Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study.
Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study.
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DOI：
10.12688/wellcomeopenres.15259.2
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Burton, Matthew J
中科院分区：
文献类型：
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作者：
Arunga, Simon;Asiimwe, Allen;Burton, Matthew J
背景：在非洲许多地区，传统眼科医学（TEM）经常用于治疗微生物角膜炎（MK）。很少有报道表明这与更糟糕的结果有关。我们进行了这项大型前瞻性研究，以确定TEM的使用如何影响MK的表现和结果，并探讨乌干达人们使用TEM进行治疗的原因。方法：在一项混合方法前瞻性队列研究中，我们招募了2016年12月至2018年3月期间在乌干达南部两个主要眼科就诊的MK患者，并收集了病史、TEM使用、微生物学和3个月预后的信息。我们对患者、护理人员、传统治疗师进行了定性访谈，了解人们使用TEM的原因。结果测量包括视力和3个月时，TEM使用者和非使用者的比较。一个专题编码框架被部署来探索使用瞬变电磁法的原因。结果：在313名参与者中，188人报告使用TEM。TEM用户的演示延迟；中位就诊时间18天vs 14天，p= 0.005；溃疡较大5.6 mm vs 4.3 mm p=0.0005；最小分辨角的中位数对数（Log MAR）为1.5比0.6,p=0.005；3个月时视力较差，中位Log MAR为0.6比0.2,p=0.010。在多变量logistic回归模型中，距离眼科医院的距离和延迟就诊与TEM的使用有关。使用TEM的原因包括对传统医学缺乏信心、卫生系统崩溃、贫困、对眼科医院的恐惧、对TEM的文化信仰、传统治疗师的影响、个人情况和无知。结论：TEM使用者有较差的临床表现和预后。应鼓励初级保健中心的能力建设，以改善获得眼科保健的机会，并鼓励社区改变行为倡议，反对使用TEM。
Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large prospective study to determine how TEM use impacts presentation and outcome of MK and to explore reasons why people use TEM for treatment in Uganda. Methods: In a mixed method prospective cohort study, we enrolled patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018 and collected information on history, TEM use, microbiology and 3-month outcomes. We conducted qualitative interviews with patients, carers traditional healers on reasons why people use TEM. Outcome measures included presenting vision and at 3-months, comparing TEM Users versus Non-Users. A thematic coding framework was deployed to explore reasons for use of TEM. Results: Out of 313 participants enrolled, 188 reported TEM use. TEM Users had a delayed presentation; median presenting time 18 days versus 14 days, p= 0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse presenting visual acuity median logarithm of the minimum angle of resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at 3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable logistic regression model, distance from the eye hospital and delayed presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system breakdown, poverty, fear of the eye hospital, cultural belief in TEM, influence from traditional healers, personal circumstances and ignorance. Conclusion: TEM users had poorer clinical presentation and outcomes. Capacity building of the primary health centres to improve access to eye care and community behavioural change initiatives against TEM use should be encouraged.