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

Abstract

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.

Assessment of the distribution of human and material resources for eye health in the public sector in Nampula, Mozambique

“…This results in overcrowding in public hospitals, longer waiting time in health facilities or in long distances to travel to enjoy eye health services, with additional transport costs. These factors constitute barriers to access to eye health services and a major obstacle in the fight against preventable and treatable VI [ 37 ].…”

Assessment of cataract surgery outcomes in Nampula (Mozambique): visual acuity, visual function and quality of life

“…Refractive errors stand out among the main causes of visual impairment after cataract surgery. Studies performed in Mozambique have shown that the acquisition of corrective glasses is still not easily accessible for a large proportion of the population of Nampula, with financial difficulties being indicated as the main barrier, in a country where 49.9% of the population lives in conditions of severe poverty [ 27 , 28 ], resulting in the circumstance that some people who undergo surgery can continue having visual deficiencies due to uncorrected refractive errors. Therefore, for our study, the presenting visual acuity (with the available correction) was used as a reference over visual acuity with better correction since it better reflects the daily reality of the patient, being more associated to the characteristics that wish to be measured such as VFm and QoLm.…”

“…The results of this study show that some patients undergo cataract surgery when aspects of their VF and QoL are already very debilitated, compromising the psychosocial well-being of the individual and his family. Therefore, these instruments (VFm and QoLm) may also help in the management and decision making by clinicians, such as, for example, the choice of the best time to operate, since studies have revealed that one of the barriers of access to cataract surgery has been the fact that “the cataract is not yet mature enough” [ 28 , 30 – 32 ] leading the doctor or the patient to choose to wait for the appropriate time to perform the surgery.…”

“…Therefore, these instruments (VFm and QoLm) may also help in the management and decision making by clinicians, such as, for example, the choice of the best time to operate, since studies have revealed that one of the barriers of access to cataract surgery has been the fact that "the cataract is not yet mature enough" [28,[30][31][32] leading the doctor or the patient to choose to wait for the appropriate time to perform the surgery.…”

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

“…Sengo et al performed a literature review and interviewed 25 people in Mozambique with vision impairment to identify which barriers should be used in a wider survey. 34 However, the exercise was inadequately described and the authors do not provide any detail on how the qualitative data were analysed.…”