title: Eye Care Service Use and Its Determinants in Marginalized Communities in Pakistan: The Karachi Marine Fishing Communities Eye and General Health Survey.
abstract: OBJECTIVE
  To examine gender, ethnic, and socioeconomic differences in access to eye care services in marine fishing communities in Karachi, Pakistan.
  
  
  METHODS
  The Karachi Marine Fishing Communities Eye and General Health Survey was a door-to-door, 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 three islands and in four coastal areas were enrolled. Participants underwent a detailed interview regarding sociodemographics, eye problems and eye care service use, testing of presenting and best-corrected visual acuity with a reduced logMAR chart, and detailed eye examination.
  
  
  RESULTS
  A total of 700 people were planned to be included in the study; 638 (91.1%) were interviewed and examined. Most participants were extremely poor and had no formal education. Only 45.3% (95% confidence interval, CI, 41.4-49.2%) of participants reported having had an eye examination in the past; 12.1% (95% CI 9.5-14.6%) and 30.9% (95% CI 27.3-34.5%) had seen an eye doctor within the last year or prior 5 years, respectively. In the multivariable analysis, ethnicity was the strongest independent predictor of eye care service use, followed by self-reported eye problems and diabetes. Ethnic Bengalis were 4.2 times less likely (adjusted odds ratio 0.24, 95% CI 0.15-0.38; p < 0.001) to have had an eye examination in the past than Kutchis.
  
  
  CONCLUSIONS
  Despite a high prevalence of visual impairment and blindness, levels of eye care examinations in fishing communities, especially among ethnic Bengalis, are disappointingly low. Such communities deserve particular attention in Vision 2020 and other national and international strategies and plans.
authors.affiliation: a School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales , Sydney , New South Wales , Australia .|b Section of Ophthalmology and Office of Surgical Research, Department of Surgery, Aga Khan University , Karachi , Pakistan .
authors.forename: Khabir
authors.initials: K
authors.lastname: Ahmad
authors.affiliation: a School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales , Sydney , New South Wales , Australia .
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Zwi
authors.affiliation: c School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales , Sydney , New South Wales , Australia , and.
authors.forename: Daniel J M
authors.initials: DJ
authors.lastname: Tarantola
authors.affiliation: d Department of Community Health Sciences , Aga Khan University , Karachi , Pakistan.
authors.forename: Syed Iqbal
authors.initials: SI
authors.lastname: Azam
mesh_terms: D001766:Blindness / Q000453:epidemiology / Q000534:rehabilitation; D003430:Cross-Sectional Studies; D005260:Female; D005398:Fisheries; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations; D009885:Ophthalmology; D010154:Pakistan / Q000453:epidemiology; D062487:Social Marginalization; D015354:Vision, Low / Q000453:epidemiology / Q000534:rehabilitation; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*
keywords: Access; Vision 2020; equity; eye care; fishing communities; health disparities; inequalities; marginalized groups; visual impairment