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. Kariuki Millicent Muthoni -Prof. Jefitha Karimurio-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.

KNOWLEDGETable 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.

Organs Number of Respondents Percentage

Eye 75 92.6

Kidney 62 76.5

Foot 30 37.0

Heart 27 33.3

Brain 20 24.7

Genital organs 7 8.6

Peripheral nerves 6 7.4

Stomach 1 1.2

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.

Parts of the eye Number of Respondents Percentage

Retina 77 95.1

Optic nerve 17 21.0

Cornea 14 17.3

Vessels 11 13.6

Lens 8 9.9

Iris 4 4.9

Pupil 2 2.5

Table 3: Respondent's response on factors that influence the presence or severity of diabetic retinopathy (n = 81)

Responses Number of Respondents Percentage

Poor glucose control 56 69.1

Hypertension 20 24.7

Duration 13 16.1

Alcoholism 12 14.8

Smoking 9 11.1

Obesity 3 3.7

Diet 3 3.7

HIV/Aids 3 3.7

Inactivity 2 2.5

Lipids profile 2 2.5

No Response 7 8.6

- 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. Mmed Dissertion; 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

Response Number of Respondents Percentage

Diabetic Retinopathy is treatable

Yes 61 75.3

No 11 13.6

Don't Know 9 11.1

Treatment modalities that are available

35

43.2

Laser photocoagulation

Normalization of blood sugar level 31 38.3

Ocular surgery 9 11.1

Normalization of blood pressure 2 2.5

Medical treatment 2 2.5

Others 5 6.2

No Response 24 29.6

- 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)

  Variables

1 = Strongly Disagree 5 = Strongly Agree Number of respondents (n= 81) and (%)

Strongly Disagree

Moderately Disagree

Neutral Moderately Agree

Strongly Agree

Mean SD

Eye examination is only required in diabetic patients when vision is affected 

75 (92.6) 0 0 3 (3.7) 3 (3.7) 1.26Disagree

0.932

Fundoscopy done by a General Practitioner can help to detect early DR

8 (9.9) 3 (3.7) 6 (7.4) 24 (29.6) 40 (49.4) 4.05Agree

1.274

-Oega et al: 87.9%, Mensah V. et al: 98.9%-Mensah V.et al: 92.3%

  Variables

1 = Strongly Disagree 5 = Strongly Agree

Frequency (%) n = 81

Strongly Disagree

Moderately Disagree

Neutral Moderately Agree

Strongly Agree

Mean SD

Ophthalmology training in medical school was enough to detect patients with DR

12 (14.8)

2 (2.5) 9 (11.1) 21 (25.9) 37 (45.7) 3.85Agree

1.415

- 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.

Table 6: Respondents’ practice of vision testing Responses N of Resp PercentageTest the vision of diabetic patients (n = 81) Yes 

 23

 28.4

No 

58 71.6

How often do you test the vision of diabetic patient (n= 81)    

 After diagnosis 

2 2.5

At every clinic visit 

12 14.8

3 months after diagnosis 

1 1.2

6 months after diagnosis 

3 3.7

Annually 

2 2.5

If patient has visual complaints 3 3.7

- 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.

Table 7: Respondents’ practice on fundus examinationResponse N of resp Percentage

Do you examine the fundus (retina) of diabetic patient(n=81) 

   

Yes 

5 6.2

No 76 93.8

Appreciate details of the retina during Fundoscopy(n = 5) 

   

Yes 

1 20.0

No 4 80.0

Always have access to an ophthalmoscope at work (n = 81) 

   

Yes 

4 4.9

No 77 95.1

- 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.

Response N of resp Percentage

Refer diabetic patients for eye examination (n = 81) 

   

Yes 

66 81.5

No 

15 18.5

How often do you refer diabetic patients for eye examination (n = 66) 

   

After diagnosis 

37 56.1

If patient has visual complaints 29 43.9

Table 8: Respondents’ practice on referral of diabetic patients

- 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

Variables Always have access to an ophthalmoscope at

work

Chi square test (95% CI)

P value

Yes No

Examine the fundus (retina) of your diabetic patient (n = 81)

       

Yes, n = 5 4 (80.0) 1 (20.0) 63.958 0.000 No, n = 76 

0 (0.0)76

(100.0)

   

CONCLUSION1. The study participants generally had a poor knowledge on

DR

2. 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%)

3. 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

4. The participants had good practice in referral of diabetic patients 66(81.5%)

5. The majority of general practitioners did not have access to an ophthalmoscope at their work place 77(95.1%).

6. Undergraduate ophthalmology training in medical school is adequate according to the participants. But, my results demonstrated the opposite

 

RECOMMANDATIONS

1.Continuous medical education and workshops could be organized to refresh doctors’ knowledge about DR and how to screen for it

2.Undergraduate ophthalmology training should be reorganized in order to make it more skill oriented

3.Ophthalmoscopes and charts for testing vision should be available in the different District and regional hospitals

STUDY LIMITATIONS

1.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

2.Because of the nature of the questionnaire open – ended questions, all participants did not answered all questions denoted as unknown