title: Patient refusal of glaucoma surgery and associated factors in Lagos, Nigeria.
abstract: OBJECTIVE
  To determine the prevalence of patient refusal of glaucoma surgery (GSR) and the associated factors in Lagos, Nigeria.
  
  
  METHODS
  A multicenter cross-sectional survey was conducted in Lagos state, Nigeria. Twelve centres were invited to participate, but data collection was completed in 10. Newly diagnosed glaucoma patients were recruited and interviewed from these sites over a four week period on prior awareness of glaucoma, surgery refusal, and reason(s) for the refusal. Presenting visual acuity was recorded from the patient files. The odds ratio and 95% confidence intervals (CI) were calculated.
  
  
  RESULTS
  A total of 208 newly diagnosed glaucoma patients were recruited. Sixty-five (31.2%) patients refused surgery. Fear of surgery (31 (47.7%) patients), and fear of going blind (19 (29.2%) patients) were the most common reasons. The odds ratio of surgery refusal were marital status - not married versus married (2.0; 95% CI, 1.02-3.94), use of traditional medication - users versus non users (2.4; 95% CI, 1.1-5.2), perception of glaucoma causing blindness - no versus yes (3.7; 95% CI, 1.3-10.5), type of institution - government versus private (5.7; 95% CI, 1.3-25.1), and visual acuity in the better eye - normal vision versus visual impairment (2.3; 95% CI, 1.1-4.9). Age, gender, level of education, family history of glaucoma, and prior awareness of the diagnosis of glaucoma, were not significantly associated with surgery refusal. Perception of patients concerning glaucoma blindness was the strongest factor on multivariate analysis.
  
  
  CONCLUSIONS
  GSR was relatively low in this study. Unmarried status, use of traditional medications, perception that glaucoma cannot cause blindness, government hospital patients, and good vision in the better eye were associated with GSR. These factors might help in the clinical setting in identifying appropriate individuals for targeted counseling, as well as the need for increased public awareness about glaucoma.
authors.affiliation: Department of Ophthalmology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
authors.forename: Bola Josephine
authors.initials: BJ
authors.lastname: Adekoya
authors.forename: Feyisayo B
authors.initials: FB
authors.lastname: Akinsola
authors.forename: Bola Grace
authors.initials: BG
authors.lastname: Balogun
authors.forename: Modupe Medinat
authors.initials: MM
authors.lastname: Balogun
authors.forename: Olajumoke O
authors.initials: OO
authors.lastname: Ibidapo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018463:Filtering Surgery / Q000706:statistics & numerical data*; D005901:Glaucoma / Q000175:diagnosis / Q000601:surgery*; D006306:Health Surveys; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010361:Patients / Q000523:psychology*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data*; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity; D019987:Persons with Visual Disabilities; D055815:Young Adult
keywords: Blindness; Glaucoma; Nigeria; Surgery Refusal; Visual Impairment