Eye care service utilization and associated factors among older adults in Hawassa city, South Ethiopia

Barriers in older adults' decision-making process to use routine eye examinations in Hong Kong

CLINICAL RELEVANCE

The decision to have a routine eye examination involves individual- and service-level judgement. A deeper understanding of patient access barriers and expectations could facilitate the design of better-aligned service models in optometric practice, improving the utilisation rate of an important facet of primary healthcare services.

BACKGROUND

Routine eye examinations achieve several health objectives, including mitigation of sight-threatening risk factors. However, there are barriers to service uptake. Through the qualitative approach, a deeper understanding of these barriers can be realised and enhanced strategies designed to improve the uptake of the routine eye examination. A qualitative study was conducted to identify the factors influencing the decision-making process of older adults to use the routine eye examination service.

METHODS

This study was guided by the grounded theory approach. Participants were purposively recruited from six community elderly centres. Semi-structured interviews were conducted with 25 community-dwelling adults aged 65 years or above in Hong Kong. Data were transcribed and constant comparison techniques were used for data analysis.

RESULTS

Difficulty in prioritising and including the routine eye examination in the existing health service utilisation was the central theme associated with its lower use. Four sub-themes were identified to explain this phenomenon: (1) previous health care service utilisation as a reference for judging primary eye care; (2) low perceived primary eye care service needs; (3) low perceived self-efficacy on routine eye care utilisation; (4) service expectations.

CONCLUSION

Multiple modifiable factors influence decision-making by older adults, suggesting that their routine eye care seeking behaviour might be altered through behaviour change intervention. The context in which services are delivered requires further study, with a focus on exploring the factors influencing service experience and its subsequent impact on regular eye care seeking behaviour.

Eye Care Service Use and Associated Health-Seeking Behaviors Among Malawian Adults: Secondary Analysis of the Malawi Fifth Integrated Household Survey 2019-2020

Background

The use of eye care services varies among different population groups.

Objective

This study aimed to assess self-reported eye care use (ECU) and associated demographic factors among Malawian adults.

Methods

This study used secondary data from the Malawi Fifth Integrated Household Survey 2019-2020, a nationally representative survey. The study included 12,288 households and 27,336 individuals 15 years and older. We entered age, sex, level of education, residency (urban/rural), and chronic disease into a logistic regression model, and used a confusion matrix to predict the model's accuracy. A P value <.05 was considered statistically significant.

Results

About 60.6% (95% CI 60.0%-61.2%) of those with eye problems accessed formal care 2 weeks before the survey date. A logistic regression model showed that ECU was positively associated with education compared to none (odds ratio [OR] 6.6, 95% CI 5.927-7.366; P<.001), males compared to females (OR 1.2, 95% CI 1.104-1.290; P<.001), and urban residence compared to rural (OR 1.2, 95% CI 1.118-1.375; P<.001). ECU was negatively associated with age (OR 7, 95% CI 6.782-8.476; P<.001) and having chronic diseases (OR 0.6, 95% CI 0.547-0.708; P<.001).

Conclusions

Social support, women empowerment, education, and mobile clinics are key strategic areas that would increase access to eye care in Malawi. Further studies can investigate ECU among the pediatric population.

Prevalence and associated factors of visual impairment among adults aged 40 and above in Southern Ethiopia, 2022

Visual impairment is a functional limitation of the eye caused by a disorder or disease that can reduce one's ability to perform daily activities. Many studies in Ethiopia have focused on childhood visual impairments. We assessed the prevalence and factors associated with visual impairment among adults aged 40 and above. Community-based cross-sectional study was done and a systematic sampling technique was used to select 655 participants. Data were collected by interviewer administered questionnaire, E-Snell chart, pinhole, torch light, and magnifying loupe. SPSS version 25 was used for analysis. Bivariate and multivariate analyses were performed to identify factors associated with outcome variable. The overall prevalence of visual impairment was found to be 36.95% (95% CI 33.2-40.8%). Factors associated with a higher odds of visual impairment included aged 51-60 years (AOR 2.37, 95% CI 1.29-4.44), aged 61 and above (AOR 8.9, 95% CI 4.86-16.3), low wealth index (AOR 1.91, 95% CI 1.14-3.2), divorced and widowed (AOR 4.67, 95% CI 2.77-7.86), no formal education (AOR 14.28, 95% CI 2.82-71.46), not utilizing eyeglass (AOR 3.94, 95% CI 1.65-9.40). The prevalence of visual impairment was relatively high compared to other studies. Age, marital status, occupation, educational status, wealth index, and not using eyeglasses were significantly associated with visual impairment. Refractory error is the leading cause of visual impairment. Early eye care service interventions are needed in this area.

