Delay Along the Care Seeking Journey of Patients with Microbial Keratitis in Uganda

Figures & data

Table 1. Baseline characteristics of direct versus indirect presenters (n = 313).

	Direct presenters (n = 58)			Indirect presenters (n = 255)
Variable	Median	(IQR)	(Total range)	Median	(IQR)	(Total range)	p value
Age	47	(35–60)	(18–96)	47	(35–60)	(18–87)	0.772
Distance to eye units	58	(16–85)	(0.2–244)	87	(57–131)	(2–378)	0.0001
Household population	5	(3–7)	(1–14)	7	(4–8)	(1–28)	0.006
Distance to nearest health centre in km*	2	(1–3)	(0–14)	3	(1–4)	(0–45)	0.174
Variable	Category	Count	(%)	Count	(%)		p value
Gender	Female	22	(38%)	117	(46%)		0.271
	Male	36	(62%)	138	(54%)
Occupation	Farmer	34	(59%)	186	(73%)		0.031
	Nonfarmer	24	(41%)	69	(27%)
Marital status	Unmarried Ɨ	18	(31%)	77	(30%)		0.900
	Married	40	(69%)	178	(70%)
Education status	None	15	(26%)	69	(27%)		0.407
	Primary	29	(50%)	133	(52%)
	Secondary	7	(12%)	38	(15%)
	Tertiary	7	(12%)	15	(6%)
Being head of household	Yes	42	(72%)	170	(67%)		0.398
	No	16	(28%)	85	(33%)
Needed an escort to hospital*	Yes	24	(41%)	49	(20)		<0.0001
	No	34	(59%)	202	(80)

*Variables with some missing data: distance to nearest health centre was measured in km (n = 312, [direct 57]) needed an escort (n = 309, [direct 58]). Ɨ Unmarried included single, divorced, and widowed,

Table 2. Clinical history and clinical signs of direct versus indirect presenters (n = 313).

	Direct presenters (n = 58)			Indirect presenters (n = 255)
Variable	Median	(IQR)	(Total range)	Median	(IQR)	(Total range)	p value
Presentation time in days*	8	(2–18)	(0–116)	17	(8–32)	(0–370)	<0.0001
Presenting vision (Log MAR)	0.65	(0.1–2.5)	(0–4)	1.3	(0.3–2.5)	(0–4)	0.072
Infiltrate size in mm Ɨ	4.2	(2.5–7.1)	(0.9–11)	5.5	(3.5–8)	(0.5–13)	0.025
Epithelial defect size in mm Ɨ	3.5	(1.8–5.8)	(0–11)	4.1	(2.5–6.9)	(0–13)	0.048
Variable	Category	Count	(%)	Count	(%)		p value
History of trauma (overall 29%) ǂ	Yes	14	(25%)	77	(30)		0.388
	No	43	(75)	177	(70)
Used traditional eye medicine (overall 61%)	Yes	27	(46)	161	(63)		0.020
	No	31	(53)	94	(37)
Pain being the main complaint	Yes	26	(45%)	112	44		0.121
	No	32	55	143	56
Opaque stromal opacity ǂ	Yes	25	(43)	107	(44)		0.918
	No	33	(57)	137	(56)
Hypopyon ǂ	Yes	13	(22)	81	(32)		0.151
	No	45	(78)	172	(68)
Perforated at admission	Yes	10	(17)	66	(26)		0.166
	No	48	(83)	189	(74)

*Presentation time was measured as duration in days it took to come to the eye hospital after onset of symptoms. Ɨ geometrical of the largest diameter and the diameter perpendicular to the largest diameter. ǂ variables that had less than 313 observations due to missing data (trauma n = 311 [direct57], opaque stromal opacity n = 302 [direct 58], hypopyon n = 311 [direct 58]).

Table 3. Univariable and multivariable logistic regression analysis of factors associated with direct presentation to the eye hospital (n = 309).

