Factors influencing non-attendance to scheduled eye surgery in rural Swaziland

Alexander J.S Norris,Caroline E Norris

doi:10.4102/aveh.v78i1.490

Alexander J.S Norris, Caroline E Norris

Open Access

https://doi.org/10.4102/aveh.v78i1.490

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Abstract

Background: Blindness in low-income countries has significant negative impacts on patients and their communities. The World Health Organization’s ‘Vision 2020’ target requires increased numbers of ophthalmic surgeries targeting avoidable blindness to overcome this. There have been studies on barriers preventing uptake of surgical services; however, no such study has been conducted in Swaziland, sub-Saharan Africa. Aim: To investigate factors influencing disengagement with surgical services, specifically non-attendance to scheduled eye surgery in the low-income setting. Setting: Rural ophthalmology department, Good Shepherd Hospital, Siteki, Swaziland. Methods: A retrospective observational study using a structured questionnaire after literature review. A list of non-attending patients was generated from a 6-month period in the ophthalmology department of the hospital. Telephone interviews were used to collect data. Results: The average attendance of 311 patients over 21 lists was 86.8% (standard deviation [SD] ±10.37). Of the 41 non-attending patients, 23 (56.1%) consented to take part in the study. The reasons given for not attending included expense of the procedure (52.2%), forgetfulness (17.4%), fear (8.7%), illness (8.7%), belief that surgery was not required (4.3%) and bereavement (4.3%). Contributing factors on closed questioning included forgetfulness (30%), fear (22%) and seeking surgery elsewhere (17%). Review for future surgery was accepted by 93.3% of participants. Conclusion: The findings of this study are consistent to some extent with previous studies carried out in other low-income countries, but also illustrate some key differences. These data provide useful information regarding potential interventions to reduce non-attendance rates, guiding future clinical practice and research.

Highlights

Social value: Global contextBlindness and sight loss have a significant negative impact on patients and the wider community in which they live
This study focuses predominantly on the patient factors influencing disengagement with surgical services, nonattendance to scheduled eye surgery
In the ophthalmology theatre at Good Shepherd Hospital Eye Clinic (GSHEC), a book containing records of every patient operated on provides a definitive list of patients who have attended theatre lists on a particular date

Summary

Introduction

Blindness and sight loss have a significant negative impact on patients and the wider community in which they live. Costs are high, with necessary provision of informal and family care, loss of productivity in the workforce as well as premature retirement and death. These costs are true of both developed and developing countries; the disproportionately large prevalence of blindness and sight loss in low-income countries means that the developing world suffers to a greater extent. Blindness in low-income countries has significant negative impacts on patients and their communities. There have been studies on barriers preventing uptake of surgical services; no such study has been conducted in Swaziland, sub-Saharan Africa

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