Diabetic retinopathy screening in Calabar, Nigeria: Factors influencing referrals and uptake of screening service

Abstract

Context: Regular eye screening of people with diabetes is highly recommended globally to prevent avoidable blindness. Aims: To determine the frequency of referral, factors affecting referral and uptake of patients with diabetes in Calabar for the Calabar diabetes retinopathy screening service. Settings and Design: Cross-sectional descriptive study conducted among physicians in Calabar, Nigeria in the month of May 2016. Materials and Methods: A self-administered questionnaire was given to 97 physicians practicing in Calabar. This assessed their knowledge of the Calabar diabetic retinopathy (DR) screening service, referral pattern, and factors that affect referral behavior. Statistical Analysis Used: Statistical Package for Social Sciences version 24.0 software (SPSS Inc., IBM SPSS, IBM Corp, Armonk, NY, USA). Results: Regarding awareness, 57% of physicians knew of the DR screening service at the Calabar Teaching Hospital but only 41% sometimes referred patients to the center. There was a significant relationship ( P = 0.000) among location of practice, awareness of DR service at University of Calabar Teaching Hospital, and frequency of referral. Only 57% of the physicians felt that it was important to refer patients for screening; in spite of that, 40% of the physicians did not refer due to lack of awareness of the service. Barriers to the uptake of referral were long waiting time (58%), financial cost (44%), and availability of service (42%). Conclusion: Many physicians in this study did not refer patients with diabetes to avail the free Calabar DR screening service, although those physicians were aware of the importance of screening. Their reasons for lack of referral and uptake of service were lack of awareness of the service, perceived long waiting times, and erroneously imagined cost implications to patients, although the services have been actually free.