vision amongst students, followed by myopia (n = 166) and lastly long-sightedness (n = 117). The majority of participants had adequate knowledge regarding methods of correcting poor vision with 95% listing spectacles as a method of correction followed by contact lenses (n = 250) and surgery (n = 203). There were 29% of participants who reported using spectacles all the time and 22% who reported using spectacles some of the time.Conclusion: The university students are knowledgeable about the causes of poor vision amongst students. Some students have refractive error but display poor attitude and practice towards spectacle wear because they do not wear spectacles as often as they should. Awareness around eye care and spectacle use must be created.

Personal factors that affect disabled people's access to healthcare in the Bosomtwe District of Ghana

The health status and quality of life of disabled people are of immense public health concern and the Sustainable Development Goals cannot be achieved if the healthcare needs of disabled people are not met. A qualitative case study was conducted in the Bosomtwe District of Ghana to ascertain personal factors that affect disabled people's access to healthcare in the context of disability stigma. A total of 30 disabled participants were selected through purposive sampling, and data were collected through an interview guide utilizing a face-to-face interview and focus group discussion. Themes were developed and presented as findings and relevant quotes have been provided to support the findings. The study found factors such as self-stigma, knowledge about disability condition, financial challenges, location and accessibility challenges, communication challenges and lack of personal assistants which affect their access to healthcare. The experiences of disabled people have influenced them to construct their meanings regarding their conditions and subsequent health-seeking behavior. It is recommended that the district health directorate in collaboration with the National Commission for Civic Education should intensify public health education in the district which should be custom-made to suit the community's needs and understanding of disability taking into account local culture and belief system.

Time to recovery from cataract and its predictors among eye cataract patients treated with cataract surgery: A retrospective cohort study in Ethiopia

Background

Cataracts is the major global causes of blindness and a vision-affecting disease of the eye. Cataract surgery is a curative and cost-effective intervention. The number of people who undergo cataract surgery has increased rapidly. Hence, this study was aimed to determine predictors and the time of recovery of cataract patients after cataract surgery by using Simi parametric models of survival analysis.

Methods

A retrospective cohort study was conducted from January/01/2015 and January/30/2019. STATA version14.0 statistical software was used for analysis. The Kaplan-Meier survival method and log-rank test curves were applied. Weibull regression was used and adjusted hazard ratio 95% CI with a value of p less than 0.05 was used to identify a significant association.

Results

Two hundred twenty three cataract patients were recovered from cataract, 72.6% (95% CI 69.8%–75.9%). The overall median survival time was 23 weeks (IQR = 16 to 35) with (95% CI, 21%–25%). aged between 16 and 30year (AHR = 1.20 CI; 1.07–2.36), age 31 to 45 (AHR = 1.24 CI; 1.08–1.54), urban dwellers (AHR = 1.59; 95% CI, 1.18–2.14), medium visual acuity (AHR = 4.14 CI; 2.57–6.67), high visual acuity (AHR = 5.23 CI; 3.06–8.93), Secondary cataract (AHR = 2.59 CI; 1.01–3.02), traumatic cataract (AHR = 1.75 CI; 1.01–3.02), extra capsular cataract extraction surgery (AHR = 1.43 CI; 1.07–1.94),and diabetes mellitus (AHR = 0.75, CI; 0.41–0.96) were notably associated with time to recovery.

Conclusion

Time to recovery in the study area was slightly higher as compared with the global cut of time. Cataract patients with comorbidity of DM had lower recovery time.

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A 72.6% cataract patients were recovered and 27.4% of were censored from cataract.

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The overall median survival time was 23 weeks and the mean recovery time of the patients was 23.24 weeks.

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A significant difference seen in the recovery rate among cataract patients with/out diabetes mellitus.

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Time to recovery in the study area was slightly higher.

Comparison of open-ended and close-ended questions to determine signs and symptoms of eye problems among children

BACKGROUND

Parents play important role in providing information regarding their children's health status to healthcare providers. However, parents' ability in reporting signs and symptoms of eye problems among their children required more in-depth investigation. Our study aimed to compare the differences of parental report regarding eye problems among their children using two different question approaches.

