Risk factors for late presentation among glaucoma patients attending three referral hospitals in South-East Nigeria: case–control study

Abstract

Late presentation in glaucoma has been associated with rapid deterioration of visual fields and blindness even with good and effective treatment options. Glaucoma prevalence and risk of blindness is higher among the Igbo tribe, who dominate the Eastern part of Nigeria, hence the focus of this study in this area to determine modifiable risks for late presentation in glaucoma. This was an observational, hospital-based, comparative study at three tertiary hospitals. All eligible, consenting participants were examined and researcher-recorded questionnaire administered. Data was entered, validated and imported into Stata version 15.0; appropriate descriptive measures of central tendencies were presented with tables and maps. Univariate, multiple logistic regression and pairwise correlation analysis identified statistically significant risks at p-value of <0.05. 303 participants were enrolled with a mean (SD) age of 56.58 (15.63) years. The adjusted odds of presenting late were found to be 57% lower among females (CI 0.27 to 0.69), 1.73 times higher with each year increase (CI 1.42 to 2.11) and 2.31 times among hypertensives (CI 1.39 to 3.85). There were reduced adjusted odds ratio; 0.55 for participants living in urban areas compared to rural (p 0.02) and 0.52 for those who have heard about glaucoma prior to diagnosis (p 0.01). Increasing age, male sex, rural and non-awareness of glaucoma are identified risk for late presentation. Community-based health promotion activities can be explored to bridge this gap through targeted and cost-effective approaches involving existing health-care delivery systems.

Keywords:

• Glaucoma
• Igbo
• late presentation
• risk factors

PUBLIC INTEREST STATEMENT

Glaucoma is the leading cause of irreversible blindness worldwide; it occurs more, runs an aggressive course and difficult to treat among blacks. Glaucoma is undiagnosed in as high as 94% of cases in low-resource settings such as Africa. Unfortunately, screening activities are not recommended at a population level because of lack of a single screening or cost-effective treatment modality. Late presentation is a recurring feature in glaucoma as it presents little or no symptoms in the early stage and is referred to as “a silent thief of sight”. The impact of presenting late in glaucoma leads to poorer outcome even with the most effective treatment, therefore it seems profitable to present early. Improved technology in diagnosis and glaucoma surveillance favors early presentation in the west, whereas in developing countries, unfavourable factors include poor access to services, lack of awareness, low level of education and poor health seeking behaviour. Individuals above 50 years, male, rural dwellers as well as hypertensives will benefit from regular eye check for glaucoma.

Acknowledgements

• My sponsors

  • Commonwealth Shared Scholarship Commission

  • Commonwealth Eye Health Consortium

  • Queen Elizabeth Diamond Jubilee Trust

  • International Students House

• The School

  • The International Centre for Eye health staff

  • Romulo Fabunan, the Students and Alumni engagement staff

  • Proposal review panel led by Prof Allen Foster

  • London School of Hygiene & Tropical Medicine

For facilitating the process and providing the enabling platform for learning

• Academic supportMy supervisor, statisticians, trainers and mentors who guided me through the principles that supported this work;

• Local support

The study hospitals management, heads of department, consultants and members of the ophthalmic team in Nigeria

Notes on contributor

The project was carried out by research team made of ophthalmologists, research assistants, data scientist/statistician as part of an MSc in public health for eye care dissertation, led by the principal investigator Onyinye Onyia Dr. My research interest is in health prevention and promotion for glaucoma, microbial keratitis, school/child eye health and immunization preventive eye conditions. This research provides results that feeds a broader aim of identifying key areas and modalities that will improve the implementation of an effective and efficient primary eye service delivery by engaging locally sourced human resources within the communities in low-resource settings.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Criteria for inclusion in the authors list

All authors were involved in all stages of the research; proposal design, revision, data collection, data analysis, and interpretation as well as manuscript preparation.

g) I hereby affirm that this manuscript has been read and approved by all the authors, the requirements for authorship according to the journal’s regulations have been met, and that each author believes that the manuscript represents honest work.

Additional information

Funding

This work was supported by the Commonwealth Scholarship Commission [NG 2018 163]; London School of Hygiene and Tropical Medicine [LSH1802128]. Grant towards project from Commonwealth Scholarship Commission and International Centre for Eye Health and LSHTM trust fund for travel – LSH1802128.

Notes on contributors

Onyinye Onyia

Onyinye Onyia. BSc. Parasitology and Entomology (Nnamdi Azikiwe University 2000), MBBS (University of Nigeria 2008), Fellow Medical College of Nigeria Ophthalmology (FMCOph 2017), Fellow West African College of Surgeons (FWACS 2018), MSc. Public Health for Eye Care (London School of Hygiene and Tropical Medicine 2019), Scholar, PhD Public Health (Health System Management), World bank African Centre of Excellence for Public Health and Toxicology Research (ACEPUTOR) University of Port-Harcourt, Rivers State 2020 till date.