A qualitative study to understand the barriers and enablers of access to diabetic screening services in Nigeria

Authors

  • Nnenna Ozioko Department of Ophthalmology Enugu State University of Science and Technology Teaching Hospital, Parklane
  • Sureshkumar Kamalakannan Department of Social Work Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20242571

Keywords:

DR, Healthcare system, Screening services, Barriers, Enablers

Abstract

Nigeria in working to redefine its health care system's approach to diabetic retinopathy (DR) screening services needs to reduce obstacles and highlight the enablers to services provision. Due to the increased prevalence of diabetes, this has become increasingly necessary. A qualitative study examining the perceptions, practices, and experiences of Nigerian DR healthcare practitioners (HCPs) in relation to the facilitators and barriers of access to DR screening services. Mode of participant recruitment was on-line through e-mails by using snowballing method. In-depth interviews were used to acquire information from 6 DR HCPs (all ophthalmologists) at three eye centers in the three geo-political areas of Nigeria and at international center for eye health (ICEH) in London via on-line Microsoft teams. Thematic analysis was used for data analysis and all the steps applied to the data analysis process. Non-systematic screening, poverty, poor transport systems, insecurity, and poor motivation are key barriers to DR screening access in Nigeria while enablers include government participation through subsidized costs and remuneration of workers. Screening in communities, and using low-cost techniques are key to enable access. Other enablers include collaboration and integration between endocrinology and ocular units in terms of referrals, information sharing, use of intermediary carers, technology, man-power and health resource provision including low- cost services. A dearth of personnel, screening technologies, and resources, have an impact on the effectiveness of the DR screening services in Nigeria as well as social and individual factors, such as the cost of the services and national insecurity.

References

Dejkhamron P, Menon RK, Sperling MA. Childhood diabetes mellitus: recent advances and future prospects. Indian J Med Res. 2007;125(3):231-50.

Khan MA, Hashim MJ, King J, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of Type 2 Diabetes-Global Burden of Disease and Forecasted Trends. J Epidemiol Global Health. 2020;10(1):107-11.

Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2021;183(109119):109119.

Wade AN, Maposa I, Agongo G, Asiki G, Boua P, Choma SSR, et al. Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study. BMJ open. 2023;13(4):e069193.

International Diabetes Federation. IDF Diabetes Atlas 10th edition 2021. diabetesatlas.org. 2021.

Ugege. Childhood diabetes mellitus in Sokoto, north-western Nigeria: A ten year review. 2013. Available at: www.smjonline.org. Accessed on 19 April 2024.

Ogbera AO. Diabetes mellitus in Nigeria: The past, present and future. World J Diabetes. 2014;5(6):905.

Lam AA, Lepe A, Wild SH, Jackson C. Diabetes comorbidities in low- and middle-income countries: An umbrella review. J Global Health. 2021;11:15.

Vashist P, Gupta N, Singh S, Saxena R. Role of early screening for diabetic retinopathy in patients with diabetes mellitus: An overview. Indian J Community Med. 2011;36(4):247.

Fenwick EK, Man REK, Gan ATL, Aravindhan A, Tey CS, Soon HJT, et al. Validation of a New Diabetic Retinopathy Knowledge and Attitudes Questionnaire in People with Diabetic Retinopathy and Diabetic Macular Edema. Translational Vision Sci Technol. 2020 Sep 30;9(10):32.

Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye and Vision. 2015;2(1):5.

Liew G, Michaelides M, Bunce C. A comparison of the causes of blindness certifications in England and Wales in working age adults (16-64 years), 1999-2000 with 2009-2010. BMJ Open. 2014;4(2):e004015.

Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and Incidence of Type 1 Diabetes in the world: a Systematic Review and meta-analysis. Health Promotion Perspectives. 2020;10(2):98-115.

Ibrahim OA, Foster A, Oluleye TS. Barriers to an effective diabetic retinopathy service in Ibadan, Nigeria (sub -Saharan Africa)-a pilot qualitative study. Ann Ibadan Postgraduate Med. 2015;13(1):36-43.

Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. The Lancet. 2010;376(9735):124-36.

Lewis K, Patel D, Yorston D, Charteris D. A Qualitative Study in the United Kingdom of Factors Influencing Attendance by Patients with Diabetes at Ophthalmic Outpatient Clinics. Ophthalm Epidemiol. 2007;14(6):375-80.

Goh JKH, Cheung CY, Sim SS, Tan PC, Tan GSW, Wong TY. Retinal Imaging Techniques for Diabetic Retinopathy Screening. J Diabetes Sci Technol. 2016;10(2):282-94.

