Mapping the pathways to eye care in a rural south-east Nigerian population: any implications for practice, eye care programs and policy?
BACKGROUND
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.


METHODS
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.


RESULTS
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%).


CONCLUSIONS
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.
Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria. srstellao@yahoo.com.
Stella N
SN
Onwubiko
Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria. xy3165767@yahoo.com.
Boniface I
BI
Eze
Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria. nnenmauhegbu@yahoo.com.
Nnenma N
NN
Udeh
Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria. arinze.obinna@yahoo.com.
Obinna C
OC
Arinze
Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria. 1990nkiruka2000@gmail.com.
Mary N
MN
Okoloagu
Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria. chimdi_8691@yahoo.com.
Chimdi M
CM
Chuka-Okosa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004522:Educational Status; D005128:Eye Diseases / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult
Africa; Allied Health; Complementary Medicine; Consumer perspectives; Determinants of Health; Education; Health Promotion; Health Service reform; Medical; Ophthalmology; Public Health; Traditional Healers