Mumba Musonda, Hall Anthony, Lewallen Susan
Eye Department, Kilimanjaro Christian Medical Centre Hospital, Moshi, Tanzania.
Ophthalmic Epidemiol. 2007 Sep-Oct;14(5):306-10. doi: 10.1080/09286580701272079.
Sub-Saharan Africa faces an epidemic of diabetes with its attendant complications. Early treatment of diabetic retinopathy prevents visual impairment and blindness. However, very little has been done to establish diabetic retinopathy screening in Africa. We aimed to measure current use of the eye department by diabetics and the increase in eye examinations following education about diabetic eye disease by a dedicated nurse counselor and the offer of a free eye examination.
In a prospective study over 6 months we enrolled all diabetics over the age of 18 attending the diabetic clinic at KCMC. Data was collected on whether patients had had a previous dilated eye exam and whether they knew this was necessary. Education on diabetic eye disease and a referral form to the eye clinic for a free examination were given to the patient.
Three-hundred sixteen patients were enrolled in the study. 187 (59.1%) of the patients reported that they had undergone dilated fundus exam at some point since their diagnosis. 91 (28.8%) had undergone fundus examination within the past 12 months. Of the 316 patients, 114 (36%) came to the eye clinic with the referral form. 106 had not been examined in the last year. 65 of these had never been examined before. A logistic regression model demonstrated that knowledge that diabetes damages the eye (OR = 7.34, 95%CI = 4.66-11.57) and age (OR = 1.02, 95%CI = 1.01-1.03) but not duration of diabetes were independently associated with ever having had a dilated fundus exam and with having had an exam in the past year.
Only 29% of diabetics had had an eye examination in the previous year. After the intervention this increased to 47% of those who had not been examined. In the short term we achieved a reasonable, albeit less than optimal, increase in use of eye care services among diabetic patients. It is essential that we continue to strive to find ways to improve eye care for diabetic patients in Africa to avoid an increase in visual impairment.
撒哈拉以南非洲面临糖尿病及其相关并发症的流行。糖尿病视网膜病变的早期治疗可预防视力损害和失明。然而，在非洲，建立糖尿病视网膜病变筛查的工作做得很少。我们旨在衡量糖尿病患者目前对眼科的利用情况，以及在由一名专业护士顾问进行糖尿病眼病教育并提供免费眼部检查后，眼部检查的增加情况。
在一项为期6个月的前瞻性研究中，我们纳入了所有在基苏木基督教医疗中心糖尿病诊所就诊的18岁以上糖尿病患者。收集了患者是否曾接受过散瞳眼部检查以及他们是否知道有必要进行此项检查的数据。对患者进行了糖尿病眼病教育，并给了他们一张转诊至眼科诊所进行免费检查的表格。
316名患者参与了该研究。187名（59.1%）患者报告称，自确诊以来他们在某个时间点接受过散瞳眼底检查。91名（28.8%）患者在过去12个月内接受过眼底检查。在316名患者中，114名（36%）拿着转诊表格来到了眼科诊所。106名患者在过去一年中未接受过检查。其中65名患者此前从未接受过检查。一个逻辑回归模型表明，知晓糖尿病会损害眼睛（比值比=7.34，95%置信区间=4.66-11.57）和年龄（比值比=1.02，95%置信区间=1.01-1.03），但糖尿病病程与是否曾接受过散瞳眼底检查以及过去一年是否接受过检查并无独立关联。
仅29%的糖尿病患者在上一年接受过眼部检查。干预后，未接受过检查的患者中这一比例增至47%。短期内，我们在糖尿病患者中实现了对眼科护理服务利用的合理增加，尽管未达到最佳水平。我们必须继续努力寻找方法，改善非洲糖尿病患者的眼科护理，以避免视力损害增加。
