title: Self-perceived barriers to eye care in a hard-to-reach population: the Karachi Marine Fishing Communities Eye and General Health Survey.
abstract: OBJECTIVE
  We examined self-reported barriers to eye care among marginalized, hard-to-reach fishing communities in Karachi, Pakistan.
  
  
  METHODS
  The Karachi Marine Fishing Communities Eye and General Health Survey was a cross-sectional survey conducted between March 2009 and April 2010 in fishing communities in Keamari, Karachi, located on the coast of the Arabian Sea. Adults aged ≥50 years living on seven islands and coastal areas were interviewed regarding sociodemographic background, experience of eye problems, eye care use, and barriers to access. They also were examined to determine visual acuity with a reduced logMAR chart and underwent a detailed eye examination.
  
  
  RESULTS
  Of 700 people planned to be included in the study, 638 (91.1%) were interviewed and examined. Of these participants, 599 (93.9%) lived in extreme poverty and 84.3% had no school-based education, and 349 (54.7%; 95% confidence interval [CI], 50.8-58.6) of them had never had an eye examination. The common barriers to access identified included a perceived lack of or low need (176/349 or 50.4%), financial hardships (36.4%), "fears" (8.6%), and social support constraints (6.3%). Of those reporting a "lack of need," 21.9% had significant visual loss. Financial hardships, "fears," and social support constraints were more prevalent among women than men. Bengalis compared to Kutchis and Sindhis, and individuals with "poor/fragile" household financial status (self-reported) compared to those with "fine" status, were more likely to cite financial hardships.
  
  
  CONCLUSIONS
  Access to eye care in this marginalized population is substantially hindered by perceived lack of need, financial hardships, and a range of "fears" and anxieties, despite a large unmet need. These barriers should be addressed while paying particular attention to gender, and ethnic and socioeconomic differences.
authors.affiliation: School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales, Sydney, Australia.
authors.forename: Khabir
authors.initials: K
authors.lastname: Ahmad
authors.affiliation: School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales, Sydney, Australia.
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Zwi
authors.affiliation: School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Sydney, Australia.
authors.forename: Daniel J M
authors.initials: DJ
authors.lastname: Tarantola
authors.affiliation: Section of Ophthalmology, Department of Surgery, Aga Khan University, Karachi, Pakistan.
authors.forename: Tanveer Anjum
authors.initials: TA
authors.lastname: Chaudhry
mesh_terms: D003430:Cross-Sectional Studies; D005128:Eye Diseases / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010154:Pakistan / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies
keywords: Pakistan; access; barriers; equity; ethnicity; eye health; fishing communities; gender; inequalities; stigma