METHODS

A total of 416 parents with children aged between two months old and 17 years old were participated in this cross-sectional survey. The responses of parents' observation on signs and symptoms of eye problems were compared between one open-ended question and ten close-ended questions. We also examined the demographic contributing factors that could influence parental responses.

RESULTS

The total count of reported signs and symptoms through open-ended and close-ended question was 164 and 529 reports, respectively. Parents reported more diverse (70% higher) categories of signs and symptoms in open-ended compared to close-ended questions. Parent's ability to report eye problems using open-ended question was associated with their gender (p<0.05), but no similar significant association was found in close-ended questions.

CONCLUSION

Parents reported more signs and symptoms of eye problems among their children through close-ended questions (regardless of gender) and more diversified categories through open-ended question in this study suggested that different communication approaches might be needed in clinical practice between those who requested specific appointment and those attending screening or routine assessment. The discrepancy might imply the importance to enhance the parent's role in preventive eye care. Effective communication between eyecare providers and parents has the potential to improve paediatric eyecare delivery.

Validating a tool to assess eye health knowledge, attitude and practice in Cambodia and Vietnam

AIM

To develop an eye health knowledge, attitude and practice (EH-KAP) field-based assessment tool for use in implementing effective eye health care services.

METHODS

An instrument development and validation study. A Vietnam EH-KAP dataset were used to identify and eliminate redundant questions to develop a standardized tool. Face validity was assessed by the KAP survey team. Internal validity (congruency/criterion) was assessed by comparing descriptive analysis of two datasets (n=531; n=38) collected from the same sampling frame at different time points. Weighted scores were calculated for each construct. Kappa values for test-retest and inter-observer agreement were calculated to check the reliability of responses. The modified version was assessed by analysing the raw and ungrouped data. Responses were weighted and agreement was tested by comparing construct scores.

RESULTS

Totally 38 respondents were included in this validation process (mean age 58.5y). Mean scores for knowledge were 9.15 (old questionnaire n=531) and 5.05 (modified version). For attitude, the scores were 2.23 and 2.42, and for practice the scores were 3.33 and 2.21. Test-retest agreement was between 62% to 93% (Kappa 0.24 to 0.86) for the ungrouped raw data, and 55% to 72% (Kappa 0.42 to 0.65) for KAP domain. Inter-observer Kappa value for ungrouped data was 0.37 and 0.45 for the weighted scores.

CONCLUSION

This standardized tool applied at critical time points can assess trends in KAP within the same population and for comparison across groups. If used alongside a Rapid Assessment of Avoidable Blindness (RAAB), this tool provides a comprehensive perspective on eye-health of a population.

Utilization of Secondary Eye Care Services in Western Kenya

Background: Eye care provision is currently insufficient to meet the population's eye health needs in Kenya. Many people remain unnecessarily visually impaired or at risk of becoming so due to treatable or preventable conditions. A lack of access and awareness of services are key barriers, in large part due to their being too few eye care providers in the health system for this unmet need. Methods: A hospital-based, retrospective analysis of patients who attended Kitale eye unit, Trans Nzoia County, Kenya from 1st January 2013 to 31st December 2015. Age and sex standardized hospital attendance rates by residence, age group, and sex were calculated for Trans Nzoia county and each subcounty. The changing trends in attendance rates were estimated by calculating the difference between base year and last year. Incidence rate ratios for attendance for each age-group, sex, and residence were estimated using a multivariable regression model. Results: 20,695 patients from the county were seen in Kitale Eye Unit in 2013, 2014 and 2015. In that period, 8.3% had either uncorrected refractive error, cataracts or glaucoma, the priority VISION2020 diseases, and 61.0% had allergic or other conjunctivitis or normal eyes, which could potentially be managed at primary eye care. During the study period, overall average annual attendance rate increased from 609 to 792 per 100, 000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26-1.35). Attendance rates increased more in females than males (34.7% vs. 25.1%, respectively), IRR 1.07 (1.04-1.10). Attendance rates increased with increasing age, (highest among the elderly compared to the young). We found that in extreme age groups (>75 years and <15years) females were less likely to attend than males and there was reduced utilization from those based furthest from the hospital. Conclusion: Specialist eye services are heavily utilized by people with conditions that could be managed at the primary health care level. Barriers to accessing eye services were distance and gender, especially among the most vulnerable groups (young and the elderly). Integration of primary and secondary eye care services could lower barriers to essential eye care services to the population whilst lowering pressure on the limited specialist services by ensuring more appropriate utilization.

