Delay in accessing definitive care for patients with microbial keratitis in Nepal

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dc.contributor.authorHoffman, Jeremy J.
dc.contributor.authorYadav, Reena
dc.contributor.authorDas Sanyam, Sandip
dc.contributor.authorChaudhary, Pankaj
dc.contributor.authorRoshan, Abhishek
dc.contributor.authorSingh, Sanjay K.
dc.contributor.authorMishra, Sailesh K.
dc.contributor.authorArunga, Simon
dc.contributor.authorHu, Victor H.
dc.contributor.authorMacleod, David
dc.contributor.authorLeck, Astrid
dc.contributor.authorBurton, Matthew J.
dc.date.accessioned2023-03-18T16:51:03Z
dc.date.available2023-03-18T16:51:03Z
dc.date.issued2022
dc.description.abstractThe 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.en_US
dc.identifier.citationHoffman 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.2022.915293en_US
dc.identifier.other10.3389/fmed.2022.915293
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/8239
dc.language.isoenen_US
dc.publisherFrontiers in Medicineen_US
dc.subjectMicrobial keratitisen_US
dc.subjectFungal keratitisen_US
dc.subjectEpidemiologyen_US
dc.subjectHealth systemsen_US
dc.subjectNepalen_US
dc.subjectCorneaen_US
dc.titleDelay in accessing definitive care for patients with microbial keratitis in Nepalen_US
dc.typeArticleen_US
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