King's College London, London, WC2R 2LS, UK.
College of Medicine and Allied Health Sciences, Connaught Government Teaching Hospital, Freetown, Sierra Leone.
Int Ophthalmol. 2022 Nov;42(11):3479-3493. doi: 10.1007/s10792-022-02347-w. Epub 2022 May 13.
Glaucoma is a significant cause of blindness worldwide. It is more common, presents earlier and is more aggressive in those of African descent. Non-adherence and poor knowledge of glaucoma is a significant barrier to treatment and has been associated with low health literacy. We aim to establish the factors contributing to late presentation, treatment non-adherence and disease progression in glaucoma patients in Sierra Leone. This will help better understand the challenges eye services face, highlight fields requiring development in patient-clinician interaction and identify areas or specific vulnerable patient groups in which resources should be focused.
Prospective, consecutive recruitment of 120 patients with POAG attending the Lowell and Ruth Gess Eye Hospital and the Connaught Government Teaching Hospital, Freetown, Sierra Leone between February and April 2020. Data were collected from 3 sources: (1) review of clinical notes since first attendance, (2) semi-structured interviews and (3) assessment of study participant's drop instillation technique using a structured checklist. Descriptive statistics was performed for demographic data and other relevant data points. Logistic regression was used for analysis of target variables.
The average age was 62 years with more males (52.6%). Agricultural workers and informal street traders represented 13.2% of participants' occupation. 25.8% of participants had no formal school, and 47.4% had either a degree or a diploma. This is out of proportion with the general population and may represent a hidden demographic of glaucoma patients. Drop instillation technique was successful in 52% of study participants. Notable responses to the questionnaire were 30% of patients did not know the name of their eye condition and 22% had no knowledge of glaucoma.
Investment in a wide-ranging and robust screening programme and public health campaigns targeting these vulnerable groups and high-risk individuals, for example with a positive family history, alongside improved patient education and staff training is required to improve glaucoma care. Support from government, international organisations and the private sector is required to reduce the economic burden of blindness in Sierra Leone.
青光眼是全球范围内导致失明的主要原因之一。在非洲裔人群中，青光眼更为常见、发病更早且更具侵袭性。对青光眼的不遵医嘱和知识匮乏是治疗的重大障碍，且与低健康素养相关。我们旨在确定导致青光眼患者就诊延迟、治疗不依从和疾病进展的因素。这将有助于更好地了解眼保健服务所面临的挑战，突出医患互动中需要发展的领域，并确定资源应集中的特定领域或弱势群体。
2020 年 2 月至 4 月，前瞻性连续招募了 120 名在洛厄尔和露丝·盖斯眼科医院以及弗里敦的康诺特政府教学医院就诊的 POAG 患者。数据来自 3 个来源：（1）自首次就诊以来的临床记录审查，（2）半结构式访谈，以及（3）使用结构化清单评估研究参与者滴眼技术。对人口统计学数据和其他相关数据点进行描述性统计。使用逻辑回归分析目标变量。
平均年龄为 62 岁，男性占 52.6%。农业工人和非正规街头小贩占参与者职业的 13.2%。25.8%的参与者没有接受过正规学校教育，47.4%的参与者拥有学位或证书。这与总人口不成比例，可能代表了青光眼患者的一个隐藏群体。滴眼技术在 52%的研究参与者中成功。问卷调查中的显著反应是，30%的患者不知道他们的眼病名称，22%的患者不知道青光眼。
需要投资广泛而强大的筛查计划和公共卫生宣传活动，针对这些弱势群体和高危人群，例如有阳性家族史的人群，并加强患者教育和员工培训，以改善青光眼护理。需要政府、国际组织和私营部门的支持，以减轻塞拉利昂失明的经济负担。
