Eye care utilization pattern in South Africa: results from SANHANES-1

BACKGROUND: Eye examinations are recommended for all persons throughout life. However, there is disparity in the uptake of eye care services in different populations. Using data from a nationally representative population-based cross-sectional study (the South African National Health and Nutrition Examination Survey, [SANHANES-1]), this paper investigates the utilization of eye care services and its associated factors in South Africa. METHODS: Participants aged 15 years and older who participated in interviews and clinical examination were enrolled in the SANHANES from 2011 to 2012. Eye care utilization was assessed from participants’ responses to whether they had their eyes examined by a medical professional and when they were last examined. Data were analysed using multiple logistic regression models employing a hierarchical approach to add predisposing (e.g. age, sex), enabling (e.g. health insurance) and need (e.g. hypertension) factors sequentially. RESULTS: The study sampled 3320 participants, with 64.9% being females. 73.4% (95% CI [69.7–76.7]) of participants had never had an eye examination. After statistical adjustment, age groups (compared with 15–29 years: 30-44 years Odds Ratio [OR] = 1.76; 45-59 years OR = 2.13; 60-74 years OR = 2.74; ≥75 years OR = 3.22), ethnicity (compared with African descent: white OR = 4.71; mixed-race OR = 1.87; Indian OR = 7.67), high risk alcohol use (OR = 1.83), wealth index (compared with lowest quintile: third quintile OR = 1.75; fourth quintile OR = 2.23; fifth quintile OR = 2.49), health insurance (OR = 2.19), diabetes (OR = 1.75), high cholesterol (OR = 2.51), having assessed healthcare in the past 5 years (OR = 2.42), and self-reported vision problems (OR = 1.51) were significantly associated with eye care utilization. CONCLUSION: Almost three-quarters of South Africans sampled were not utilizing eye care services. It is imperative to strengthen current public health measures (including eye health promotion programs) to address the alarmingly low uptake of eye care services as well as the disparities in eye care utilization in South Africa.