Variable	Univariable analysis			Multivariable analysis
	cOR	(95% CI)	p value	aOR	(95% CI)	p value
Age in years	1.004	(0.987–1.022)	0.576
Sex (being male)	1.38	(0.77–2.48)	0.273
Marital status (being married)	0.96	(0.52–1.78)	0.900
Occupation (being a farmer)	0.52	(0.29–0.94)	0.033
Being head of household	1.31	(0.69–2.46)	0.399
Number of people in household (increase/one person)	0.59	(0.38–0.90)	0.015	0.53	(0.32–0.85)	0.008
Distance to the eye hospital
0–50 km	1		0.001			0.003
50–100 km	0.52	(0.26–1.01)		0.62	(0.30–1.27)
100–150 km	0.16	(0.05–0.44)		0.16	(0.06–0.48)
>150 km	0.42	(0.17–1.03)		0.52	(0.19–1.34)
Distance from nearest health centre (increase per 1 km)	0.92	(0.822–1.029)	0.146
Positive history of trauma	0.74	(0.38–1.44)	0.389
Positive history of TEM Use	0.50	(0.28–0.90)	0.021	0.48	(0.25–0.90)	0.020
Education status
None	1		0.462
Primary	1.00	(0.50-1.99)
Secondary	0.84	(0.31–2.25)
Tertiary	2.14	(0.74–6.17)

*patients with missing data were dropped from the model. OR less than 1 means they were less likely to come directly to the eye hospital

Figure 1. A map of Uganda showing patients homes.

Figure 2. showing where patients first accessed treatment (n = 309).

Figure 3. The care seeking journey of patients with microbial keratitis and the time taken at each step (n = 276).

Table 4. Money spent by patients per number of facilities visited before coming to the eye hospital.

			Cost of care median (IQR) in Uganda Shillings*
Facility	n	(%)	Transportation		Consultation		Medicine		Total expenditure
0	58	(18.5%)	11,000	(4,000–20,000)	15,000	(0–15,000)	0	(0–27,000)	30,000	(7,000–63,000)
1	147	(52%)	19,500	(10,000–33,000)	15,000	(15,000–15,000)	19,800	(2,750–99,500)	52,000	(31,000–142,000)
2	58	(18.5%)	22,000	(15,000–37,000)	15,000	(0–15,000)	25,750	(6,000–80,000)	67,750	(34,250–142,500)
3	29	(9%)	30,000	(19,000–51,000)	15,000	(0-15,000)	28,500	(3,000–70,000)	78,250	(32,000–209,000)
4	6	(2%)	62,500	(33,000–143,000)	12,500	(10,000–30,000)	170,500	(78,000–343,500)	284,000	(118,000–439,500)
p value of test for trend									<0.0001

*All money is quoted in Uganda shillings. The US $ exchange rate was US $1: Uganda shillings 3,700 (2017). Ɨ0-direct presenters who did not visit any other facility before coming to the eye hospital. Patients with incomplete data were not included in this analysis

Table 5. Univariable and multivariable ordinal logistic regression analysis of factors associated with delay among patients with microbial keratitis (n = 309).

Variable	Univariable analysis			Multivariable analysis
	cOR	(95% CI)	p value	aOR	(95% CI)	p value
Age in years	1.009	(0.994–1.019)	0.140
Sex (being male)	1.06	(0.71–1.58)	0.792
Marital status (being married)	0.86	(0.55–1.33)	0.316
Occupation (being a farmer)	1.24	(0.80–1.93)	0.339
Being head of household	0.83	(0.54–1.27)	0.394
Number of people in household (increase/one person)	1.14	(0.85–1.51)	0.365
Distance to the eye hospital (every 10km increase)	1.036	(1.003–1.)	0.034
Distance from nearest health centre (increase per 1km)	1.01	(0.97–1.06)	0.501
Positive history of trauma	0.96	(0.62–1.49)	0.860
Positive history of TEM Use	1.73	(1.14–2.62)	0.010	1.58	(1.03–2.43)	0.038
Other facilities visited before eye hospital
Nil (direct presenters)	1		0.0002	1		0.001
One facility	2.95	(1.63–5.38)		2.74	(1.53–4.92)
Two facilities	3.62	(1.74–7.52)		2.58	(1.30–5.15)
Three facilities	4.12	(1.82–9.34)		3.26	(1.42–7.45)
Four facilities*	15.5	(2.65–90)		14.3	(2.45–83.7)

*two patients had visited five facilities and one patient six facilities, these were dropped from the analysis