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Understanding delay in accessing specialist emergency eye care in a developing country: eye trauma in Tanzania

Al-Attas, Ahmed H, Williams, Chris D and Pitchforth, E. (2010) Understanding delay in accessing specialist emergency eye care in a developing country: eye trauma in Tanzania. Ophthalmic Empidemiology, 17 (2). pp. 103-112. ISSN 0928-6586

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Identification Number: 10.3109/09286580903453522


Purpose: To determine the extent and reasons for delay in accessing specialist eye care following a significant eye injury. Methods: Mixed methods study involving 93 consecutive admissions to Kilimanjaro Christian Medical Center, Tanzania (KCMC). Semi-structured interviews were conducted and supplemented by a review of medical notes. A statistical analysis of delay and predictor variables was conducted. Framework analysis of interviews was conducted. Results: Ninety of 93 patients took part. Significant visual loss was determined in 95.5% of affected eyes on arrival. The mean delay for treatment was 6.8 days. Of participants, 61.1% visited some health facility within 24 hours, and 82.2% within 48 hours. Injury on a weekend, using topical drops and visiting other health facilities before KCMC were independently associated with delay greater than 24 hours and greater than 48 hours, female gender with was associated with delay greater than 24 hours. Patient journeys involved key milestones and processes. Journeys were frequently "circular," involving delays caused by repeated visits to health units unable to treat the injury, often on a health worker's advice. Systems problems included unclear referral systems and opening times, frequent staff absence and unqualified staff deputizing. Individual health workers had an important influence on delay but their performance appeared variable. They influenced patient journeys positively when they made an accurate diagnosis, referred directly to KCMC, discussed practicalities and communicated the seriousness of the injury, the need for urgent treatment and the adverse consequences of delay. Conclusions: There is significant delay in accessing appropriate specialist care following eye injury in Tanzania, much of which occurs after first visiting a health facility. We present a new model of delay that may help guide interventions to reduce this delay.

Item Type: Article
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Additional Information: © 2010 Informa UK
Divisions: LSE Health
Subjects: R Medicine > R Medicine (General)
Date Deposited: 21 Oct 2010 14:25
Last Modified: 20 May 2024 16:48
Funders: David Baum International Foundation, Royal College of Paediatrics and Child Health, Seva Foundation

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