Compliance with Eye Screening Examinations among Diabetic Patients at a Tanzanian Referral Hospital

Abstract

Background: Sub-Saharan Africa faces an epidemic of diabetes with its attendant complications. Early treatment of diabetic retinopathy prevents visual impairment and blindness. However, very little has been done to establish diabetic retinopathy screening in Africa. We aimed to measure current use of the eye department by diabetics and the increase in eye examinations following education about diabetic eye disease by a dedicated nurse counselor and the offer of a free eye examination. Methods: In a prospective study over 6 months we enrolled all diabetics over the age of 18 attending the diabetic clinic at KCMC. Data was collected on whether patients had had a previous dilated eye exam and whether they knew this was necessary. Education on diabetic eye disease and a referral form to the eye clinic for a free examination were given to the patient. Findings: Three-hundred sixteen patients were enrolled in the study. 187 (59.1%) of the patients reported that they had undergone dilated fundus exam at some point since their diagnosis. 91 (28.8%) had undergone fundus examination within the past 12 months. Of the 316 patients, 114 (36%) came to the eye clinic with the referral form. 106 had not been examined in the last year. 65 of these had never been examined before. A logistic regression model demonstrated that knowledge that diabetes damages the eye (OR = 7.34, 95%CI = 4.66–11.57) and age (OR = 1.02, 95%CI = 1.01–1.03) but not duration of diabetes were independently associated with ever having had a dilated fundus exam and with having had an exam in the past year. Interpretation: Only 29% of diabetics had had an eye examination in the previous year. After the intervention this increased to 47% of those who had not been examined. In the short term we achieved a reasonable, albeit less than optimal, increase in use of eye care services among diabetic patients. It is essential that we continue to strive to find ways to improve eye care for diabetic patients in Africa to avoid an increase in visual impairment.

Keywords:

• Diabetic retinopathy
• Tanzania
• Screening