Prevalence of Visual Impairment and Associated Factors Among Older Adults in Southern Ethiopia, 2022

Background

Visual impairment is a functional limitation of the eye brought on by a disorder or disease that can make it more difficult to carry out daily tasks. Visual impairment causes a wide range of public health, social, and economic issues, particularly in developing nations, where more than 90% of the world's visually impaired people reside. Although many studies conducted in Ethiopia related with the topic, there were focused on childhood visual impairments.

Objectives

To assess the prevalence and factors associated with visual impairment among older adults.

Methodology

A community-based cross-sectional study design was conducted in Arba Minch Zuria District. Systematic sampling technique was employed to select 655 adults aged 40 and above. Data were gathered through face-to-face interviews and visual acuity measurements, and SPSS version 25 was used for analysis. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with visual impairment.

Results

The overall prevalence of visual impairment was found to be 36.95% (95% CI=33.2-40.8%). Factors associated with a higher odds of visual impairment included aged 51-60 years (AOR=2.37,95%CI=1.29-4.44), aged 61 and above (AOR=8.9, 95%CI=4.86-16.3), low wealth index ((AOR=1.81, 95%CI: 1.14-3.2), divorced and widowed (AOR=4.67, 95%CI:2.77-7.86), no formal education (AOR=14.28, 95%CI: 2.82-71.46), not utilizing eyeglass (AOR=3.94, 95%CI (1.65-9.40). The most possible causes of visual impairment were found to be refractive error and cataract.

Conclusions and Recommendations

The prevalence of visual impairment among study population was relatively high, and more than three-fifths of participants had unilateral visual impairment. Age, marital status, occupation, educational status, wealth index, and not wearing of prescribed eyeglasses were significantly associated with visual impairment. Refractive error is the leading cause of visual impairment. Awareness of spectacle use and expanding cataract surgery coverage are urgently needed in this area.

A community-based cross-sectional study of eye care service utilization among the adult population in southern Ethiopia

Background

Visual impairment, which is related to many eye diseases, is a major public health problem. If detected and treated early, it can be prevented; therefore, regular use of vision services is very important.

Objective

This study aimed to assess the proportion of utilization of eye care services and associated factors among the rural community population in southern Ethiopia.

Methods

A community-based cross-sectional study design with a two-stage cluster random sampling technique was conducted to collect data from adults aged 40 years and above using interviewer-administered questionnaires. Kebeles were randomly selected by the lottery method, and systematic random sampling with proportional distribution was used to select the households. An adult individual was randomly selected from a household when there was more than one adult available. A binary logistic regression model was used to establish the association between eye care service utilization and the variables that might affect it.

Results

Of the 551 study population, 510 responded to this study, and the response rate was 92.6%. The mean age of the respondents was 52.2 years. The rate of eye care service utilization was 29% (95% confidence interval (0.25, 0.33)). The study shows that older participants, aged 65 and above (adjusted odds ratio: 4.04; 95% confidence interval (2.20, 7.43)), having previous eye problems (adjusted odds ratio: 10.04; 95% confidence interval (5.81, 17.33)), the presence of systemic illness (adjusted odds ratio: 2.52; 95% confidence interval (1.21, 5.21)), and having awareness about regular checkups (adjusted odds ratio: 11.75; 95% confidence interval (6.62, 20.84)) were found to be the predictors of eye care service utilization.

