Utilization of Secondary Eye Care Services in Western Kenya

Abstract

Background: Eye care provision is currently insufficient to meet the population’s eye health needs in Kenya. Many people remain unnecessarily visually impaired or at risk of becoming so due to treatable or preventable conditions. A lack of access and awareness of services are key barriers, in large part due to their being too few eye care providers in the health system for this unmet need. Methods: A hospital-based, retrospective analysis of patients who attended Kitale eye unit, Trans Nzoia County, Kenya from 1st January 2013 to 31st December 2015. Age and sex standardized hospital attendance rates by residence, age group, and sex were calculated for Trans Nzoia county and each subcounty. The changing trends in attendance rates were estimated by calculating the difference between base year and last year. Incidence rate ratios for attendance for each age-group, sex, and residence were estimated using a multivariable regression model. Results: 20,695 patients from the county were seen in Kitale Eye Unit in 2013, 2014 and 2015. In that period, 8.3% had either uncorrected refractive error, cataracts or glaucoma, the priority VISION2020 diseases, and 61.0% had allergic or other conjunctivitis or normal eyes, which could potentially be managed at primary eye care. During the study period, overall average annual attendance rate increased from 609 to 792 per 100, 000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26–1.35). Attendance rates increased more in females than males (34.7% vs. 25.1%, respectively), IRR 1.07 (1.04–1.10). Attendance rates increased with increasing age, (highest among the elderly compared to the young). We found that in extreme age groups (>75 years and <15years) females were less likely to attend than males and there was reduced utilization from those based furthest from the hospital. Conclusion: Specialist eye services are heavily utilized by people with conditions that could be managed at the primary health care level. Barriers to accessing eye services were distance and gender, especially among the most vulnerable groups (young and the elderly). Integration of primary and secondary eye care services could lower barriers to essential eye care services to the population whilst lowering pressure on the limited specialist services by ensuring more appropriate utilization.

Prevalence of ocular findings regardless of visual acuity status in older adults from the Brazilian Amazon Region

“…In accordance to those previous studies, most cases in our sample affected the eye anterior segment, with pterygium and cataract as the most frequent abnormalities 10 , 19 – 21 . In terms of posterior segment, glaucoma cupping was the most observed finding.…”

“…A previous study performed in the UK with over 3 million people attending eye health consultations showed that 88.1% of cases were not associated with visual impairment complaint 20 . Similar results were recently observed in India and Kenya, with conditions not associated with visual acuity decrease accounting for 59% and 52%, respectively 19 , 21 .…”

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

“…The resulting morbidity needs to be addressed, forming a substantial proportion of ophthalmic service work. 6 …”

“…Similarly, data from a secondary eye unit in Kenya found that less than half of presentations were for conditions associated with vision impairment. 6 …”

Determinants of Eye Care Service Utilization Among Malawian adults; A Secondary Analysis of the Malawi fifth Integrated Household Survey 2019-2020

“…[1] Approximately, 26 million people are visually impaired and 3 million blind in sub Saharan region. [2] In Malawi, 3.3 % of the population is blind compared to 1.01 % in America. [3,4] Accordingly, visual impairment is directly related to access, Utilization and poverty.…”