Knowledge, attitude and practice of medical officers on diabetic retinopathy in Kampala District, Uganda

Abstract

Background: Diabetic retinopathy is a common complication of diabetes mellitus and it is among the preventable causes of blindness. Diabetic patients usually come for eye checkup at a late stage of diabetic retinopathy, when there are visual complaints. Screening and management at an early stage of the disease will prevent diabetic retinopathy or at least delay its progress. In Uganda medical officers are among the primary care clinicians for diabetic patients and they are at the front line in the management of diabetic patients, yet little is known about their knowledge, attitude and practice concerning diabetic retinopathy.

Aim: To explore the level of knowledge, attitude and practice of medical officers regarding diabetic retinopathy. Methods and materials: This was a cross- sectional study among medical officers in six selected hospitals in Kampala city at medical out-patients‟ departments and medical wards from January 2018 to March 2018 using a pre-tested questionnaire designed in knowledge, attitude and practise sections. Purposeful sampling method was used to choose the study hospitals and sample size calculated using modified Kish and Leslie formulae. Data was entered using Epi data version 3.1 and Statistical analysis was done using STATA version 4.0 computer package and results summarized.

Results: The numbers of respondents interviewed in this study were 111, of whom 38.7% were intern doctors,32.4% were general medical officers and 28.8% were senior house officers. More than a third of the respondents (66.7%) were male and the majority of the respondents were of age group 25-30 years, (70.2%). More than a half, (53.2%) had practiced for less than one year. Regarding knowledge, the total knowledge level among the respondents was poor. The vast majority of the respondents, (85%) knew that diabetes mellitus(DM) affects the retina, however only a few were aware that DM can affect the iris (5%), retinal vessels (15%) and the cornea (12%). Less than a quarter knew other fundus changes due to diabetes such as micro-aneurysms (28%) and retinal neovascularization (20%) while (20%) did not know any changes that can be seen on fundus examination. The majority of the respondents, (76%)were aware that DR can be treated, only a few mentioned ocular surgeries, 18%, medical treatment, (23%) and Laser photocoagulation (28%)as modes of treatment.

Concerning attitude towards eye examination, (73%) of the participants said that fundus examination by non-ophthalmologists would help detect diabetic retinopathy(DR) in diabetic patients. Regarding practice on eyes examination, only 36% of the respondents had access to an ophthalmoscope at work place and fundus exam was done by less than a third of the respondents (31%). More than a half (58%) of the respondents were able to refer diabetic patients to an eye healthcare worker.

Conclusion: The level of knowledge about diabetic retinopathy is poor, although majority of the respondents were aware of the complications of diabetes, and attitude regarding DR was good. 73% of the medical officers agreed that fundus examination by the non-ophthalmologist could help detect DR while practice on referral of DM patients was good and majority refer DM although there was poor practice on fundoscopy. Recommendations  Conduct teaching workshop on fundoscopy and continuous medical education on diabetic retinopathy.  Provide basic screening equipments and screening guideline for diabetic retinopathy at each medical unit.  Development and dissemination of screening guidelines to the medical officers.  The training during internship should include rotation of intern doctors in ophthalmology department.  The curriculum for training senior house officers in internal medicine should include training in ophthalmology to improve on their skills.