Conclusion

In this study, utilization of eye care services was low. Older age, previous eye problems, systemic illness, and awareness about checkups were found to be predictors of eye care service utilization. Hence, there is a need to increase the absorption of existing ophthalmic services and create awareness of the use of ophthalmology services to reduce preventive blindness.

Eye Care Utilization among Older Subjects with Visual Impairment in Northwest Ethiopia

Purpose

To find out the level of eye care service utilization and its determinants among the elderly visually impaired populations while visiting ophthalmic outreach locations in North-Western Ethiopia, 2021.

Methods

An ophthalmic outreach-based cross-sectional study was conducted on 852 visually impaired older people. Participants were selected by using a systematic random sampling method from January to July 2021. Data were collected by using an interviewer-administered questionnaire and an ocular examination. The collected data were entered into the Epi Info 7, and analyzed using SPSS 20. A binary logistic regression was fitted.

Results

A total of 821 participants, with a response rate of 96.5%, were included in the study. The utilization of eye care services within the past two years prior to the study was 21.1% (95 % CI: 18.2-23.9). Having systemic disease (AOR = 3.2, 95% CI: 1.5-7.0), being a spectacle wearer (AOR = 4.5, 95% CI: 2.0-9.4), having visual impairment at distance (AOR = 2.9; 95% CI: 1.5-5.6), being blind (AOR = 2.9; 95% CI: 1.5-5.6), duration of visual impairment ≤ 1 year (AOR = 2.5; 95% CI: 1.3-4.9) were all significantly associated.

Conclusion

In this study, utilization of eye care services was low. Being visually impaired at distance, being blind, recent onset of visual impairment, being a spectacle wearer, and having systemic disease were all related to the use of eye care services. The commonest barriers to utilization of eye care services were financial scarcity and long distances between eye care facilities.

Utilization of eye care services in an underserved community in Enugu State, Nigeria

Background and Aim

To determine the utilization of eye care services in an underserved community in Enugu State, Nigeria.

Materials and Methods

A community-based cross-sectional study was conducted among adults aged 18 years and older. A structured questionnaire was used to collect information on the utilization of eye care services within the last two years.

Result

A total of 500 adults with a mean age of 48 ± 10 years participated in the study, the majority (65.6%) of whom were females. The utilization rate within the last two years was 18% (40/500). Utilization of eye care services was associated with age, religion, occupation, marital status, monthly income, education, family history, and history of ocular disease (all P < 0.05). The major barrier to the utilization of eye care services was cost (30%), distance (22.6%), and bad road infrastructure (15.2%).

Conclusion

There is a low rate of eye care service utilization in the Ugbawka community of Enugu State, Nigeria. The cost of eye care services, distance, and bad road infrastructure were the major barriers to the use of eye care services. These suggest the need for the provision of affordable and accessible eye care services in this community to reduce the burden of visual impairment and blindness.

Visual impairment in Ethiopia: Systematic review and meta-analysis

WHO Prevention of Blindness Program launched ‘‘VISION 2020” in 1999 to reduce visual impairment and eradicate avoidable blindness by the year 2020. Ethiopia launched the “VISION 2020” initiative in 2002. This systematic review and meta-analysis aimed to present the national prevalence of visual impairment at the end of “VISION 2020”. Electronic search was conducted on the PubMed, SCOPUS, EMBASE, Web of Science, CINAHL, Google scholar databases for including articles. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Endnote reference manager was used for downloading, organizing, and citing articles. Methodological quality was assessed using the Joanna Briggs Institute (JBI) quality appraisal tool for prevalence studies. Statistical analysis was done using the STATA™ software version 14. In this systematic review and meta-analysis, 18 studies involving 14,953 participants were included. The pooled prevalence of visual impairment in Ethiopia after correction for publication bias by Duval and Tweedie’s trim and fill analysis was estimated to be 6.24% (95% confidence interval [CI] = [2.66, 9.82]). The pooled prevalence of visual impairment among school children and adults in Ethiopia was 6.13% (95% CI = [4.27, 7.98]) and 19.89% (95% CI = [10.85, 28.93]), respectively. The most common causes of visual impairment in decreasing order of prevalence were refractive error, cataract, trachoma, glaucoma, and corneal opacity. Amblyopia was the cause of visual impairment among school-age child. The prevalence of visual impairment in Ethiopia was still significant at the end of “VISION 2020” program. Therefore, the program of “VISION 2020” should be extended and other large-scale programs were needed to reduce the prevalence of vision impairment in Ethiopia.

