Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study [version 1; peer review: awaiting peer review]
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Wellcome open research
Abstract
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 prospective study to determine how TEM use impacts presentation
and outcome of MK and to explore reasons why people use TEM for
treatment in Uganda.
Methods: In a mixed method prospective cohort study, we enrolled
patients presenting with MK at the two main eye units in Southern Uganda
between December 2016 and March 2018 and collected information on
history, TEM use, microbiology and 3-month outcomes. We conducted
qualitative interviews with patients, carers traditional healers on reasons
why people use TEM. Outcome measures included presenting vision and at
3-months, comparing TEM Users versus Non-Users. A thematic coding
framework was deployed to explore reasons for use of TEM.
Results: 188 out of 313 participants reported TEM use. TEM Users had a
delayed presentation; median presenting time 18 days versus 14 days, p=
0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse
presenting visual acuity median logarithm of the minimum angle of
resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at
3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable
logistic regression model, distance from the eye hospital and delayed
presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system
breakdown, poverty, fear of the eye hospital, cultural belief in TEM,
influence from traditional healers, personal circumstances and ignorance.
: TEM users h Conclusion ad poorer clinical presentation and outcomes.
Capacity building of the primary health centres to improve access to eye
care and community behavioural change initiatives against TEM use should
be encouraged.
Description
Keywords
Microbial Keratitis, Traditional Eye Medicine, Traditional Healers, Blindness
Citation
Arunga S, Asiimwe A, Apio Olet E et al. Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study [version 1; peer review: awaiting peer review] Wellcome Open Research 2019, 4:89 ( https://doi.org/10.12688/wellcomeopenres.15259.1)