Factors Associated with Knowledge, Attitude and Practices of Common Eye Diseases in General Population: A Multicenter Cross-Sectional Study from Pakistan

High prevalence of blindness coupled with low public awareness of eye diseases is a severe problem in Pakistan. The objective of this study was to evaluate the awareness, attitude and practices related to common ocular problems and eye care use among general population of Punjab, Pakistan. Data were collected cross-sectionally, using random selection of participants from five districts of Punjab, Pakistan. A pre-tested questionnaire was used to collect the data from January to March 2017. The ordinal data were converted to interval--based data by Rasch analysis, which is termed as "knowledge score" and ranges from -3 to +3. Descriptive statistics, linear regression, binary logistic regression and chi square analysis were performed to evaluate the data. Of the 2073 people contacted, 96.4% (2019) responded the interviewer. The mean (SD) age was 39.9 (11.4) years, majority were males (64.8%) and only 3.1% were illiterate. The majority (68.1%) of respondents were aware that blindness can be prevented and are least aware of age-related macular degradation (31.4%). Multivariate analysis to knowledge scores demonstrated that male gender (β = 0.53 95%CI = 0.39, 0.66, p < 0.001), higher education (β = 0.31 95%CI = 0.25, 0.37, p < 0.001) were significantly associated with knowledge score. Eighty-two percent of our respondents had a positive attitude towards health-seeking behavior and those who had adequate income on most of occasions were 1.82 (AOR = 1.82 95%CI = 1.26, 2.62 p = 0.001) times more prone towards health-seeking behavior than those who had insufficient income. Out of all respondents, 21.5% had an eye examination at least once a year and this frequency was significantly higher in lower age, females, high education and high Socio Economic Status level (p < 0.05). Among the general population of Pakistan, awareness about prevention of blindness and refractive error was optimum, while awareness of blindness causing eye conditions, like age-related macular degradation was low. Intensive improvements in the health literacy and public interventions-specifically in old age people, males and respondents with lower education-are urgently needed.

Knowledge about cataract and associated factors among adults in Gondar town, northwest Ethiopia

Purpose

The aim of this study was to assess knowledge regarding cataract and associated factors among adults in Gondar town Northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted on 836 adults age ≥18years, using multi-stage systematic random sampling technique, in Gondar town Northwest Ethiopia from April 15-May 7, 2017. Data were collected using pre-tested structured questionnaires through face to face interview. The collected data was entered to Epi info version 7 and analyzed using SPSS version 20. Binary logistic regression was used to identify associated factors. Those variables with p-value <0.05 and confidence interval ≠ 1 in multivariable logistic regression were considered as statistically significant factors for knowledge regarding cataract.

Result

Among 845 eligible adults, 98.9% (836) of them were fully participated. The median age of participants was 28 years with an interquartile range of 17 years. Of the total participants, 67.2% (562) of them had awareness about cataract [95% CI, 63.8–70.2]. Among 562 participants, 61.7% of them had good knowledge about cataract [95% CI, 57.5–66.00]. It was also found that higher level of education [AOR = 2.86, 95%CI: 1.37–5.96], higher family monthly income [AOR = 1.92, 95%CI: 1.03–3.57], having previous eye examination [AOR = 1.53, 95% CI: 1.02–2.31] and positive family history of cataract [AOR = 1.76, 95%CI: 1.03–3.01] were positively associated with good knowledge.

