Alternate eye care services in a ghanaian district

Eye health-seeking behaviour of traders in rural Nigeria

Aim:

The aim of this article was to determine the healthcare provider first sought, reasons for the choice, and symptom duration before hospital presentation among traders in rural Nigeria.

Materials and Methods:

This was a cross-sectional study of traders at a rural Nigerian market, selected by systematic random sampling. A structured questionnaire was used to obtain information on sociodemographics, eye disease symptoms, eye care provider first sought, and reasons for choice. The analysis was carried out with Statistical Package for Social Sciences using descriptive and inferential statistics with an alpha level at 0.05.

Results:

Of the 177 traders, 88 (49.7%) were males and 89 (50.3%) were females. The mean age was 46.5 ± 13.75 years (range 19–72). Of the 83 traders who had ocular symptoms 23 (27.7%) never sought any care. The eye care providers first sought were patent medicine vendors 22 (26.5%), orthodox hospital 17 (20.5%), eye glass vendors 3 (3.6%), and traditional healers 3 (3.6%). The median symptom duration before presentation to an eye health facility was 83 days. Reasons for not seeking orthodox eye care first included cost 33 (39.8%), ‘ailment not serious’ 22 (26.5%), and advice from friends 7 (8.4%). Females were more likely to seek orthodox care (χ²=4.22, P=0.04), whereas males were more likely to feel that their ailment was not serious. Traders aged >50 years were less likely to seek any care for eye ailment (χ² =8.41, P=0.04).

Conclusion:

Traders with eye disorders seek care late and most first seek care outside the orthodox hospital. Cost and feeling that ailment was not serious are barriers to seeking orthodox eye care. Eye health education and cost reduction would improve uptake of orthodox eye care services.

Perception of red eye among senior secondary students in Sagamu, Southwest Nigeria

Background:

Red eye is a very common presenting complaint in clinical practice among all age groups, including adolescents. Health habits formed during adolescence is carried to adulthood and is often a consequence of their perception. This study, therefore, determined the perception of students toward the red eye.

Aim:

To determine the perception of red eye and its associated factors among secondary school students in Sagamu.

Methods:

A cross-sectional descriptive study was carried out among 1082 senior secondary school students in Sagamu local government area, using a semi-structured self-administered questionnaire. Data were analyzed using SPSS Version 20. Relevant descriptive and inferential statistics were calculated.

Results:

The mean age of respondents was 15.27 ± 1.48 years. There were more females (54.8%) than males. Majority (81%) had heard of red eye, and this was mainly from neighbors; 58.4% felt they could not contact red eye from an infected person. About 35% would instill onion if they had a red eye. About 50.2% felt red eye could lead to blindness. Awareness of red eye was associated with age (P = 0.005), but not with sex and religion. Among respondents, 95.5% and 96.2% had a poor perception as well as a poor attitude toward red eye, respectively.

Conclusion:

The perception and attitude of senior secondary school students in Sagamu to red eye is poor. Appropriate eye health education and promotional services, including periodic eye examination of students, should be carried out in school health services. Early presentation to eye care centers for its treatment should be encouraged.

Determinants of Eye Care Utilization in Rural South-eastern Nigeria

To determine the barriers and incentives to eye care utilization (ECU) in Abagana, a rural south-eastern Nigerian community. The study was a population-based cross-sectional mixed method (quantitative and qualitative) survey of adult inhabitants of Abagana, in July-August, 2011. Data on respondents' socio-demographics, barriers and incentives to ECU were collected, and analysed using descriptive and comparative statistics. A p < 0.05 was considered statistically significant. Qualitative data were obtained from focus group discussions and in-depth interviews and analyzed using ATLAS.ti software. The 549 respondents (males 224) were aged 49.8 ± 15.9 SD years (range 18-93 years). Overall, orthodox eye care had ever been sought by 42.4%, and 46.4% of those who reported change in vision. Lack of awareness-31.8%, cost-18.0%, and fatalistic attitudes-15.9% were the main ECU barriers. Possession of health insurance (OR 11.49; 95% CI 4.21-31.34; p = 0.001), family history of eye disorder (OR 3.27, 95% CI 2.03-5.26; p = 0.001), noticed change in vision (OR 11.30; 95% CI 1.42-90.09; p = 0.022), current eye disease (OR 4.06; 95% CI 2.29-7.19; p = 0.001) and systemic co-morbidity (OR 4.33; 95% CI 2.67-7.02; p = 0.001) were the incentives to ECU. To enhance the low ECU in Abagana community, educational interventions on eye health maintenance and eye health seeking behaviours, and measures to reduce eye care cost are recommended.

Prevalence of harmful/traditional medication use in traumatic eye injury

Aim:

Ocular trauma of varying aetiologies do occur frequently, however when different traditional/harmful substances are applied before presentation in the hospital, prognosis in terms of visual outcome following treatment may be worse than expected. This study is aimed at determining the prevalence of harmful/traditional eye medication practices among patients with traumatic eye injury in a tertiary institution.

Study Design/Setting:

It is a retrospective study of patients seen at the eye clinic of the Ekiti State University Teaching Hospital (a state government owned hospital), Ado Ekiti, from January to December 2009.

Method:

A review of case notes (medical records) of patients with history of ocular trauma both open and closed globe injury and who presented to the eye clinic of the Ekiti State University Teaching Hospital, Ado Ekiti from January to December 2009 was carried out. Demographic data of the patients, nature of the ocular trauma, substances applied to the eyes, visual acuity at presentation and after treatment were extracted. Frequencies and percentages were used in analysing the data.

Result:

A total of 1420 new patients attended the eye clinic during the study period (January to December 2009). Forty eight (3.4%) applied various substances into their eyes after sustaining ocular injury. Substances applied include Kerosene 25%, cassava water 20.8%, breast milk 12.5%, personal urine 10.8%, and cow urine 8.3%. Nearly half of the patients 23 (47.9%) presented with low vision and after treatment there was no visual improvement in almost all of them, 22 (45.8%). The period before presentation ranges between 1hr -2weeks post injury. However, the number of monocular blindness reduced from 8 (16.7%) to 5 (10.4%) after treatment.

Conclusion:

Kerosene and Cassava water were the common substances applied to the injured eye. The use of these harmful and traditional eye medications on injured eyes can reduce further the visual prognosis despite ophthalmic intervention.

Applying principles of health system strengthening to eye care

Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries) often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.