A population-based study of care-seeking behavior in rural Tanzanians with glaucoma blindness.
OBJECTIVE
To describe the care-seeking behavior of a representative sample of rural Africans blind from glaucoma.


METHODS
Patients blind from posterior segment diseases (including diseases affecting the retina or optic nerve) were identified though a population-based survey in Kilimanjaro Region, Tanzania in 2007. A year later they were traced to their homes to detail the diagnoses with more thorough examination. In-depth interviews were conducted to determine healthcare sought and received and symptoms which prompted this. Data were analyzed by framework analysis.


RESULTS
Of 30 patients previously identified, 20 were found and interviewed, 4 had died, 2 had moved, 2 lived too far to trace, and 2 could not be located. The average age was 77 years. Few patients could give a clear temporal history of how their vision failed or a sequential description of visits made to healthcare facilities over the years. However, every patient had sought eye care and most made numerous visits. Understanding of the disease and treatment was uniformly limited. Most received topical medicines and the histories of nonglaucoma and glaucoma blind were similar except that 5 glaucoma patients had received surgery. Patients described obstacles to care including poverty and other lack of support.


CONCLUSIONS
These findings contrast to previous which showed that most rural Africans blind from glaucoma have not sought or received treatment. It is likely that this is partly the result of widely accessible services offered in Kilimanjaro Region. However, the challenges in treating this chronic disease are highlighted.
Lewallen
Susan
S
Kilimanjaro Centre for Community Ophthalmology, Good Samaritan Foundation, Moshi, Tanzania. slewallen@kcco.net
Hassan
Hassan G
HG
Al Attas
Ahmed H
AH
Courtright
Paul
P
D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005901:Glaucoma / Q000453:epidemiology* / Q000628:therapy; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D013636:Tanzania / Q000453:epidemiology