Abstract
The appropriateness of the initial pathway to care, especially eye care, is critical for timeliness and outcomes of care. Individual-dependent and health system-determined factors influence the preferred initial pathway to care. This study aimed to map the initial pathways to eye care in a rural population in south-east Nigeria and identify the associated factors. This study was a population-based, cross-sectional descriptive survey conducted in Abagana, a rural south-east Nigeria community, in September 2011. Using a researcher-administered questionnaire, data on participants' sociodemographics, preferred initial eyecare pathway when confronted with an eye disorder and their reason(s) for the choice of pathway were collected. Descriptive and analytical statistics were performed. Regression analysis was used to identify independent predictors of visiting an ophthalmologist when confronted with an eye disorder. In all comparisons, p < 0.05 was considered statistically significant. The participants (n = 501: 263 men; 238 women) were aged 48.9±16.3 years (range 18-93 years). The majority of the participants were married (339; 67.7%) and possessed formal education (415; 82.8%). The participants' frequently preferred initial pathways to eye care were to consult a patent medicine dealer (178; 35.0%), to consult an ophthalmologist (165; 33.0%), and to self-medicate (125; 25.0%). Possession of formal education (odds ratio 0.3; 95% confidence interval 0.1-0.5; p < 0.001) was the only significant sociodemographic predictor of consulting an ophthalmologist when confronted with an eye disorder The participants' main reasons for not consulting an ophthalmologist were ignorance (190; 56.5%), cost (199; 59.2%), and restricted spatial access (228; 67.9%). The majority of the respondents chose an inappropriate eyecare pathway in the event of an eye disorder. The reported barriers to appropriate pathway selection are amenable to community-based eye health education, enhanced affordability, and even distribution of eyecare services. Integrating other alternative care pathways into orthodox eye care should be considered.
Highlights
The appropriateness of the initial pathway to care, especially eye care, is critical for timeliness and outcomes of care
The high burden of avoidable blindness and other non-blinding eye disorders in Nigeria is attributable to scarcity of human and material resources for eyecare delivery, sub-optimal functionality and restricted availability of the recently introduced public health insurance scheme
While between-survey differences in study design might account for these observed differences, further comparisons with other reports in Nigeria[15] and other countries[9,10] have been restricted by their lack of equivalent comparable data
Summary
The appropriateness of the initial pathway to care, especially eye care, is critical for timeliness and outcomes of care. This study aimed to map the initial pathways to eye care in a rural population in south-east Nigeria and identify the associated factors. Using a researcher-administered questionnaire, data on participants’ sociodemographics, preferred initial eyecare pathway when confronted with an eye disorder and their reason(s) for the choice of pathway were collected. Possession of formal education (odds ratio 0.3; 95% confidence interval 0.1–0.5; p
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