KNOWLEDGE, ATTITUDES AND PRACTICES ON DIABETIC RETINOPATHY AMONG GENERAL PRACTITIONERS IN DISTRICT AND REGIONAL HOSPITALS IN THE NORTH REGION OF BURUNDI LEOPOLD NIYONSAVYE Supervisors • Dr. KariukiMillicent Muthoni • Prof.JefithaKarimurio • Dr. Levi Kandeke
Broad Objective To establish the knowledge, attitudes and practices on diabetic retinopathy among general practitioners working in District and Regional Hospitals in the North Region of Burundi Specific Objectives • Establish the current knowledge on diabetic retinopathy among the general practitioners in the North Region of Burundi
2. Assess the attitudes towards screening for diabetic retinopathy among the general practitioners in the North Region of Burundi 3. Establish and evaluate the practices among the general practitioners in the North Region of Burundi, regarding screening for diabetic retinopathy 4. Establish factors that affects the knowledge, attitudes and practices of the general practitioners in the North Region of Burundi, with regards to screening for diabetic retinopathy
MATERIALS AND METHODS • Study Design cross-sectional study - Study Setting District and Regional Hospitals in the North Region of Burundi • Study Population General practitioners working in District and Regional Hospitals in the study area
Inclusion Criteria All general practitioners working at district or regional hospital in the North Region of Burundi • Exclusion criteria specialist or doctors in specialty training • Study Period From 21 January 2014 to15/12/2014 • Sample size The minimum simple was 69 GP
- Selection of the participants - Data Collection Tool - Data Collection Procedure - Quality Assurance Procedures - Data Analysis - Ethical Considerations
RESULTS AND DISCUSSION Flow chart of data collection
DEMOGRAPHIC DATADistribution of respondents by sex (N=81) Male to female ratio is 4.8:1
Distribution of respondents by age (n = 81) The mean age :34.1 years (SD = 3.121) The minimum age : 28 years, maximum age : 44 years
Distribution of respondents by duration of practice in years (n = 81) The mean duration of practice :2.4 years (SD = 2.03). The minimum duration : 0.08 year, maximum : 7.5 years.
KNOWLEDGE Table 1: Respondent's response on organs affected by microvascular complications in a person with DM (n = 81) • - retinopathy: 91.2% , nephropathy: 80.2% ,Neuropathy: 56.0% (1) • 1. Mensah V. et al. Knowledge, Attitude and Practices of Diabetic Retinopathy among officers in the Regional Hospitals of GHANA. Mmed dissertation; 2013.
Table 2: Respondent's response on parts of the eye that can be affected by diabetes mellitus (n = 81) • Retina: 86(94.5%) , Lens: 46 (50.6%), Iris : 23(25.3%) (1) • - 23(58%) correctly gave the name of one eye part that is usually affected • by diabetes, 43% of staff knew that the lens could be affected in diabetes (2) • 1. Mensah V. et al. Knowledge, Attitude and Practices of Diabetic Retinopathy • among officers in the Regional Hospitals of GHANA. Mmed dissertation; 2013. • 2. Khandekar R, Shah S, Al Lawatti J. Retinal examination of diabetic patients: • knowledge, attitudes and practices of physicians in Oman. • East Mediterr Health J. 2008;14 (4):850-7.
