Author(s): Ahmadou M. Jingi1 , Jean Jacques Noubiap2 , Yannick Bilong3 , Aurel T. Tankeu1 and Côme Ebana Mvogo3
Diabetes has reached epidemic proportions with the greatest burden on low-to-medium income settings , where it is under-diagnosed, under-investigated, and under-treated . For, instance, it affects about 6.5% of adults Cameroonians . This high disease burden is associated with low availability of investigation tests and essential medicines for the management of diabetes . This translates into high rates of vascular complications which occurs early in the course of the disease , and which carries a high morbidity and mortality. Thus, after 6 years of diagnosis of diabetes in low-income settings, about 40% of patients with type 2 diabetes have diabetic retinopathy, of whom 15-17% have sight threatening retinopathy [5, 6]. Prevention of diabetic retinopathy and diabetes related blindness requires strict control of risk factors, regular eye checks with timely laser therapy . Most patients with diabetes in low-income settings are first cared for by primary care physicians. There is evidence of a gap in the diagnosis and management of diabetes in low-income settings . However, evidence on the standard of care to prevent diabetes related blindness, as well as the determinants of standard care are lacking in low-income settings. We report on the prevalence and determinants of comprehensive eye care in a group of patients with diabetes in a sub-Saharan African (SSA) setting.
Study design and setting
This was a cross-sectional study in the eye department of the Douala General Hospital between August and September 2006. It is a tertiary centre in the economic capital of Cameroon (a low-income setting located in sub-Saharan Africa), with a catchment population of over three million inhabitants. The eye department of this hospital served as the reference centre for entire Country and the sub region in terms of retinal pathologies, and likely to receive patients from all walks of life.
Participants were adult patients aged [greater than or equai to] 18 years, of both sex having diabetes (type 1 or 2), who gave their inform consent. Pregnant women were excluded.
Before the comprehensive eye examination, each patient was interviewed using a standard questionnaire. The questionnaire used in this study was designed specifically for this study and was not pre-tested. Information registered are presented in Additional file 1. Patients then underwent a comprehensive eye examination. Outcome: The main outcome was a first ever comprehensive eye examination or at least a dilated fundus examination. The secondary outcome was haven been counseled on the risk of visual impairment and blindness due to diabetes. Possible determinants of having an eye examination were age, sex, residence, duration of diabetes, health insurance, level of education, sector of activity, treating physician, counseled on diabetes complications, associated hypertension, difficulties to reach the eye clinic, low visual acuity,
Sample size and power
With an estimated catchment population of three million, an expected prevalence of diabetes to be 5.4 and 80% power, and an accepted error of 5%, the...