Delay Along the Care Seeking Journey of Patients with Microbial Keratitis in Uganda
Simon Arunga, Guyguy M. Kintoki , Stephen Gichuhi , John Onyango , Rob Newton , Astrid Leck, David Macleod , Victor H. Hu, and Matthew J. Burton
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PURPOSE To describe the care seeking journey and causes of delay among patients with Microbial Keratitis in Uganda. METHODS A prospective cohort of patients presenting with microbial keratitis at the two main eye units in Southern Uganda (2016–2018). We collected information on demographics, home address, clinical history, and presentation pathway including, order of facilities where patients went to seek care, treatment advice, cost of care, and use of Traditional Eye Medicine. Presentation time was noted. We compared “direct” presenters versus “indirect” presenters and analysed predictors of delay. RESULTS About 313 patients were enrolled. All were self-referred. Only 19% of the patients presented directly to the eye hospital. Majority (52%) visited one facility before presenting, 19% visited two facilities, 9% visited three facilities, and 2% visited four facilities. The cost of care increased with increase in the number of facilities visited. People in a large household, further distance from the eye hospital and those who used Traditional Eye Medicine were less likely to come directly to the eye hospital. Visiting another facility prior to the eye hospital and use of Traditional Eye Medicine aOR 1.58 (95%CI 1.03–2.43), p = .038 were associated with delayed presentation to the eye hospital. CONCLUSION This study provided information on patient journeys to seek care. Delay was largely attributable to having visited another health facility: a referral mechanism for microbial keratitis was non-existent. There is need to explore how these health system gaps can be strengthened.
- Internal Medicine 
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Simon Arunga , Allen Asiimwe , Eunice Apio Olet , Grace Kagoro-Rugunda , Bosco Ayebazibwe , John Onyango , Robert Newton , Astrid Leck , David Macleod , Victor H. Hu , Janet Seeley , Matthew J. Burton (The Wellcome Trust, 2019)Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large ...
Simon Arunga Guyguy M. Kintoki, James Mwesigye, Bosco Ayebazibwe, John Onyango, Joel Bazira, Rob Newton, Stephen Gichuhi, Astrid Leck, David Macleod, Victor H. Hu, and Matthew J. Burton (Taylor & Francis, 2020)Purpose: To describe the epidemiology of Microbial Keratitis (MK) in Uganda. Methods: We prospectively recruited patients presenting with MK at two main eye units in Southern Uganda between December 2016 and March 2018. ...
Simon Arunga, Guyguy M. Kintoki, Stephen Gichuhi, John Onyang, Bosco Ayebazibwe, Rob Newton, Astrid Leck, David Macleod, Victor H. Hu, and Matthew J. Burton (Taylor & Francis, 2020)Purpose: Microbial keratitis (MK), is a frequent cause of sight loss worldwide, particularly in low and middle-income countries. This study aimed to investigate the risk factors of MK in Uganda. Methods: Using a nested ...