Barriers to utilisation of eye care services in Kibera slums of Nairobi

Ndegwa, Linus; Karimurio, J; Okelo, R. O.; Adala, H. S.

doi:10.4314/eamj.v82i10.9347

Cited by 26 publications

(24 citation statements)

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“…In regions of Latin America and Africa, for example, lack of awareness and unmanageable costs appear to be the central barriers to care, while insurance coverage and language are more common in Australia. [2][3][4] For other countries, however, the blame resides in lack of access to services. [2][3][4][5][6] In 2014, the Pan American Health Organization's Plan of Action for the Prevention of Blindness and Visual Impairment, approved by the Ministries of Health of Latin America and the Caribbean (LAC), used 'cataract surgical coverage' data 7 (from epidemiological studies on blindness and visual impairment in Latin America) as an indicator of access to eye care services.…”

Section: Introductionmentioning

confidence: 99%

The Challenge of Universal Eye Health in Latin America: distributive inequality of ophthalmologists in 14 countries

et al. 2016

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BackgroundNo comprehensive study currently exists on the supply of ophthalmologists across Latin America. We explored sociogeographic inequalities in the availability and distribution of ophthalmologists across 14 Latin American countries.MethodsThe National Ophthalmologic Societies of Argentina, Bolivia, Brazil, Colombia, Costa Rica, Chile, the Dominican Republic, Ecuador, Guatemala, Mexico, Paraguay, Peru, Uruguay and Venezuela provided data on affiliated ophthalmologists by first-order subnational divisions in 2013. Human Development Index (HDI) estimates at the corresponding subnational division were used as equity stratifiers. Distributional inequality of ophthalmologists within each country was assessed by the health concentration index (HCI) and the index of dissimilarity (ID), along with the mean level of ophthalmologists per population.ResultsAcross all countries studied, there were 5.2 ophthalmologists per 100 000 population on average (95% CI 5.0 to 5.4) in 2013, with a mean HCI of 0.26 (0.16 to 0.37) and a mean relative ID of 22.7% (20.9% to 24.7%). There was wide inequality in ophthalmologist availability between countries, ranging from 1.2 (1.1 to 1.4) in Ecuador to 8.6 (8.5 to 8.8) in Brazil. All countries had positive (ie, pro-rich) HCI values ranging from 0.68 (0.66 to 0.71) in Guatemala to 0.02 (−0.11 to 0.14) in Venezuela. Correspondingly, redistributive potential to achieve equity was closest in Venezuela (ID: 1.5%) and farthest in Guatemala (ID: 60.3%). Benchmarked against regional averages, most countries had a lower availability of ophthalmologists and higher relative inequality.ConclusionsThere is high inequality in the level and distribution of ophthalmologists between and within countries in Latin America, with a disproportionate number concentrated in more developed, socially advantaged areas. More equitable access to ophthalmologists could be achieved by implementing incentivised human resources redistribution programmes and by improving the social determinants of health in underserved areas.

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Section: Introductionmentioning

confidence: 99%

The Challenge of Universal Eye Health in Latin America: distributive inequality of ophthalmologists in 14 countries

et al. 2016

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“…Complex behavior in seeking and receiving eye care services may be embedded in socioeconomic determinants, and more research needs to be done to confirm those findings. [80–82]…”

Section: Discussionmentioning

confidence: 99%

Social inequalities in blindness and visual impairment: A review of social determinants

