Diabetic retinopathy; knowledge, attitudes and practice among general practitioners in provincial hospitals in Kenya

Abstract

Background: Diabetes is increasingly becoming a significant problem in Kenya with more than three million people affected. Diabetic retinopathy, a complication of diabetes is among the leading causes of avoidable and preventable blindness. There are no data on awareness of diabetic retinopathy among general practitioners (GPs) in Kenya. The GPs are the primary health care providers for most diabetic patients. As such they are well placed to assess ahd refer diabetic patients to the eye specialists. This study aimed at evaluating the awareness of diabetesrelated eye disease among GPs working at provincial hospitals in Kenya. Design: A cross-sectional study Objective: To assess and determine the knowledge, attitudes and practices of general practitioners working at provincial hospitals in Kenya toward diabetic retinopathy. Methodology: The study was carried out at seven provincial general hospitals in Kenya. Participants comprised of general practitioners working at these hospitals. The GPs were given a self administered questionnaire following which the data collected was coded, entered and managed in a pre-designed Microsoft Access database. Data analysis was carried out using SPSS version 17.0. Results were presented in tables, graphs and pie charts. Results: Ninety one GPs were interviewed over a period of two months in the seven PGH's. The male to female ratio was 1: 1 and mean age was 27.8years (SD 4). The level of knowledge regarding diabetes and its complications was good among the study GPs. All GPs (100%) indicated that the eyes and visual function can be impaired in DM. There were gaps noted regarding the factors influencing the presence, severity and complications of DR. Only 46.2% and 33% were aware ofrenal disease and pregnancy respectively as being factors that can affect presence and severity of DR. Among the GPs in the study 65.9% and 52.7% were not aware of vitreous hemorrhage and retinal detachment respectively as being complications of DR. The practice patterns of GPs in regard to DR were generally poor with 60.5% never examining vision or only doing so when the patient complained of visual symptoms. Among these GPs 63.7% never examine the retina of their diabetic patient while 38.5% only refer DM patients to the eye specialist when they have a complaint. Conclusions: This study establishes gaps in the knowledge on diabetic retinopathy among general practitioners working at provincial hospitals in Kenya. This included lack awareness of sight threatening complications of diabetic retinopathy such as retinal detachment and vitreous hemorrhage. It also established that the GPs had good attitude toward DR though this did not translate to good practice patterns.