The prevalence and determinants of diabetic retinopathy in Botswana: Findings from a screening programme

Master Thesis


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University of Cape Town

Background: The International Diabetes Federation estimates that the number of adults with diabetes in Africa will increase by 98% by the year 2030. The importance of diabetic retinopathy as a cause of blindness has increased because of longevity and a decline in the other preventable causes of blindness in developing countries. Retinopathy diagnosed early, followed closely, and treated timeously with retinal laser therapy, prevents blinding retinopathy. The objective of the study is to determine the prevalence of Diabetic Retinopathy, its determinants and the acceptability as well as accessibility of the screening service by patients. Methods: The study is a cross-sectional study conducted at Gaborone diabetic retinopathy screening clinic. Convenience sampling was used where every eligible patient that arrived for DR screening and had consented was included in the study. Basic descriptive statistics of the study sample were reported and a multivariate analysis was performed with DR as the outcome of interest. Results: A total of 220 participants attended the clinic between 12th of January and 6th of February 2015. The mean age of the participants was 55.96 (p=0.32) years and females comprised the majority 65.45% (n= 144, p=0.33)) of participants. A fifth of the participants (n=43, p=0.67) felt they had poor knowledge of diabetes and 25.91% (n=57, p=0.96) stated they did not understand the purpose of screening. Only 63.64% (n=140, p=0.46) reported to always being compliant with their medication and compliance did not differ significantly between those who had retinopathy and those who did not. Traditional medicine use was reported in 16.36% of the participants (n=36, p=0.33). Diabetic Retinopathy was found in 31.82% (n=70) of the population and of those, 3 participants (1.36%) had referable DR. Maculopathy was found in 21.82% (n=48) of participants. Increasing household number and years living with DM were the only variables found to have a significant association with development of diabetic retinopathy. Conclusion: The prevalence of diabetic retinopathy has increased in our population compared to previous studies. The number of Diabetics attending the DR screening service in Gaborone has also increased but continuous diabetes health education cannot be over emphasized. Incorporation of local cultural values into the overall management of the disease is the best way to increase patient compliance.