Ulldemolins

Lansingh

València

et al. 2012

Indian J Ophthalmol

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Health inequities are related to social determinants based on gender, socioeconomic status, ethnicity, race, living in a specific geographic region, or having a specific health condition. Such inequities were reviewed for blindness and visual impairment by searching for studies on the subject in PubMed from 2000 to 2011 in the English and Spanish languages. The goal of this article is to provide a current review in understanding how inequities based specifically on the aforementioned social determinants on health influence the prevalence of visual impairment and blindness. With regards to gender inequality, women have a higher prevalence of visual impairment and blindness, which cannot be only reasoned based on age or access to service. Socioeconomic status measured as higher income, higher educational status, or non-manual occupational social class was inversely associated with prevalence of blindness or visual impairment. Ethnicity and race were associated with visual impairment and blindness, although there is general confusion over this socioeconomic position determinant. Geographic inequalities and visual impairment were related to income (of the region, nation or continent), living in a rural area, and an association with socioeconomic and political context was suggested. While inequalities related to blindness and visual impairment have rarely been specifically addressed in research, there is still evidence of the association of social determinants and prevalence of blindness and visual impairment. Additional research should be done on the associations with intermediary determinants and socioeconomic and political context.

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“…A study in the Kibera slums and Dagoretti area of Nairobi found that the main barriers to utilization of eye health services were a lack of a perceived need for treatment (49% of respondents), lack of money (33% of respondents), while a small proportion (8%) did not know where to obtain help [9]. A study from Tanzania found that for eye trauma cases an injury at the weekend, use of topical treatment, and visiting other facilities were independently associated with delay of more than 24 h in accessing specialist eye care.…”

Section: Introductionmentioning

confidence: 99%

Delay along the care-seeking journey of patients with ocular surface squamous neoplasia in Kenya

Gichuhi

Kabiru²,

Zindamoyen³

et al. 2017

BMC Health Serv Res

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BackgroundIn Africa, accessing eye health services is a major challenge. Ocular surface squamous neoplasia (OSSN) is a substantial ocular health problem in Africa related to solar UV light exposure and HIV infection among other risk factors. The disease causes visual loss and even death in advanced cases. This study was conducted to assess referral pathway and treatment delay for patients with OSSN in Kenya.MethodsAdults with conjunctival lesions presenting to four eye centres were asked about their occupations, when they noticed the growth, health facilities visited in seeking care, cost of consultation, surgery, medicines and histopathology and dates at each step. The time-to-presentation was divided into quartiles and correlates analysed using ordinal logistic regression.ResultsWe evaluated 158 first-time presenters with OSSN. Most were women (102 [65%]), living with HIV (78/110 tested [71%]), with low to medium income (127 [80%]). Most of the HIV patients (49/78 [63%]) were in antiretroviral care programs. About half (88/158, [56%]) presented directly to the study centres while the rest were referred. Indirect presenters sought care earlier than direct presenters (median 2.0 months vs 5.5 months) and travelled a shorter distance to the first health facility (median 20 km vs 30 km) but had surgery later (median 12.5 months vs 5.5 months). Visits beyond the first health facility for indirect presenters markedly increased delay (median 7.3, 29.0, 37.9, and 32.0 months for 1–4 facilities, respectively). Delay was associated with number of health facilities visited (adjusted ordered OR = 9.12; 95%CI 2.83–29.4, p < 0.001) and being female (adjusted ordered OR = 2.42; 95%CI 1.32–4.44, p = 0.004). At the time of presentation at the study centres for surgery the median tumour diameter in both directly and indirectly presenting patients was 6 mm (p = 0.52) and the histological spectrum of OSSN was similar between the groups (p = 0.87).ConclusionsReferral delays definitive treatment for OSSN. Women were more likely to experience delay. Despite regular contact with the health system for those with known HIV infection, delays occurred. Early detection and referral of OSSN in the HIV service might reduce delays, but reassuringly delay did not give rise to a larger proportion with more advanced grade of OSSN.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2428-4) contains supplementary material, which is available to authorized users.

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Barriers to utilisation of eye care services in Kibera slums of Nairobi

Cited by 26 publications

References 0 publications

The Challenge of Universal Eye Health in Latin America: distributive inequality of ophthalmologists in 14 countries

The Challenge of Universal Eye Health in Latin America: distributive inequality of ophthalmologists in 14 countries

Social inequalities in blindness and visual impairment: A review of social determinants

Delay along the care-seeking journey of patients with ocular surface squamous neoplasia in Kenya

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