Piyasena MMPN, Murthy GVS, Yip JLY, Gilbert C, Zuurmond M, Peto T, et al. Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings. PLoS One. 2019;14(4):e0198979.

Huemer J, Wagner SK, Sim DA. The Evolution of Diabetic Retinopathy Screening Programmes: A Chronology of Retinal Photography from 35 mm Slides to Artificial Intelligence. Clin Ophthalmol. 2020;14:2021-35.

Braun V, Clarke V. Thematic Analysis. SAGE Publications Inc. 2021. Available at: https://us.sagepub.com/en-us/nam/thematic-analysis/book248481. Accessed on 12 April 2024.

Liu Y, Zupan NJ, Shiyanbola OO, Swearingen R, Carlson JN, Jacobson NA, et al. Factors influencing patient adherence with diabetic eye screening in rural communities: A qualitative study. Bourgeois D, editor. PLOS One. 2018;13(11):e0206742.

Lu Y, Serpas L, Genter P, Anderson B, Campa D, Ipp E. Divergent Perceptions of Barriers to Diabetic Retinopathy Screening Among Patients and Care Providers, Los Angeles, California, 2014-2015. Preventing Chronic Disease. 2016;13:E140.

Prothero L, Cartwright M, Lorencatto F, Burr JM, Anderson J, Gardner P, et al. Barriers and enablers to diabetic retinopathy screening: a cross-sectional survey of young adults with type 1 and type 2 diabetes in the UK. BMJ Open Diabetes Res Care. 2022;10(6):e002971.

Sivaram S, Majumdar G, Perin D, Nessa A, Broeders M, Lynge E, et al. Population-based cancer screening programmes in low-income and middle-income countries: regional consultation of the International Cancer Screening Network in India. Lancet Oncol. 2018;19(2):e113-22.

Eme Ichoku H, Fonta WilliamM, Ataguba JE. Political Economy and History: Making Sense of Health Financing In Sub-Saharan Africa. J Int Development. 2012;25(3):297-309.

Low L, Law JP, Hodson J, McAlpine R, O’Colmain U, MacEwen C. Impact of socioeconomic deprivation on the development of diabetic retinopathy: a population-based, cross-sectional and longitudinal study over 12 years. BMJ Open. 2015;5(4):e007290.

Inegbedion HE. COVID-19 lockdown: implication for food security. J Agribusiness Developing Emerging Economies. 2020;11(5):437-51.

Adeloye D, David RA, Olaogun AA, Auta A, Adesokan A, Gadanya M, et al. Health workforce and governance: the crisis in Nigeria. Human Resources Health. 2017;15(1):25.

Mohammed I, Waziri A. Awareness of diabetic retinopathy amongst diabetic patients at the murtala mohammed hospital, Kano, Nigeria. Nigerian Med J. 2009;50(2):1.

Ojo JS, Oyewole S, Aina F. Forces of Terror: Armed Banditry and Insecurity in North-west Nigeria. Democracy Security. 2023;1-28.

Enekwechi B. Nigeria’s Highways of Risks and Insecurity-Thisdaylive. 2021. Available at: https://www.thisdaylive.com/index.php/2021/12/15/nigerias-highways-of-risks-and-insecurity. Accessed on 12 April 2024.

Strutton R, Du Chemin A, Stratton IM, Forster AS. System-level and patient-level explanations for non-attendance at diabetic retinopathy screening in Sutton and Merton (London, UK): a qualitative analysis of a service evaluation: Table 1. BMJ Open. 2016;6(5):e010952.

Aghaji A, Burchett HED, Oguego N, Hameed S, Gilbert C. Primary health care facility readiness to implement primary eye care in Nigeria: equipment, infrastructure, service delivery and health management information systems. BMC Health Services Research. 2021;21(1):1.

Dunne F, Clifford G, Jackson D, Hipkiss H, MD Tsaloumas. The impact of community diabetic eye screening. Int J Clin Pract. 2000;54(1):66-6.

Kumar S, Kumar G, Velu S, Pardhan S, Sivaprasad S, Ruamviboonsuk P, et al. Patient and provider perspectives on barriers to screening for diabetic retinopathy: an exploratory study from southern India. BMJ Open. 2020;10(12):e037277.

Downloads

Published

2024-08-30

How to Cite

Ozioko, N., & Kamalakannan, S. (2024). A qualitative study to understand the barriers and enablers of access to diabetic screening services in Nigeria. International Journal Of Community Medicine And Public Health, 11(9), 3642–3650. https://doi.org/10.18203/2394-6040.ijcmph20242571

Issue

Section

Short Communication