Exploring public health intervention strategies to address barriers and challenges in the prevention of avoidable blindness due to glaucoma in Anambra State, Nigeria

Renewed emphasis by World Health Organisation in recent times has heightened the need for countries to address the issue of eye health with increased effort. However, due to scarcity of both human and material resources in Nigeria and many other developing countries health care is often marginalised; especially eye health. This contributes to the rise in prevalence of avoidable blindness. Glaucoma has been identified as one of the major causes of avoidable blindness globally, yet many people still lack the awareness of this disease. Most often the disease attacks without any obvious symptoms, and by the time the person becomes aware of the problem, probably more than 50% of the vision has been lost. Public health strategy such as health promotion when properly coordinated proves to be a cost-effective approach in tackling the incidence of avoidable blindness.
This study assessed the population’s health seeking behaviour and examined the factors and barriers which hampered the people in Anambra State, Nigeria from accessing knowledge and eye health services in order to prevent avoidable blindness due to glaucoma. It also explored how the policy makers and service providers could be prompted for positive actions.
This is a qualitative study that utilised face-to-face semi-structured interviews to investigate the level of glaucoma awareness and perception of its risk factors in the state. Purposive, non-random sampling technique was used to recruit 39 participants, [aged 21-73] for interviews. Three main stakeholders in eye health comprising of a sample of 28 key informants (the target population), 8 service providers (the eye doctors) and 3 policy makers were identified and recruited for this study. The resulting data were analysed using Nvivo 10 software and Interpretative phenomenological analysis framework. Eye health seminar was also delivered to the target population at two different venues in the state. The reason for the eye health seminar was to teach the attendees some good eye care practices that could contribute positively to blindness prevention.
Of the 28 key informants, 53.6% live in urban areas and 46.4% live in the rural areas; 39.3% of the participants were male and 60.7% were females. Glaucoma awareness appeared to be higher among people in the urban areas 39.3% than people in the rural areas 35.7%. People with higher education appeared to have better awareness than people with less education; 42.9% for people with university degree and above, 3.6% for diploma, 17.9% for people with secondary education and 10.7% for primary. Glaucoma was perceived as “a dangerous eye disease that can cause blindness if not treated early; a serious eye problem; an incurable eye problem that can eventually result to blindness, and a dangerous eye problem that can easily render a person blind”.
Poverty and inability to pay for eye care services has been the most prominent barrier among this population. Other barriers include distance of eye care service centres from the rural dwellers, fear of financial exploitation from the service providers, fear of negative treatment outcomes and the availability of other cheaper but unsafe treatment options. Other barriers identified were: the lack of awareness of eye diseases and the related risk factors, the inability to cope with eye disease, and the seriousness of the symptoms. Five apriori themes and fourteen emergent themes were identified in the analysis of the data.
The implication of these findings is that the incidence of glaucoma-induced blindness will continue to rise unless a robust public health policy and adequate resources are put in place to address the challenges and problems identified by this study. The result of the present study confirms that there is low awareness of the causes and consequences of glaucoma in the state. This, as well as the associated factors listed above have huge impact on economy and well-being of the population.