Table 3:Respondent's response on factors that influence the presence or severity of diabetic retinopathy (n = 81)
Oega R.B et al; glycaemic control: 95.6% hypertension: 84.6%, duration: 89.0% (3) • Mensah V. et al ; glycaemic control : 86.8%, hypertension 46.2% , duration: 28.6% Renal disease and pregnancy were mentioned respectively by 4.4% respondents (1) • 100% agreed that hypertension and renal disease duration : 93.1%, pregnancy: 68.97% serum lipid profile: 93.1% (4) 3.Oega R.B et al. Diabetic Retinopathy: knowledge, attitude and practice among General Practitioners in provincial hospitals in Kenya. MmedDissertion; 2012. 4. Mahesh G, Giridhar A., Saikumar S. J., Kumar R., Bhat S. Knowledge, Attitude and Practice Pattern among Health Care Providers Regarding Diabetic Retinopathy
Table 4: Respondent's response on treatment and treatment modalities that are available for DR
Oega et al, DR was treatable: 67% laser photocoagulation 47.3% & surgery 11% (3) • Mensah V. et al, DR was treatable: 78% laser photocoagulation55% ; surgical & medical modalities: 12.1%&27.5% (1) - 75.86% participants believed that laser treatment is curative for DR and 62.07% said surgical treatment was available for advance DR (4) 4. Mahesh G, Giridhar A., Saikumar S. J., Kumar R., Bhat S. Knowledge, Attitude and Practice Pattern among Health Care Providers Regarding Diabetic Retinopathy
Table 5: Participants’ attitude towards screening for diabetic retinopathy (n = 81) • Oega et al: 87.9%, Mensah V. et al: 98.9% • -Mensah V.et al: 92.3%
Mensah V. et al: 52.8% disagree (1) • - only 42.9% agreed that ophthalmology knowledge was sufficient and • 25.9% agreed that skills in ophthalmology were enough.(5) • 5. Nobel J, Somal K, Gill HS, Lam WC. An analysis of undergraduate ophthalmology • training in Canada. Canadian Journal of Ophthalmology. 2009 October; 5(44): 513-518. • Department of Ophthalmology and Vision Sciences, University of Toronto, Ont, Canada.
Oega et al: 37.4% assessed vision / year . 26.4% never assessed vision . visual complaints 34.1%. • Mensah V. et al: 17(18.7%) every 6 months . 11(12.1%) every year, 3(3.3%) at every visit & admission . 12(13.2%) never testing the vision .34.1% respondents would test the vision/year • Rajiv et al: 31.3 %( n=50) six months, . 53.3 %( n=85) every year &15.4% every 2 years (6) 6. Rajiv R., Pradeep G., Padmajakumari R., Tarun S. Knowledge and attitude of general practitioners towards diabetic retinopathy practice in South India. Community Eye Health. 2006 March; 19(57):13 - 14.
- Oega et al: 51.6% never did fundus examination (3) • Mensah V. et al: 16(17.6%) practice it 11% details of the retina 33% ophthalmoscope (1) - Rajiv et al: 2 (2/159) of the general practitioners (6) - Khandekar et al: 20 (50%) fundus examination 9 (22.5%) details of the retina (2) 2. Khandekar R, Shah S, Al Lawatti J. Retinal examination of diabetic patients: knowledge, attitudes and practices of physicians in Oman. East Mediterr Health J. 2008;14 (4):850-7. 6. Rajiv R., Pradeep G., Padmajakumari R., Tarun S. Knowledge and attitude of general practitioners towards diabetic retinopathy practice in South India. Community Eye Health. 2006 March; 19(57):13 - 14.
- Oega et al: 51.6% referred and advised yearly eye examination, 38.5% referred only when patient had visual complaints (3) • Mensah V et al: 92.3% referred their diabetic patients (1) - Yung CW et al: 35% never refer, 26% refer all patients (7) 7. Yung CW, Boyer MM, Marrero DG, Gavin TC. Patterns of diabetic eye care by primary care physicians in the state of Indiana. Ophthalmic Epidemiology. 1995 Jun; 2(2): 85-91.
Table 8: Association between respondents’ practice on examining the fundus of their diabetic patient and practice on having access to an ophthalmoscope at work
CONCLUSION • The study participants generally had a poor knowledge on DR • Participants had good knowledge about relationship between DR and others end organs which can be affected by microvascular complication of diabetes mellitus like kidney 62 (76.5%) • Participants had very poor practice on screening for DR, with only 22.2% testing the vision in a year and only 5(6.2%) attempted fundus examination on their diabetic patients.
Conclusions ctnue • The participants had good practice in referral of diabetic patients 66(81.5%) • The majority of general practitioners did not have access to an ophthalmoscope at their work place 77(95.1%). • Undergraduate ophthalmology training in medical school is adequate according to the participants. But, my results demonstrated the opposite
RECOMMANDATIONS • Continuous medical education and workshops could be organized to refresh doctors’ knowledge about DR and how to screen for it • Undergraduate ophthalmology training should be reorganized in order to make it more skill oriented • Ophthalmoscopes and charts for testing vision should be available in the different District and regional hospitals
STUDY LIMITATIONS • This study was conducted in the North region of Burundi and did not reach all General Practitioners in the entire country. Results may not reflect the reality for the entire country • Because of the nature of the questionnaire open – ended questions, all participants did not answered all questions denoted as unknown