Barriers to Accessing Eye Health Services in Suburban Communities in Nampula, Mozambique

Globally, an estimated 2.2 billion people are visually impaired (VI) or blind, and a large proportion (90%) of those affected live in low- and middle-income countries (LMICs), where access to eye health services is limited. This study aimed to identify barriers to accessing eye health services and associated factors in suburban communities of Nampula. A cross-sectional community-based study was carried out on adults ≥18 years old. A total of 338 adults were randomly selected from three communities (Muthita, Piloto, and Nthotta). Individual interviews were carried out and socio-demographic data, eye symptoms, date of last eye examination, and barriers to access to eye health services were extracted. Among participants, 49.4% had eye symptoms and 41.7% did not have their eye examinations up to date. The most cited barriers were crowding in hospitals (40.7%), financial difficulties (30.0%), self-medication (20.5%), traditional treatment (17.8%), and buying eyeglasses on the street (11.6%). Barriers limited the service target to 33%. Lower levels of schooling and monthly family income and farmer occupation were statistically associated with the most barriers as risk factors. The use of eye health services was lower due to barriers to accessing eye services. More specific intervention plans and greater cooperation between sectors are needed to improve these indicators.

Utilization of eye health services and diabetic retinopathy: a cross-sectional study among persons living with diabetes visiting a tertiary eye care facility in Ghana

BACKGROUND

There have been a major advance made in screening, early diagnosis, and prompt treatment of Diabetic Retinopathy among Person living with diabetes (PLWD). However, screening services remain a challenge in Low-Middle-Income-Countries where access to eye care professionals is inadequate. This study assesses the utilization of Eye Health Service prevalence (UEHS) among PLWD and associated factors and further quantifies its association with Non-Proliferative Diabetic Retinopathy (NPDR).

METHODS

A cross-sectional study design with a random sample of 360 PLWD was conducted at Korle-Bu Teaching Hospital, a National Referral Centre in Ghana from May to July 2019. UEHS and DR were the study outcomes. We adopted Poisson and Probit regression analysis to assess factors associated with UEHS over the past year. We employed pairwise and phi correlation (fourfold correlational analysis) to assess the relationship between UEHS and DR (ordinal and binary respectively). Ordered Logistic and Poisson regression were applied to assess the association between the UEHS and DR. Stata 16.1 was used to perform the analyses and a p-value ≤ 0.05 was deemed significant.

RESULTS

The prevalence of UEHS over the past year and DR was 21.7 %(95 %CI = 17.7-26.2) and 65.0 %(95 %CI = 59.9-69.8 respectively. The prevalence of severe NPDR with Clinically Significant Macular Edema (CSME) was 23.9 %(19.8-28.6). Type of diabetes, increasing age, educational level, mode of payment for healthcare services, marital status, years since diagnosis, and current blood glucose significantly influenced UEHS. There was a negative relationship between DR and UEHS (Pairwise and φ correlation were - 20 and - 15 respectively; p < 0.001). Non-UEHS among PLWD doubles the likelihood of experiencing severe NPDR with CSME compared with UEHS among PLWD [aOR(95 %CI) = 2.05(1.03-4.08)]. Meanwhile, the prevalence of DR among patients per non-UEHS was insignificantly higher [12 %; aPR(95 %CI) = 0.89-1.41)] compared with patients who utilized eye care health service.

CONCLUSIONS

Most of the PLWD did not utilize the eye health service even once in a year and that was highly influenced by type of diabetes and increasing age. Type 2 diabetes patients and middle age decreased the likelihood of UEHS. There was a negative relationship between DR and UEHS among PLWD and this doubled the likelihood of experiencing severe NPDR with CSME. Structured health education and screening interventions are key to improving UEHS.

