Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study

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dc.contributor.authorMtuya, Christina
dc.contributor.authorCleland, Charles R
dc.contributor.authorPhilippin, Heiko
dc.contributor.authorPaulo, Kidayi
dc.contributor.authorNjau, Bernard
dc.contributor.authorMakupa, William U
dc.contributor.authorHall, Claudette
dc.contributor.authorHall, Anthony
dc.contributor.authorCourtright, Paul
dc.contributor.authorMushi, Declare
dc.date.accessioned2021-10-08T06:54:45Z
dc.date.available2021-10-08T06:54:45Z
dc.date.issued2016
dc.description.abstractAbstract Background Diabetes is an emerging public health problem in sub-Saharan Africa. Diabetic retinopathy is the commonest microvascular complication of diabetes and is a leading cause of blindness, mainly in adults of working age. Follow-up is crucial to the effective management of diabetic retinopathy, however, follow-up rates are often poor in sub-Saharan Africa. The aim of this study was to assess the proportion of patients not presenting for follow-up and the reasons for poor follow-up of diabetic patients after screening for retinopathy in Kilimanjaro Region of Tanzania. Methods All diabetic patients referred to a tertiary ophthalmology hospital after screening for retinopathy in 2012 were eligible for inclusion in the study. A randomly selected group of patients from the community-based diabetic retinopathy screening register were identified; among this group, follow-up was assessed. Interviews were conducted within this group to inform on the reasons for poor follow-up. Results Among the 203 patients interviewed in the study 50 patients (24.6 %) attended the recommended referral appointment and 153 (75.4 %) did not. Financial reasons were self-reported by 35.3 % of those who did not attend the follow-up appointment as the reason for non-attendance. Multiple logistic regression analysis showed that the patient report of the clarity of the referral process (p = 0.014) and the patient report of whether a healthcare worker told the patient that diabetic retinopathy could be treated (p = 0.005) were independently associated with attendance at a follow-up appointment. Income per month was not associated with attendance at a follow-up appointment on multivariate analysis. Conclusions Financial factors are commonly cited as the reason for non-compliance with follow-up recommendations. However, the reasons for poor compliance are likely to be more complicated. This study highlights the importance of health system factors. Improving the clarity of the referral process and frequent reminders to patients that diabetic retinopathy can be treated are practical strategies that should be incorporated into screening programmes to increase attendance at subsequent follow-up appointments. The results from this study are applicable to other screening programmes as well as those for diabetic retinopathy.
dc.identifier.apacitationMtuya, C., Cleland, C. R., Philippin, H., Paulo, K., Njau, B., Makupa, W. U., ... Mushi, D. (2016). Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study. <i>BMC Ophthalmology</i>, 16(1), 174 - 177. http://hdl.handle.net/11427/34327en_ZA
dc.identifier.chicagocitationMtuya, Christina, Charles R Cleland, Heiko Philippin, Kidayi Paulo, Bernard Njau, William U Makupa, Claudette Hall, Anthony Hall, Paul Courtright, and Declare Mushi "Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study." <i>BMC Ophthalmology</i> 16, 1. (2016): 174 - 177. http://hdl.handle.net/11427/34327en_ZA
dc.identifier.citationMtuya, C., Cleland, C.R., Philippin, H., Paulo, K., Njau, B., Makupa, W.U., Hall, C. & Hall, A. et al. 2016. Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study. <i>BMC Ophthalmology.</i> 16(1):174 - 177. http://hdl.handle.net/11427/34327en_ZA
dc.identifier.issn1471-2415
dc.identifier.ris TY - Journal Article AU - Mtuya, Christina AU - Cleland, Charles R AU - Philippin, Heiko AU - Paulo, Kidayi AU - Njau, Bernard AU - Makupa, William U AU - Hall, Claudette AU - Hall, Anthony AU - Courtright, Paul AU - Mushi, Declare AB - Abstract Background Diabetes is an emerging public health problem in sub-Saharan Africa. Diabetic retinopathy is the commonest microvascular complication of diabetes and is a leading cause of blindness, mainly in adults of working age. Follow-up is crucial to the effective management of diabetic retinopathy, however, follow-up rates are often poor in sub-Saharan Africa. The aim of this study was to assess the proportion of patients not presenting for follow-up and the reasons for poor follow-up of diabetic patients after screening for retinopathy in Kilimanjaro Region of Tanzania. Methods All diabetic patients referred to a tertiary ophthalmology hospital after screening for retinopathy in 2012 were eligible for inclusion in the study. A randomly selected group of patients from the community-based diabetic retinopathy screening register were identified; among this group, follow-up was assessed. Interviews were conducted within this group to inform on the reasons for poor follow-up. Results Among the 203 patients interviewed in the study 50 patients (24.6 %) attended the recommended referral appointment and 153 (75.4 %) did not. Financial reasons were self-reported by 35.3 % of those who did not attend the follow-up appointment as the reason for non-attendance. Multiple logistic regression analysis showed that the patient report of the clarity of the referral process (p = 0.014) and the patient report of whether a healthcare worker told the patient that diabetic retinopathy could be treated (p = 0.005) were independently associated with attendance at a follow-up appointment. Income per month was not associated with attendance at a follow-up appointment on multivariate analysis. Conclusions Financial factors are commonly cited as the reason for non-compliance with follow-up recommendations. However, the reasons for poor compliance are likely to be more complicated. This study highlights the importance of health system factors. Improving the clarity of the referral process and frequent reminders to patients that diabetic retinopathy can be treated are practical strategies that should be incorporated into screening programmes to increase attendance at subsequent follow-up appointments. The results from this study are applicable to other screening programmes as well as those for diabetic retinopathy. DA - 2016 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Ophthalmology LK - https://open.uct.ac.za PY - 2016 SM - 1471-2415 T1 - Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study TI - Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study UR - http://hdl.handle.net/11427/34327 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34327
dc.identifier.vancouvercitationMtuya C, Cleland CR, Philippin H, Paulo K, Njau B, Makupa WU, et al. Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study. BMC Ophthalmology. 2016;16(1):174 - 177. http://hdl.handle.net/11427/34327.en_ZA
dc.language.isoeng
dc.publisher.departmentDivision of Ophthalmology
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Ophthalmology
dc.source.journalissue1
dc.source.journalvolume16
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12886-016-0288-z
dc.subject.otherAfrica
dc.subject.otherDiabetic retinopathy
dc.subject.otherFollow-up
dc.subject.otherScreening
dc.subject.otherAdult
dc.subject.otherAftercare
dc.subject.otherAged
dc.subject.otherAged, 80 and over
dc.subject.otherAttitude to Health
dc.subject.otherCross-Sectional Studies
dc.subject.otherDiabetic Retinopathy
dc.subject.otherFemale
dc.subject.otherHealth Services Accessibility
dc.subject.otherHumans
dc.subject.otherInsurance, Health
dc.subject.otherLogistic Models
dc.subject.otherMale
dc.subject.otherMass Screening
dc.subject.otherMiddle Aged
dc.subject.otherPatient Compliance
dc.subject.otherSocioeconomic Factors
dc.titleReasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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