Gender bias within a diabetic retinopathy screening programme in Tanzania

BACKGROUND: The Kilimanjaro Diabetic Programme has been running since 2010 and screens persons with diabetes for diabetic retinopathy (DR). It was noted that women were less likely to attend follow-up appointments compared to men. The aim of this study was to explore gender biases amongst persons registered with the screening programme. METHODS: A prospective mixed-methods study was carried out using a questionnaire of closed-ended questions and a semi-structured interview guide. RESULTS: Of the 300 participants included in the quantitative component of the study, 193 (64.3%) were female and 107 (35.7%) were male. Females were significantly less educated (p < 0.001) and self-reported as less likely to attend the tertiary hospital if referred (p = 0.022). Of the married participants, on multivariate analysis, men were significantly more likely to make both financial decisions in the household (p = 0.001) and to decide if, and when, family members should attend hospital compared to women (p = 0.0048), independent of age, education level and whether they were from an urban or rural area. Qualitative analysis of the 33 interviews revealed a good understanding of the threat to vision from DR, but limited appreciation of disease chronicity. A common theme was that men are regarded as the head of the household and therefore make the financial decisions; this was especially true in less educated families. CONCLUSION: As screening and treatment facilities for DR are developed in SSA, it is important that strategies are employed to reduce the burden of blindness and visual impairment from the under-utilisation of diabetic eye care services by women.