Delay in accessing definitive care for patients with microbial keratitis in Nepal
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Frontiers in Medicine
Abstract
The aim of this study was to describe the health-seeking journey
for patients withmicrobial keratitis (MK) in Nepal and identify factors associated
with delay.
Methods: Prospective cohort study where MK patients attending a large,
tertiary-referral eye hospital in south-eastern Nepal between June 2019 and
November 2020 were recruited. We collected demographic details, clinical
history, and examination findings. Care-seeking journey details were captured
including places attended, number of journeys, time fromsymptomonset, and
costs.We compared “direct” with “indirect” presenters, analyzing for predictors
of delay.
Results: We enrolled 643 patients with MK. The majority (96%) self-referred.
“Direct” attenders accounted for only 23.6% (152/643) of patients, the majority
of “indirect” patients initially presented to a pharmacy (255/491). Over half
(328/643) of all cases presented after at least 7 days. The total cost of care
increased with increasing numbers of facilities visited (p < 0.001). Those
living furthest away were least likely to present directly (p < 0.001). Factors
independently associated with delayed presentation included distance >50 km
from the eye hospital [aOR 5.760 (95% CI 1.829–18.14, p = 0.003)], previous
antifungal use [aOR 4.706 (95% CI 3.139–5.360)], and two or more previous
journeys [aOR 1.442 (95% CI 1.111–3.255)].
Conclusions: Most patients visited at least one facility prior to our institution,
with time to presentation and costs increasing with the number of prior
journeys. Distance to the eye hospital is a significant barrier to prompt, direct
presentation. Based on these findings, improving access to eye care services,
strengthening referral networks and encouraging early appropriate treatment
are recommended to reduce delay, ultimately improving clinical outcomes.
Description
Keywords
Microbial keratitis, Fungal keratitis, Epidemiology, Health systems, Nepal, Cornea
Citation
Hoffman JJ, Yadav R, Das Sanyam S, Chaudhary P, Roshan A, Singh SK, Mishra SK, Arunga S, Hu VH, Macleod D, Leck A and Burton MJ (2022) Delay in accessing definitive care for patients with microbial keratitis in Nepal. Front. Med. 9:915293. doi: 10.3389/fmed.2022.915293