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Effectiveness of community outreach screening for glaucoma in improving equity and access to eye care in Nigeria
  1. Olusola Oluyinka Olawoye1,2,
  2. Olufunmilayo Fawole3,
  3. Adeyinka O Ashaye1,
  4. Ving Fai Chan2,
  5. Augusto Azuara-Blanco2,
  6. Nathan Congdon2,4,5
  1. 1 Department of Ophthalmology, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
  2. 2 Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
  3. 3 Department of Epidemiology and Medical Biostatistics, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
  4. 4 Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangdong, China
  5. 5 Orbis International, New York, New York, USA
  1. Correspondence to Dr Olusola Oluyinka Olawoye, Department of Ophthalmology, University of Ibadan College of Medicine, Ibadan 200004, Oyo, Nigeria; solaolawoye{at}yahoo.com

Abstract

Purpose To determine the effectiveness of community outreach screening for glaucoma in improving equity and access to eye care in Nigeria.

Methodology This was a prospective study in which two cohort of participants were recruited in Nigeria: 1 from 24 outreach screenings and another from consecutive patients presenting spontaneously to a tertiary eye clinic in Nigeria. Sociodemographic and clinical data were obtained from participants and compared.

Results Our sample consisted of 120 patients with glaucoma or suspected glaucoma (6.38% of 1881 screenees) recruited from the 24 outreach screenings, and another 123 patients with glaucoma who presented spontaneously at the eye clinic. Participants from the screenings were significantly older (p=0.012), less educated (p<0.001), had lower incomes (p<0.001), lower glaucoma knowledge scores and were less aware of their glaucoma (both p<0.001) and were more likely to be dependent on relations and children (p=0.002) compared with clinic participants. Of the 120 patients identified at the screenings and referred to the clinic for definitive care, 39 (32.5%) presented at the clinic within 3 months. Reasons for poor uptake of referral services were lack of a felt need and lack of money for transportation. Considering only patients who accepted referral, they were still less educated (p<0.001), poorer (p=0.001) and less knowledgeable about glaucoma (p=0.003) than spontaneous clinic presenters.

Conclusion Outreach screening improved equity of access but its effects were somewhat reduced by poor uptake of referral care. Interventions such as free transportation and educational efforts may improve the uptake of referral services and maximise equity gains.

  • glaucoma
  • epidemiology

Data availability statement

Data are available on reasonable request. Data are deidentified participant data from patients at outreach screenings and patients presenting to the glaucoma clinic of the University College Hospital Ibadan during the period of the study.

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Data availability statement

Data are available on reasonable request. Data are deidentified participant data from patients at outreach screenings and patients presenting to the glaucoma clinic of the University College Hospital Ibadan during the period of the study.

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Footnotes

  • Contributors OOO, OF and AOA conceived and designed the study. NC, AA-B, VC, OOO, OF and AOA played a critical role in the drafting, organisation, analysis and interpretation of data, designing and writing of the manuscript.

  • Funding This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand, South Africa and is funded by Sida (Grant No: 54100113), Carnegie Corporation of New York (Grant No. G-19-57145), the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) Grant number 087547/Z/08/Z and the UK government. OOO is a CARTA fellow.

  • Disclaimer The statements made and the views expressed are solely those of the authors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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