Access to community-based eye services in Meru, Kenya: a cross-sectional equity analysis

Abstract

Background: Over 80% of blindness in Kenya is due to curable or preventable causes, with an estimated 7.5 million Kenyans in need of quality eye care services. Embedding sociodemographic data collection into the national eye screening programme could help identify the groups facing systematic barriers to care. We aimed to determine the sociodemographic characteristics that are associated with access among patients diagnosed with an eye problem and referred for treatment in the national eye screening programme. Method: We used an embedded, pragmatic, cross-sectional study design. A list of sociodemographic questions was developed with input from researchers, community members, policymakers, and programme implementers. After five rounds of iteration, the final sociodemographic question set included the following domains: age, gender, religion, marital status, disability, education, occupation, income, housing, assets, and health insurance. These were integrated into an app that is used to screen, refer, and check-in (register) participants within a major eye screening programme. We gathered data from 4,240 people who screened positive during community screening and were referred to a local outreach treatment clinic in Meru County. We used logistic regression to identify groups for whom services were inaccessible. Findings: Only 46% of those who were referred to local treatment outreach clinics were able to access care. In our fully adjusted model, at the 0.05 level there were no statistically significant differences in the odds of attendance within the domains of disability, health insurance, housing, income, or religion. Strong evidence (p<0.001) was found of an association between access and age, gender, and occupation, with males, younger adults, and those working in sales, services and manual jobs being the least likely to access care. Conclusions: Less than half of those identified with an eye need and referred to free local clinics were able to access care in Meru. Younger people are being left behind, with less than a third of those aged 18-44 receiving care. Future work should explore the barriers and potential solutions to equitably improve access to care for this group.