Conclusion

Significant portion of the participants had good knowledge about cataract, which was positively associated with higher level of education, higher family monthly income, presence of previous eye examination and positive family history of cataract. However, significant knowledge gap regarding the risk factors and prevention strategies was recognized. Hence, it might be logical to pay special attention in prospering knowledge on how to prevent the occurrence of the disease.

Formative research for the development of an Eye Health Strategic Planning and Evaluation Framework and a Checklist: A health systems approach

This formative research process aimed to develop an Eye Health Strategic Planning and Evaluation Framework and indicator Checklist. The research process utilized a multi-phased multiple methods approach including literature review, initial expert review (n = 27), findings from a Cambodian Avoidable Blindness Initiative demonstration project (2009-2012), observation and analysis of four rural sites of the Indian LV Prasad Eye Institute Pyramid Model (n = 21), and finally, a critique by Cambodian government eye health professionals/staff (n = 15), health center staff and community representatives (n = 77) and patients (n = 62). Results from three Cambodian population-based surveys (KAP n = 599, patient follow-up n = 354, and RAAB 4650) also informed the development of the Framework and the Checklist. The Framework domains include: situation analysis, determinants of accessibility, service delivery systems, operation systems, networks and linkages, outcomes, and impact. Domains were subdivided into 59 components. The Checklist consists of 253 indicator items. The Eye Health Strategic Planning and Evaluation Framework and the Checklist can assist policy makers, program planners, and evaluators to develop a comprehensive whole of systems approach to eye health care to improve coverage and utilization of services.

Leaving No One Behind: Strengthening Access to Eye Health Programs for People With Disabilities in 6 Low- and Middle-Income Countries

PURPOSE

To assess the impact of inclusive eye health programs for people with disabilities.

DESIGN

A synthesis evaluation study.

METHODS

A cross-disciplinary team of ophthalmologists, evaluation, and disability-inclusive development advisors purposively selected evaluation reports of CBM-supported inclusive eye health programs in low- and middle-income countries. Employing a change-promoting paradigm, salient achievements and challenges were narratively analyzed and recommendations suggested based on a previously developed framework for strengthening disability inclusion in eye health programs.

RESULTS

Evaluations from 10 programs implemented in 6 countries (Cambodia, Egypt, Ethiopia, Indonesia, Pakistan, Vietnam) from 2011 to 2016 were identified. Training of medical staff and government officials resulted in increased awareness about disability rights and improved physical accessibility of eye health facilities. Relevant information about inclusion in eye health was incorporated in national eye health training curricula in some countries. Information, education, and communication material about eye health neglected patients with hearing and learning impairments. An overly narrow focus on disability inclusion confounded intersectoral barriers to eye health services. Collaboration of eye health staff with disability peoples organizations improved significantly but evidence of its impact was elusive. Collection of disability-disaggregated data posed significant challenges and made it difficult to demonstrate increased access to eye health programs by people with disabilities.

CONCLUSIONS

Introduction of disability inclusion in eye health systems of countries with limited resources poses significant challenges. Future programs striving to improve access to eye health services for marginalized populations including people with disabilities might consider more flexible and contextualized approaches.

A qualitative study on gender barriers to eye care access in Cambodia

BACKGROUND

The Fred Hollows Foundation (FHF) Cambodia recently partnered with the Ministry of Women's Affairs (MoWA) and National Program for Eye Health (NPEH, part of the Ministry of Health) to establish the Gender Equality in Eye Health Project. As part of this project, a qualitative study was carried out to identify barriers affecting women's access to eye health in Cambodia.

METHODS

A cross-sectional qualitative study was conducted in four provinces in both urban and rural locations between May and June 2015. Purposive sampling was used to identify respondents from a range of age groups, geographical locations, and experiences to explore different perceptions regarding access barriers to eye health care. Thirteen women experiencing eye problems (age range 45-84 years; mean age 63 years) and 25 eye health professionals took part in in-depth interviews. Eleven focus groups discussions were held with 69 participants (50 women, 19 married men) to capture the views and experiences of both younger and older women, as well as household decision makers' perspectives.

