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

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...

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Autores principales: Mtuya, Christina, Cleland, Charles R., Philippin, Heiko, Paulo, Kidayi, Njau, Bernard, Makupa, William U., Hall, Claudette, Hall, Anthony, Courtright, Paul, Mushi, Declare
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950081/
https://www.ncbi.nlm.nih.gov/pubmed/27435362
http://dx.doi.org/10.1186/s12886-016-0288-z
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author Mtuya, Christina
Cleland, Charles R.
Philippin, Heiko
Paulo, Kidayi
Njau, Bernard
Makupa, William U.
Hall, Claudette
Hall, Anthony
Courtright, Paul
Mushi, Declare
author_facet Mtuya, Christina
Cleland, Charles R.
Philippin, Heiko
Paulo, Kidayi
Njau, Bernard
Makupa, William U.
Hall, Claudette
Hall, Anthony
Courtright, Paul
Mushi, Declare
author_sort Mtuya, Christina
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12886-016-0288-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-49500812016-07-20 Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study Mtuya, Christina Cleland, Charles R. Philippin, Heiko Paulo, Kidayi Njau, Bernard Makupa, William U. Hall, Claudette Hall, Anthony Courtright, Paul Mushi, Declare BMC Ophthalmol Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12886-016-0288-z) contains supplementary material, which is available to authorized users. BioMed Central 2016-07-19 /pmc/articles/PMC4950081/ /pubmed/27435362 http://dx.doi.org/10.1186/s12886-016-0288-z Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Mtuya, Christina
Cleland, Charles R.
Philippin, Heiko
Paulo, Kidayi
Njau, Bernard
Makupa, William U.
Hall, Claudette
Hall, Anthony
Courtright, Paul
Mushi, Declare
Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study
title Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study
title_full Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study
title_fullStr Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study
title_full_unstemmed Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study
title_short Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study
title_sort reasons for poor follow-up of diabetic retinopathy patients after screening in tanzania: a cross-sectional study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950081/
https://www.ncbi.nlm.nih.gov/pubmed/27435362
http://dx.doi.org/10.1186/s12886-016-0288-z
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