The Appointment System Influences Uptake of Cataract Surgical Services in Rwanda
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample Selection
2.2. Ethics
2.3. Data Collection
- Sociodemographic characteristics: Literacy status (literate vs. illiterate), socioeconomic status (Ubudehe Level 1 (poorest) to 4 (wealthiest)), family support status (number of children, escorted to appointment, decision-making), travel time to the eye clinic (hours), cost of transport (US$);
- Whether counselling about surgery was delivered by the ophthalmic clinic officer (counselling received vs. not received);
- Appointment-related factors such as ownership of a mobile telephone in the family, whether a specific date was provided for the surgical appointment, method of receiving appointment information, whether a reminder was provided, the number of days between the diagnosis and surgical appointment;
- General health status (e.g., diabetes, hypertension, HIV and AIDS, rheumatoid arthritis, chronic heart problems);
- Self-reported disability using the Washington group short set of questions on disability [11].
2.4. Analysis
3. Results
3.1. Uptake of Appointment
3.2. Factors Associated with Uptake of Appointments
3.3. Barriers to Uptake of Appointment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Sample Frame n = 297 | Participants n = 221 | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Facility | Attended Surgical Appointment | Did not Attend Surgical Appointment | Attended Surgical Appointment | Did not Attend Surgical Appointment | ||||||||
M | F | T | M | F | T | M | F | T | M | F | T | |
Referral Hospital | ||||||||||||
Kabgayi | 19 | 31 | 50 (66.6) | 10 | 15 | 25 (33.3) | 12 | 16 | 28 (57.1) | 8 | 13 | 21 (42.9) |
Ruhengeri | 7 | 14 | 21 (60.0) | 5 | 9 | 14 (40.0) | 5 | 11 | 16 (72.7) | 2 | 4 | 6 (27.3) |
District Hospital | ||||||||||||
Nemba | 13 | 27 | 40 (42.1) | 19 | 36 | 55 (57.9) | 13 | 27 | 40 (50.6) | 13 | 26 | 39 (49.3) |
Nyamata | 6 | 11 | 16 (55.2) | 5 | 8 | 13 (44.8) | 6 | 11 | 17 (68.0) | 3 | 5 | 8 (32.0) |
Kabutare | 15 | 17 | 32 (51.6) | 11 | 19 | 30 (48.4) | 12 | 13 | 25 (54.3) | 8 | 13 | 21 (45.6) |
Total | 60 | 100 | 160 (53.9) | 50 | 87 | 137 (46.1) | 48 | 78 | 126 (57.0) | 34 | 61 | 95 (43.0) |
Total | Attended | OR (95%CI) | p-Value * | |||
---|---|---|---|---|---|---|
n | % | |||||
Literate | No | 157 | 80 | (51.0) | Ref | |
Yes, with difficulty | 24 | 17 | (70.8) | 2.3 (0.9–5.9) | 0.07 | |
Yes, easily | 40 | 29 | (72.5) | 2.5 (1.2–5.4) | 0.02 | |
Number of children | 8+ | 63 | 24 | (38.1) | Ref | |
4 to 7 | 123 | 79 | (64.2) | 2.3 (1.2–4.3) | 0.008 | |
<4 | 35 | 24 | (68.6) | 3.1 (1.3–7.4) | 0.01 | |
Vision impairment (VI) | Not VI | 38 | 25 | (65.8) | Ref | |
Mild | 41 | 22 | (58.5) | 0.7 (0.1–2.0) | 0.5 | |
Moderate | 82 | 28 | (34.2) | 0.3 (0.1–0.6) | 0.002 | |
Severe | 29 | 23 | (79.3) | 2.0 (0.6–6.1) | 0.2 | |
Blind | 31 | 26 | (84.0) | 2.7 (1.1–10.0) | 0.03 | |
Mobile telephone in the family | No | 120 | 45 | (37.5) | Ref | |
Yes | 101 | 66 | (65.4) | 3.6 (2.0–6.3) | <0.0001 | |
Counselling received | Yes | 187 | 100 | (54.3) | Ref | |
No | 37 | 26 | (70.3) | 0.5 (0.2–1.1) | 0.08 | |
Specific appointment date provided | No | 74 | 26 | (31.4) | Ref | |
Yes | 133 | 100 | (75.2) | 2.3 (1.3–5.2) | 0.004 | |
Appointment reminder provided | No | 105 | 54 | (51.5) | Ref | |
Yes | 26 | 23 | (88.5) | 6.4 (1.8–22.9) | 0.004 | |
Number of days between diagnosis and surgical appointment | 30+ | 39 | 22 | (56.4) | Ref | |
10 to 29 | 38 | 22 | (57.9) | 1.4 (0.8–4.1) | 0.1 | |
<10 | 66 | 44 | (66.6) | 1.6 (1.1–4.3) | 0.05 | |
Walking difficulties | None | 161 | 99 | (61.5) | Ref | |
Some/a lot | 60 | 27 | (45.0) | 0.5 (0.3–0.9) | 0.03 |
Barriers | Referral Hospital—Permanent Services (n = 27) | District Hospital—Outreach Services (n = 68) | ||||
---|---|---|---|---|---|---|
Male | Female | Total (n, %) | Male | Female | Total (n, %) | |
Cost | 6 | 12 | 18 (66.6) | 7 | 22 | 29 (42.6) |
Insufficient/unclear information | 2 | 2 | 4 (14.8) | 13 | 27 | 40 (58.8) |
Lack of escort | 2 | 4 | 6 (22.2) | 0 | 7 | 7 (10.3) |
Sickness/other disability | 1 | 2 | 3 (11.1) | 6 | 4 | 10 (14.7) |
Fear of surgery | 2 | 2 | 4 (14.8) | 1 | 3 | 4 (5.9) |
Lack of transport | 0 | 0 | 0 (0.0) | 4 | 5 | 9 (13.2) |
Other | 1 | 0 | 1 (3.7) | 6 | 7 | 13 (19.1) |
Enablers | Referral Hospital—Permanent Services (n = 20) | District Hospital—Outreach Services (n = 14) | ||||
---|---|---|---|---|---|---|
Male | Female | Total (n, %) | Male | Female | Total (n, %) | |
Received information | 4 | 10 | 14 (70.0) | 5 | 2 | 7 (50.0) |
Family support | 2 | 9 | 11 (55.0) | 4 | 4 | 8 (57.1) |
Transport provided | 3 | 1 | 4 (20.0) | 2 | 2 | 4 (28.6) |
Severity of vision loss | 1 | 4 | 5 (25.0) | 0 | 2 | 2 (14.3) |
Other | 0 | 0 | 0 (0.0) | 2 | 3 | 5 (35.7) |
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Kitema, G.F.; Morjaria, P.; Mathenge, W.; Ramke, J. The Appointment System Influences Uptake of Cataract Surgical Services in Rwanda. Int. J. Environ. Res. Public Health 2021, 18, 743. https://doi.org/10.3390/ijerph18020743
Kitema GF, Morjaria P, Mathenge W, Ramke J. The Appointment System Influences Uptake of Cataract Surgical Services in Rwanda. International Journal of Environmental Research and Public Health. 2021; 18(2):743. https://doi.org/10.3390/ijerph18020743
Chicago/Turabian StyleKitema, Gatera Fiston, Priya Morjaria, Wanjiku Mathenge, and Jacqueline Ramke. 2021. "The Appointment System Influences Uptake of Cataract Surgical Services in Rwanda" International Journal of Environmental Research and Public Health 18, no. 2: 743. https://doi.org/10.3390/ijerph18020743