Transcript presentation results power point Dr Leopold

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
1. 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
5 not
participated
86 general
practitioners
1 lacking of
time
4 out of duty
81 participated
participation
rate 94.2%
81 questionnaires
submitted,
completed&
analysed
DEMOGRAPHIC DATA
Distribution 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)
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
- 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)
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
- 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)
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
9
11.1
Don't Know
Treatment modalities that are available
Laser photocoagulation
35
43.2
31
38.3
Ocular surgery
9
11.1
Normalization of blood pressure
2
2.5
Medical treatment
2
2.5
Others
5
6.2
24
29.6
Normalization of blood sugar level
No Response
- 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 Moderately Neutral Moderate Strongly Mean
Disagree Disagree
ly Agree Agree
Eye examination is 75 (92.6) 0
only required in
diabetic patients
when vision is
affected
0
Fundoscopy done 8 (9.9)
by a General
Practitioner can
help to detect early
DR
6 (7.4) 24 (29.6) 40 (49.4) 4.05 1.274
Agree
3 (3.7)
3 (3.7)
-Oega et al: 87.9%, Mensah V. et al: 98.9%
-Mensah V.et al: 92.3%
3 (3.7)
SD
1.26 0.932
Disag
ree
1 = Strongly Disagree
5 = Strongly Agree
Frequency (%) n = 81
Variables
Strongly Moderately
Disagree Disagree
Ophthalmology 12
training in
(14.8)
medical school
was enough to
detect patients
with DR
2 (2.5)
Neutral
Moderatel Strongly
y Agree
Agree
Mean
SD
9 (11.1) 21 (25.9) 37 (45.7) 3.85
1.415
Agree
- 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
Test the vision of diabetic patients (n = 81)
Yes
No
N of Resp
Percentage
23
28.4
58
71.6
2
2.5
12
14.8
1
1.2
3
3.7
2
2.5
3
3.7
How often do you test the vision of diabetic patient (n= 81)
After diagnosis
At every clinic visit
3 months after diagnosis
6 months after diagnosis
Annually
If patient has visual complaints
- 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 examination
Response
Do you examine the fundus (retina) of diabetic patient(n=81)
Yes
N of resp
Percentage
5
6.2
76
93.8
1
20.0
No
Always have access to an ophthalmoscope at work (n = 81)
4
80.0
Yes
4
4.9
No
77
95.1
No
Appreciate details of the retina during Fundoscopy(n = 5)
Yes
- 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.
Table 8: Respondents’ practice on referral of diabetic
patients
Response
N of resp
Percentage
Refer diabetic patients for eye examination (n = 81)
Yes
No
66
81.5
15
18.5
37
56.1
29
43.9
How often do you refer diabetic patients for eye
examination (n = 66)
After diagnosis
If patient has visual complaints
- 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 Chi square P value
an ophthalmoscope at test (95% CI)
work
Yes
No
4 (80.0)
1 (20.0)
Examine the fundus (retina) of
your diabetic patient
(n = 81)
Yes, n = 5
No, n = 76
0 (0.0)
76
(100.0)
63.958
0.000
CONCLUSION
1. 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