Utilization of eye health services and diabetic retinopathy: a cross-sectional study among persons living with diabetes visiting a tertiary eye care facility in Ghana
Loading...
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Health Services Research
Abstract
Background: There have been a major advance made in screening, early diagnosis, and prompt treatment of
Diabetic Retinopathy among Person living with diabetes (PLWD). However, screening services remain a challenge in
Low-Middle-Income-Countries where access to eye care professionals is inadequate. This study assesses the
utilization of Eye Health Service prevalence (UEHS) among PLWD and associated factors and further quantifies its
association with Non-Proliferative Diabetic Retinopathy (NPDR).
Methods: A cross-sectional study design with a random sample of 360 PLWD was conducted at Korle-Bu Teaching
Hospital, a National Referral Centre in Ghana from May to July 2019. UEHS and DR were the study outcomes. We
adopted Poisson and Probit regression analysis to assess factors associated with UEHS over the past year. We
employed pairwise and phi correlation (fourfold correlational analysis) to assess the relationship between UEHS and
DR (ordinal and binary respectively). Ordered Logistic and Poisson regression were applied to assess the association
between the UEHS and DR. Stata 16.1 was used to perform the analyses and a p-value ≤ 0.05 was deemed
significant.
Results: The prevalence of UEHS over the past year and DR was 21.7 %(95 %CI = 17.7–26.2) and 65.0 %(95 %CI =
59.9–69.8 respectively. The prevalence of severe NPDR with Clinically Significant Macular Edema (CSME) was
23.9 %(19.8–28.6). Type of diabetes, increasing age, educational level, mode of payment for healthcare services,
marital status, years since diagnosis, and current blood glucose significantly influenced UEHS. There was a negative
relationship between DR and UEHS (Pairwise and φ correlation were − 20 and − 15 respectively; p < 0.001). Non-
UEHS among PLWD doubles the likelihood of experiencing severe NPDR with CSME compared with UEHS among
PLWD [aOR(95 %CI) = 2.05(1.03–4.08)]. Meanwhile, the prevalence of DR among patients per non-UEHS was
insignificantly higher [12 %; aPR(95 %CI) = 0.89–1.41)] compared with patients who utilized eye care health service.
Conclusions: Most of the PLWD did not utilize the eye health service even once in a year and that was highly
influenced by type of diabetes and increasing age. Type 2 diabetes patients and middle age decreased the
likelihood of UEHS. There was a negative relationship between DR and UEHS among PLWD and this doubled the
likelihood of experiencing severe NPDR with CSME. Structured health education and screening interventions are key
to improving UEHS.
Description
Research Article
Keywords
Diabetes, Eye Care Health Service Utilization, Diabetic Retinopathy, Non-Proliferative Diabetic Retinopathy