title: The clinical characteristics of patients with glaucoma presenting to Botswana healthcare facilities: an observational study.
abstract: OBJECTIVE
  This study aimed to establish the clinical characteristics of patients with glaucoma attending eye care facilities in Botswana, and management of glaucoma among patients who received care in these facilities. The study also aimed to calculate the number of new diagnoses of glaucoma within the glaucoma service.
  
  
  METHODS
  A prospective, hospital-based, observational study.
  
  
  METHODS
  A multicentre study was undertaken in government-run eye departments in Botswana from June to August 2012.
  
  
  METHODS
  All patients with a diagnosis of glaucoma attending clinics at seven study sites were invited to participate.
  
  
  METHODS
  Examination findings, diagnosis and management were extracted from individual patient-held medical charts. Sociodemographic characteristics, patient knowledge and understanding of glaucoma were assessed through face-to-face interviews. In addition, details of outpatient attendances for 2011 were collected from 21 government-run hospitals.
  
  
  RESULTS
  The majority of the 366 patients interviewed had a diagnosis of primary glaucoma (86.6%). The diagnoses were mainly made by ophthalmologists (48.6%) and ophthalmic nurses (44.0%). Many patients (38.5%) had been symptomatic for over 6 months before visiting an eye clinic. The mean presenting intraocular pressure was 28.2 mm Hg (SD 11.9 mm Hg). Most follow-up patients (79.2%) had not received surgery, however, many (89.5%) would accept surgery. Only 11.5% of participants had heard of glaucoma prior to diagnosis. Many participants (35.9%) did not understand glaucoma after being diagnosed. The majority (94.9%) of living first-degree relatives had never been examined. The number of newly diagnosed glaucoma cases for 2011 in the south of the country was 14.1/100,000; 95% CI (12.0 to 16.5), in the north it was 16.2/100,000; 95% CI (13.8 to 19.0).
  
  
  CONCLUSIONS
  Glaucoma is a significant burden that presents challenges to ophthalmic services in Botswana. Many patients have limited understanding of the condition and poor access to services. There is a need to develop a treatment infrastructure to include safe surgery and a reliable supply of effective medication.
authors.affiliation: University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Jackson
authors.affiliation: University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Mohammad S
authors.initials: MS
authors.lastname: Razai
authors.affiliation: University of Botswana School of Medicine, Gaborone, Botswana.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Falama
authors.affiliation: University of Botswana School of Medicine, Gaborone, Botswana.
authors.forename: Matlhogonolo
authors.initials: M
authors.lastname: Mongwa
authors.affiliation: University of Botswana School of Medicine, Gaborone, Botswana.
authors.forename: Mishell
authors.initials: M
authors.lastname: Mutapanduwa
authors.affiliation: University of Botswana School of Medicine, Gaborone, Botswana.
authors.forename: Chao
authors.initials: C
authors.lastname: Baemisi
authors.affiliation: University of Botswana School of Medicine, Gaborone, Botswana.
authors.forename: Engelinah
authors.initials: E
authors.lastname: Josiah
authors.affiliation: University of Botswana School of Medicine, Gaborone, Botswana.
authors.forename: Oathokwa
authors.initials: O
authors.lastname: Nkomazana
authors.affiliation: Ministry of Health, Gaborone, Botswana.
authors.forename: Alice
authors.initials: A
authors.lastname: Lehasa
authors.affiliation: Addenbrooke's Abroad, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Brealey
authors.affiliation: Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: White
authors.affiliation: Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Jankowski
authors.affiliation: Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Kerr-Muir
authors.affiliation: Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Martin
authors.affiliation: Institute of Public Health, University of Cambridge, Cambridge, UK.
authors.forename: Jeremiah M
authors.initials: JM
authors.lastname: Ngondi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001902:Botswana / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006268:Health Facilities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: EPIDEMIOLOGY