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Factors associated with adherence to treatment in patients with open angle glaucoma in Sierra Leone, West Africa: patient demographics and questionnaire

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Abstract

Background

Glaucoma is a significant cause of blindness worldwide. It is more common, presents earlier and is more aggressive in those of African descent. Non-adherence and poor knowledge of glaucoma is a significant barrier to treatment and has been associated with low health literacy. We aim to establish the factors contributing to late presentation, treatment non-adherence and disease progression in glaucoma patients in Sierra Leone. This will help better understand the challenges eye services face, highlight fields requiring development in patient–clinician interaction and identify areas or specific vulnerable patient groups in which resources should be focused.

Methods

Prospective, consecutive recruitment of 120 patients with POAG attending the Lowell and Ruth Gess Eye Hospital and the Connaught Government Teaching Hospital, Freetown, Sierra Leone between February and April 2020. Data were collected from 3 sources: (1) review of clinical notes since first attendance, (2) semi-structured interviews and (3) assessment of study participant’s drop instillation technique using a structured checklist. Descriptive statistics was performed for demographic data and other relevant data points. Logistic regression was used for analysis of target variables.

Results

The average age was 62 years with more males (52.6%). Agricultural workers and informal street traders represented 13.2% of participants’ occupation. 25.8% of participants had no formal school, and 47.4% had either a degree or a diploma. This is out of proportion with the general population and may represent a hidden demographic of glaucoma patients. Drop instillation technique was successful in 52% of study participants. Notable responses to the questionnaire were 30% of patients did not know the name of their eye condition and 22% had no knowledge of glaucoma.

Conclusion

Investment in a wide-ranging and robust screening programme and public health campaigns targeting these vulnerable groups and high-risk individuals, for example with a positive family history, alongside improved patient education and staff training is required to improve glaucoma care. Support from government, international organisations and the private sector is required to reduce the economic burden of blindness in Sierra Leone.

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Funding

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. No funding was received for this research.

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Authors and Affiliations

  1. King’s College London, London, WC2R 2LS, UK

    Alasdair Kennedy

  2. College of Medicine and Allied Health Sciences, Connaught Government Teaching Hospital, Freetown, Sierra Leone

    Ukwamma Abosi

  3. London School of Hygiene and Tropical Medicine, London, UK

    Clare Gilbert

  4. Head of Eye Care Programme, Ministry of Health and Sanitation, Connaught Government Teaching Hospital, Freetown, Sierra Leone

    Jalikatu Mustapha

Authors
  1. Alasdair Kennedy
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  2. Ukwamma Abosi
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  3. Clare Gilbert
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  4. Jalikatu Mustapha
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Contributions

AK, JM and UA designed the study proforma, collected and interpreted the data and co-authored the manuscript. CG interpreted the data and co-authored the manuscript.

Corresponding author

Correspondence to Alasdair Kennedy.

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Conflict of interest

The authors declare they have no competing interests or funding.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Sierra Leone research ethics committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

This project was approved by the research ethics committee in Sierra Leone, and all participants gave informed consent to participate in the project.

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Kennedy, A., Abosi, U., Gilbert, C. et al. Factors associated with adherence to treatment in patients with open angle glaucoma in Sierra Leone, West Africa: patient demographics and questionnaire. Int Ophthalmol 42, 3479–3493 (2022). https://doi.org/10.1007/s10792-022-02347-w

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