Eye Care Service Use and Its Determinants in Marginalized Communities in Pakistan: The Karachi Marine Fishing Communities Eye and General Health Survey

ABSTRACT

Purpose: To examine gender, ethnic, and socioeconomic differences in access to eye care services in marine fishing communities in Karachi, Pakistan.

Methods: The Karachi Marine Fishing Communities Eye and General Health Survey was a door-to-door, cross-sectional survey conducted between March 2009 and April 2010 in fishing communities in Keamari, Karachi, located on the coast of the Arabian Sea. Adults aged ≥50 years living on three islands and in four coastal areas were enrolled. Participants underwent a detailed interview regarding sociodemographics, eye problems and eye care service use, testing of presenting and best-corrected visual acuity with a reduced logMAR chart, and detailed eye examination.

Results: A total of 700 people were planned to be included in the study; 638 (91.1%) were interviewed and examined. Most participants were extremely poor and had no formal education. Only 45.3% (95% confidence interval, CI, 41.4–49.2%) of participants reported having had an eye examination in the past; 12.1% (95% CI 9.5–14.6%) and 30.9% (95% CI 27.3–34.5%) had seen an eye doctor within the last year or prior 5 years, respectively. In the multivariable analysis, ethnicity was the strongest independent predictor of eye care service use, followed by self-reported eye problems and diabetes. Ethnic Bengalis were 4.2 times less likely (adjusted odds ratio 0.24, 95% CI 0.15–0.38; p < 0.001) to have had an eye examination in the past than Kutchis.

Conclusions: Despite a high prevalence of visual impairment and blindness, levels of eye care examinations in fishing communities, especially among ethnic Bengalis, are disappointingly low. Such communities deserve particular attention in Vision 2020 and other national and international strategies and plans.

• Access
• equity
• eye care
• fishing communities
• health disparities
• inequalities
• marginalized groups
• Vision 2020
• visual impairment

Acknowledgments

This research was undertaken as part of a PhD study by the first author under the primary supervision of Professor Anthony B. Zwi and Professor Daniel J. M. Tarantola.

The authors would like to acknowledge the invaluable support of The Fred Hollows Foundation (FHF), Australia.

Special thanks to Rashin Choudhry, Michael Johnson, Rubina Gillani, Virginia Sarah, and Brian Doolan of FHF.

We would also like to thank all study participants who gave their valuable time. We acknowledge, in particular, our survey team members Adeel Sarfaraz, Faraz Ahmed, Munawar Ali, Abid Butt, Abdul Qadeem Soomro, Amna Kutchi, Humaira Kutchi, Fawad Umer, Samana Zaidi, Heena Ali, Younus Kutchi and Hanif Kutchi for their contributions across different stages of the survey. We also acknowledge Iqbal Adamjee, Ashraf Adamjee and Jamshaid Khan of Adamjee Eye Hospital/Adamjee Foundation, Karachi, for their generous support for the treatment of participants and many others in these communities in whom eye disease was diagnosed. Zahid Jadoon, Ebrahim Hasan Khan, Bal Chand, and Saleh Memon also deserve special mention for their great support.

The first author would also like to thank the Aga Khan University, Karachi, for providing him with the space and support to complete this work, in particular the following: Tanveer Chaudhry, Azam Ali, Asad Jamil Raja, Farhat Abbas, Amanullah Memon, Mohammad Khurshid and Sean Victor. We would also like to thank the two anonymous reviewers for their helpful comments.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This work was funded through a scholarship grant to the first author from The Fred Hollows Foundation, Australia.