RESULTS

Gender-based differences in decision-making, access and control over resources and women's social status all contributed to impeding women's access to eye health services. Women relied predominantly on informal sources of information about health, and these channels might be utilised to address barriers to information and access. Disparities in perceived costs of eye health treatment were evident between eye healthcare providers and users: costs were not perceived as a barrier by service providers due to health financing support for poor patients, however, many users were not aware of the availability of the scheme.

CONCLUSION

Demand-side and supply-side elements interact to reduce women's ability to seek eye treatment.

Towards Universal Eye Health: Hospital-based disability-disaggregated data collection in Takeo province, Cambodia

BACKGROUND

Universal access and equity are salient principles of the World Health Organization global action plan 'Towards Universal Eye Health'. However, collection of disability-disaggregated data to measure access to eye hospitals in low- and middle income countries, including referral to rehabilitative services, are not routinely integrated into Health Management Information Systems.

OBJECTIVE

This report presents secondary-data analysis of disability-disaggregated data collection that was introduced at a tertiary eye hospital in a rural province in Cambodia.

METHODS

A modified version of the Washington Group Short Set of Questions was used to count the number of eye patients with self-reported difficulties. The number of referrals of patients with unavoidable visual impairment to low vision services as well as referral to rehabilitative services was also counted.

RESULTS

From 2011 to 2016, out of 182,327 patients overall 4981 (2.7%; 95% CI 2.66-2.81) reported difficulties with hearing, moving or communicating in addition to visual or other eye-related problems. Most of the difficulties were reported in the age group of patients aged 50 years and older (89.8% [95% CI 88.9-90.6]). All together 901 (0.5%; 95% CI 0.46-0.53) patients were treated at the low vision unit and 652 (0.36%; 95% CI 0.33-0.39) patients were referred to rehabilitation services. The number of referrals to rehabilitation declined annually from the year 2013-2016.

CONCLUSIONS

Patients with self-reported impairments constitute a significant proportion of the eye hospital's population. A modified version of the Washington Group Short Set of Questions enabled routine disability-disaggregated data collection but resulted also in possible under-reporting of difficulties.

Knowledge and practices of teachers associated with eye health of primary school children in Rawalpindi, Pakistan

PURPOSE

Teachers' perspectives on eye health can be limited, particularly in developing countries. The aim of this study was to assess teachers' knowledge and practices associated with eye health of primary students in Rawalpindi, Pakistan.

METHODS

This was a cross-sectional survey of primary school teachers. Simple random sampling technique was used to select 443 participants from 34 private and 17 public schools. A self-administered questionnaire was used.

RESULTS

Teachers' knowledge ranged from "high" (35.89%), "moderate" (49.89%), and "low" (14.22%). Teachers' practices associated with students' eye health ranged from "high" (10.16%), "moderate" (23.02%), and "low" (66.82%). The teachers' knowledge index scores increased 4.28 points with successive age groups and increased 2.41 points with each successive level of education. For teachers whose close relatives experienced eye disease, their knowledge index score was 4.51 points higher than those teachers whose relatives never had any eye disease. Teachers' age, education level, and their close relatives experiencing eye disease were significant predictors of their knowledge (R² = 0.087, P < 0.001). Female teachers' practices index score was 10.35 points higher than the male teachers and public school teachers had 10.13 points higher than the private school teachers. Teachers' gender and type of school were significant predictors of their practices (R² = 0.06, P < 0.001).

CONCLUSION

There was a significant gap among primary school teachers' knowledge and practices related to students' eye health. Innovative strategies are needed to improve how teachers address students' eye health issues in the classroom.

Patient Perspectives on Acquiring Spectacles: A Cambodian Experience

PURPOSE

To assess the perspectives of patients who acquired spectacles from an eye unit/vision center in Cambodia.

DESIGN

A sample (n = 62) of patients was selected across 4 provinces: Prey Veng, Siem Reap, Battambang, and Takeo.