Use of Eye Care Service and Associated Factors Among Adult Diabetic Patients Attending at Diabetic Clinics in Two Referral Hospitals, Northeast Ethiopia

PURPOSE

The objective of this study was to determine the proportion of use of eye care service and associated factors among adult diabetic patients attending diabetic clinics in two referral hospitals, Northeast Ethiopia, 2020.

METHODS

A hospital-based cross-sectional study was carried out with a sample size of 546 at Dessie and Debre-Birhan Comprehensive Specialized Hospitals from July 06 to August 14/2020. Systematic random sampling with a sampling fraction of 2 was employed to select study participants at outpatient departments in diabetic clinics. A pre-tested structured questionnaire, checklist, and visual acuity chart were used to collect the data. The collected data were entered into EPI-data version 4.4 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression was fitted to identify the possible factors associated with the outcome variable, and the strength of association was expressed using an adjusted odds ratio at a 95% confidence interval. Variables with p-values of less than 0.05 were considered statistically significant.

RESULTS

A total of 531 adult patients with diabetes participated with a response rate of 97.3%. In this study, the proportion of use of eye care service within the past 1 year was 31.5% (95% CI: 27.5, 35.4). Age from 40 to 64 years (AOR=2.86, 95% CI; 1.43,5.70) and >65 years (AOR=3.15, 95% CI: 1.32,7.50), duration of diabetes 6-10 years (AOR=2.15, 95% CI: 1.26, 3.69) and >11 years (AOR=2.93, 95% CI: 1.51, 5.69), presence of visual symptoms (AOR=3.12, 95% CI: 1.56, 6.18), good attitude on the need of a regular eye checkup (AOR=2.87, 95% CI: 1.68, 4.94), and good knowledge about diabetic ocular complication (AOR=2.29, 95% CI: 1.33, 3.94) were positively associated with the use of eye care service.

CONCLUSION

The proportion of use of eye care service among adult diabetic patients was low. The use of eye care service was significantly and independently associated with older age, longer duration of diabetes, presence of visual symptoms, good attitude on the need of a regular eye checkup, and good knowledge about diabetic ocular complication. We recommend that the patients with diabetes should be taught about diabetic ocular complications and the importance of regular eye check-ups by health professionals to increase utilization of eye care services by patients with diabetes.

Prevalence of Polypharmacy and Risks of Potentially Inappropriate Medication Use in the Older Population in a Developing Country: A Systematic Review and Meta-Analysis

BACKGROUND AND AIM

Polypharmacy and potentially inappropriate medication (PIM) use in older populations (65+ years) have not yet been investigated by meta-analyses in developing countries. This systematic literature review and meta-analysis aimed to investigate the prevalence of polypharmacy and PIM use and major risk factors associated with PIM prescribing in older adults in Ethiopia.

METHODS

We searched PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify relevant studies published between January 1990 and October 2020. Observational studies reporting the prevalence and association of risk factors with polypharmacy and PIM use in the older population were meta-analyzed. A multilevel meta-analysis was conducted to pool the prevalence estimates, and the risk of PIM use was reported as a relative risk (RR) with a 95% confidence interval (CI).

RESULTS

We identified by systematic literature review 404 articles. Of those, 8 studies fulfilled inclusion criteria, comprising a total sample of 2,608 participants. The overall prevalence of polypharmacy and PIM use pooled by meta-analysis in the Ethiopian older population was 33 and 37%, respectively. The risk factors of PIM use were analyzed in the meta-analysis (particularly polymorbidity, polypharmacy, gender, and older age), and only older age of 65+ (RR: 1.71, 95% CI: 1.16-2.51) was significantly associated with PIM use.

CONCLUSION

This first meta-analysis from a developing country revealed a high prevalence of polypharmacy and PIM use in the Ethiopian older population. There was no awareness about the risk of PIMs in patients with polypharmacy and polymorbidity, and older age significantly predicted PIM use. Interventions ensuring rational geriatric pharmacotherapy are essential in developing countries in order to reduce the expected burden of PIM-related geriatric morbidity, higher costs, and mortality.