Awareness of diabetes and diabetic retinopathy among a group of diabetic patients in main public hospitals in Damascus, Syria during the Syrian crisis

Abstract

Background The awareness of diabetes mellitus (DM) and its complications, especially diabetic retinopathy (DR), is the key to reducing their burden. This study aimed to assess both the awareness of diabetic outpatients and their action towards periodic eye exam, and to determine the causes of non-compliance amongst patients who were aware. Because the Syrian Crisis affected all aspects of Syrians’ life, the study aimed to determine the crisis’ effects on patients’ care-seeking behavior. Our study was the first step in paving the way of prevention strategies. Methods This observational cross-section study was conducted on 260 patients with DM who were visiting the four main hospitals in the Syrian capital, Damascus between August and November 2017. Results The mean (±SD) age of participants was 54.3(±12.8) years. Females were more than half (56.2%). The majority were from areas outside Damascus (72.3%). The mean (±SD) DM duration was 10.6 (±7.1) years. Almost all patients (93.8%) thought that DM could affect the eye. 67.3% believed that it could cause blindness. 86.9% of the patients conceived that DM patients should visit an ophthalmologist regularly. 37% did not visit any ophthalmologists at all, while 63% reported they had visited their ophthalmologists. Only 21.5% had a regular eye exam. Gender, educational level, economic status, province, and family history of DM had statistically an insignificant relation with an ophthalmologist visit. The preponderance of the patients who haven’t visited regularly did not appreciate the necessity of regular eye exam. Diabetic neuropathy was the most common complication of DM that patients were aware of (92%) and suffered from (56.5%). Meanwhile, regarding the effects of the Syrian Crisis: 41.2% of diabetic patients had stopped their medications for at least one month, mainly because the drugs were unavailable (74.7% of them), as some drug companies had been destroyed. Half of the patients had struggled to reach a medical care center. Half of the patients had been displaced, two-third of them were from outside Damascus. Conclusion A screening program for DR should be initiated. Also, awareness about DM and its complications, especially DR, should be raised through doctors and media. Electronic supplementary material The online version of this article (10.1186/s12913-019-4375-8) contains supplementary material, which is available to authorized users.

Conflict-Related Population Health Research in Syria, 2011-2019: An Assessment of Information Gaps, Research Needs and Challenges, for The Lancet - AUB Commission on Syria

“…, Alhaffar, Alawabdi et al 2019, Falb, Blackwell et al 2019, Roumieh, Bashour et al 2019), health seeking behaviours(Hamzeh, Almhanni et al 2019, Terkawi, Bakri et al 2019) and exposure to violence as a determinant of health(Vernier, Cramond et al 2019). Several other papers focus primarily on health determinants and risks, including neighbourhood socioeconomic status(Ahmad 2014, Ahmad, Fouad et al 2018, occupational stress(Othman, Steel et al 2018), food security(Doocy, Tappis et al 2017), and smoking prevalence and smoking behaviours before and during the war(Idris, Al Saadi et al 2018).…”

Effect of an interventional program on diabetic patients’ awareness regarding diabetic retinopathy

“…This result was the same in Syria (22) where 59.6% of diabetic patients reported having an eye problem due to DM but it's not in agreement with a study done in Egypt (23) on 1,325 patients was selected with a mean age of 49 years; DR was found in 20.5% of patients. Higher duration of Diabetes mellitus, an older mean of age, and the presence of other comorbidities in the form of hypertension and dyslipidemia may be the clue for higher prevalence among our studied sample.…”

“…(25) In our study patients for screening for diabetic retinopathy, but the continuity of care and better compliance need good communication with patients, in addition to a thorough explanation about diabetes and its complications, especially diabetic retinopathy. (22) Limitations: Some lack of cooperation was found from the participants due to a shortage of time and the clinic crowdedness, but we persuaded them after explaining the importance of the study and implementing the valued patient education.…”

Educational Model for Cadres and Housewives Against Changes in Family Knowledge and Behavior in Efforts to Prevent Complications of Type II DM in Bunut Wetan Village, Malang Regency

“…Diabetes education can improve the quality of life of diabetic patients and can also prevent long-term expenses from complications of diabetes in patients. Various factors such as cost, distance, lack of adequate counselors or clinics, and lack of appropriate services influence diabetics to gain knowledge (6) .…”