Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
Kenya Medical Research Institute, Nairobi, Kenya.
Int J Equity Health. 2024 Aug 26;23(1):170. doi: 10.1186/s12939-024-02244-x.
Over 80% of blindness in Kenya is due to curable or preventable causes and 7.5 m Kenyans currently need eye services. Embedding sociodemographic data collection into screening programmes could help identify the groups facing systematic barriers to care. We aimed to determine the sociodemographic characteristics that were associated with access among patients diagnosed with an eye problem and referred for treatment in the Vision Impact Programme, currently operating in Meru County.
We used an embedded, pragmatic, cross-sectional design. A list of sociodemographic questions was developed with input from key stakeholders. The final question set included the following domains: age, gender, religion, marital status, disability, education, occupation, income, housing, assets, and health insurance. These were integrated into an app that is used to screen, refer, and check-in (register) participants within a major eye screening programme. We gathered data from 4,240 people who screened positive and were referred to their local outreach treatment clinic. We used logistic regression to identify which groups were facing the greatest barriers to accessing care.
A quarter of those screened between April - July 2023 were found to have an eye problem and were referred, however only 46% of these people were able to access care. In our fully adjusted model, at the 0.05 level there were no statistically significant differences in the odds of attendance within the domains of disability, health insurance, housing, income, or religion. Strong evidence (p < 0.001) was found of an association between access and age, gender, and occupation; with males, younger adults, and those working in sales, services and manual jobs the least likely to receive care.
Access to essential eye services is low and unequal in Meru, with less than a third of those aged 18-44 receiving the care they need. Future work should explore the specific barriers faced by this group.
在肯尼亚，超过 80%的失明是由可治愈或可预防的原因造成的，目前有 750 万肯尼亚人需要眼部护理服务。将社会人口统计学数据收集纳入筛查项目可以帮助确定面临系统护理障碍的群体。我们的目的是确定与在梅鲁县开展的视觉影响项目中被诊断出眼部问题并转诊接受治疗的患者获得治疗机会相关的社会人口学特征。
我们采用嵌入式、实用、横断面设计。在关键利益攸关方的投入下，制定了一份社会人口学问题清单。最终的问题集包括以下领域：年龄、性别、宗教、婚姻状况、残疾、教育、职业、收入、住房、资产和医疗保险。这些问题被整合到一个应用程序中，该应用程序用于在一个主要的眼部筛查项目中对参与者进行筛查、转诊和登记（注册）。我们从 4240 名筛查呈阳性并被转诊到当地外展治疗诊所的人中收集了数据。我们使用逻辑回归来确定哪些群体在获得护理方面面临最大的障碍。
2023 年 4 月至 7 月期间，有四分之一的筛查者被发现有眼部问题并被转诊，但只有 46%的人能够获得治疗。在我们完全调整的模型中，在残疾、医疗保险、住房、收入或宗教领域，在就诊几率方面没有统计学上的显著差异。有强有力的证据（p<0.001）表明，就诊几率与年龄、性别和职业之间存在关联；男性、年轻成年人以及从事销售、服务和体力劳动的人最不可能获得治疗。
在梅鲁，获得基本眼部护理服务的机会较低且不平等，年龄在 18-44 岁之间的人中，不到三分之一的人获得了所需的护理。未来的工作应该探讨这一群体所面临的具体障碍。
