Curran Katie, Ahmed Munir, Sultana Mirza Manbira, Moutari Salissou, Hossain Mohammad Awlad, Cushley Laura, Peto Tunde, Husain Lutful, Zabeen Bedowra, Congdon Nathan
Faculty of Medicine Health and Life Sciences, Queen's University Belfast, Great Britain and Northern Ireland, Belfast, UK.
Orbis International, Dhaka, Bangladesh.
Clin Diabetes Endocrinol. 2024 Dec 4;10(1):41. doi: 10.1186/s40842-024-00208-2.
Effective diabetic retinopathy screening (DRS) programmes are important in preventing vision impairment and blindness caused by diabetes. This study focuses on identifying the factors affecting attendance or non-adherence to DRS among children and young adults with diabetes mellitus (DM) in Bangladesh.
A mixed-methods approach was used, which included patients diagnosed with DM aged 12-26 years from Bangladesh who were registered at BIRDEM Women and Children hospital in Dhaka. Data collection occurred between July 2019 and July 2020, mainly through telephone and email due to restrictions imposed by the COVID-19 pandemic. Statistical analyses, including chi-squared tests, t-tests, and logistic regression, were used to assess the demographic and clinical factors influencing attendance at DRS.
The study reported a high 88% attendance rate for DRS among children and young adults in Bangladesh. However, some barriers to attendance were identified. Children under 15 years of age showed a higher tendency to attend their last DRS appointment when compared to older age participants (16-26 years), P < 0.05. Male participants demonstrated a lower likelihood of attending their DRS appointments than females (OR 0.29, CI: 0.17 to 0.50), P < 0.001. Additionally, participants with higher HbA1c levels (mean 9.1%, IQR 2.5) attended their last DRS appointment compared to those with lower levels (mean 8.0%) (p < 0.05). The primary barriers leading to missed DRS appointments were distance to the hospital (15, 31.9%), financial limitations (19, 40.4%), and busy schedules (14, 29.8%).
Compliance with DRS was high in this setting especially among younger patients, females, and those with higher HbA1c levels, highlighting the effectiveness of current DRS initiatives in Bangladesh. Addressing barriers such as cost, service accessibility and transportation could improve attendance rates further, and strategies such as flexible scheduling, transport subsidies, telemedicine, and use of artificial intelligence may help overcome these challenges.
有效的糖尿病视网膜病变筛查（DRS）项目对于预防糖尿病导致的视力损害和失明至关重要。本研究聚焦于确定影响孟加拉国糖尿病（DM）儿童和青年参加或不坚持DRS的因素。
采用混合方法，研究对象包括来自孟加拉国、年龄在12 - 26岁且在达卡的BIRDEM妇女儿童医院登记的DM患者。由于COVID - 19大流行带来的限制，数据收集于2019年7月至2020年7月期间主要通过电话和电子邮件进行。使用包括卡方检验、t检验和逻辑回归在内的统计分析来评估影响DRS参与率的人口统计学和临床因素。
该研究报告称，孟加拉国儿童和青年的DRS参与率高达88%。然而，也发现了一些参与障碍。与年龄较大的参与者（16 - 26岁）相比，15岁以下儿童参加上一次DRS预约的倾向更高，P < 0.05。男性参与者参加DRS预约的可能性低于女性（OR 0.29，CI：0.17至0.50），P < 0.001。此外，糖化血红蛋白（HbA1c）水平较高（平均9.1%，四分位距2.5）的参与者与水平较低（平均8.0%）的参与者相比，参加了上一次DRS预约（p < 0.05）。导致错过DRS预约的主要障碍是距离医院远（15例，31.9%）、经济限制（19例，40.4%）和日程繁忙（14例，29.8%）。
在这种情况下，对DRS的依从性较高，特别是在年轻患者、女性以及HbA1c水平较高的患者中，这凸显了孟加拉国当前DRS举措的有效性。解决成本、服务可及性和交通等障碍可以进一步提高参与率，灵活排班、交通补贴、远程医疗和使用人工智能等策略可能有助于克服这些挑战。