METHODS

The Patient Spectacle Satisfaction Survey covering demographic and semistructured questions regarding patient satisfaction, style, and costs incurred was used to collect data. Information was transcribed and translated into English and analyzed by thematic coding using NVivo.

RESULTS

Although there were more women seeking eye health care treatment, there was no significant age difference. Patient satisfaction levels were high although the patients had to pay for transportation, registration, and the glasses themselves. A total of 60 patients (96.7%) stated they would recommend the refractive service center to others. Despite a high level of awareness of eye disease such as cataract, only 2 in 10 people could accurately identify cataract as a major cause of poor vision or blindness. Most of the people (52%) blamed bad vision or blindness on dust or other foreign objects getting into the eye, old age (31%), or poor hygiene (16%).

CONCLUSIONS

Most people will pay eye care costs once barriers to seeking treatment have been broken via education and encouragement. Satisfaction of wearing spectacles was associated with improved vision; style, color, and fit of the spectacles; and protection from sunlight and dust. The proximity of and easy access to health facilities influenced patient desire to seek treatment.

Factors Associated with Awareness, Attitudes and Practices Regarding Common Eye Diseases in the General Population in a Rural District in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES)

Background

To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh.

Methods

Data were collected using a multilevel cluster random sampling technique from 3104 adults aged ≥30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history.

Results

Participants were aged between 30 and 89 years with a mean (SD) age of 51 (12) years and 65% were female. The majority of participants had heard of cataracts (90%), trachoma (86%) and Pterygium (84%), yet only 4% had heard of diabetic retinopathy (DR), 7% of glaucoma and 8% of Age-related macular degeneration (AMD). However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57%) of people with no schooling compared to those who had attained at least secondary school certificate education (72%) reported that they knew that vision loss could be prevented (p<0.001). Overall 51% of people had heard of at least six (67%) out of nine items relating to awareness of common eye diseases. This included 41% of participants aged 65 years or older compared to 61% of those aged 30–35 years (p<0.001). Only 4% had an eye check at least once a year and higher education and better SES were associated with higher frequency of eye checks.

Conclusions

In rural Bangladesh awareness of cataract, trachoma and pterygium was good but limited in relation to the potentially blinding conditions of glaucoma, DR, and AMD. The results show a large gap between public awareness and treatment practices about common eye diseases. Public health promotion should be designed to address these knowledge gaps.

Prevalence of blindness and cataract surgical outcomes in Takeo Province, Cambodia

PURPOSE

To estimate the prevalence of blindness and cataract surgical outcomes in persons 50 years or older above in Takeo Province, Cambodia.

DESIGN

A population based survey.

METHODS

A total of 93 villages were selected through probability proportionate to size using the Rapid Assessment of Avoidable Blindness methodology. Households from 93 villages were selected using compact segment sampling. Visual acuity (VA) of 4650 people 50 years or older was tested and lens status and cause of visual impairment were assessed.

RESULTS

The response rate was 96.2%. The age- and sex-adjusted prevalence of bilateral blindness [presenting visual acuity (PVA) <3/60 in the better eye] was 3.4% (95% confidence interval, 2.8%-4.0%), resulting in an estimated 4187 people blind in Takeo Province. The age- and sex-adjusted prevalence of low vision (PVA <6/18 to 3/60) was 21.1%, an estimated 25,900 people. Cataract surgical coverage in the bilaterally blind was 64.7% (female 59.5%, male 78.1%). Cataract surgical outcome was poor (best-corrected visual acuity <6/60) in only 7.7% and good in 88.7% (best-corrected visual acuity ≥6/18) of eyes operated in the last 5 years before the survey.

CONCLUSIONS

The cataract surgical coverage for women is less than that for men. The increased life expectancy in Cambodia and the fact that women constitute 60.6% of the population (aged ≥50 years) at Takeo Province could have had an impact on cataract workload and high prevalence of blindness. A repeated survey using the same methodology after 8-12 years might be helpful in proving genuine change over time.