Socio-demographic characteristics of study participants
Out of 238 sample, 230 were participated, giving a 96.68% response rate. The mean age of the participants was 49(±17.6) years. The median monthly income was 850 ETB [IQR of 500-3500ETB]. (Table 1)
Table 1: Socio-demographic characteristics of the study participants at Debark hospital, Northwest Ethiopia, 2018 (n=230)
Variable Frequency Percentage
Sex
Male 119 51.7
Female 111 48.3
Age (year)
18-35 58 25.2
36-50 63 27.4
51-62 53 23.1
≥63 56 24.3
Residence
Rural 123 53.5
Urban 107 46.5
Religion
Orthodox 170 73.9
Muslim 60 26.1
Ethnicity
Amhara 213 92.6
Tigrie 17 7.4
Marital status
Single 51 22.2
Married 143 62.2
Divorced 12 5.2
Widowed 24 10.4
Occupation
Farmer 77 33.5
Private 54 23.5
Government employed 47 20.4
Housewife 32 13.9
Retired 20 8.7
Education
Can’t read and write 89 38.7
Can read and write 45 19.6
Elementary (1-8) 27 11.7
Secondary (9-12) 23 10.0
College and above 46 20.0
Monthly income (in ETB)
≤ 500 88 38.3
501-850 23 10.0
851-3500 59 25.6
3501-8000 60 26.1
n = sample size
Health profile of study participants
The median duration of diabetes mellitus from diagnosis was 5 years [IQR 3-12]. Eight-three (36.1%) of study subjects had a history of previous eye disease. (Table 2)
Table 2: Health profile of study participants at Debark hospital, Northwest Ethiopia 2018(n= 230)
Variable Frequency Percentage
Type of DM
Type one 36 15.7
Type two 89 38.7
Don’t know 105 45.6
DM duration (years)
≤ 2 64 27.8
3-5 55 23.9
6-12 64 27.8
13-25 47 20.5
Hypertension
Yes 57 24.8
No 168 73.0
Don’t know 5 2.2
History of eye disease
Yes 83 36.1
Knowledge about diabetic retinopathy among study participants
The mean (+SD) knowledge score of study participants about DR was 5.55 (±4.66) with a maximum possible score of 14. One hundred nine (47.4%) [95% CI: 41.7%-53.9%] participants had good knowledge and 121 (52.6%) participants had poor knowledge regarding diabetic retinopathy. Among those participants who had good knowledge about DR 25.6% were males and 33.9% had urban residence. One hundred sixty-seven (72.6%) of participants knew that diabetes affects the eye.
The respective correct response on risk factors for DR for poorly controlled blood glucose level, long duration of DM, hypertension, high body mass index, smoking and pregnancy were 42.6%, 36.6%, 26.1%, 21.3%, 12.2%, 2.2% respectively. One hundred nine (66.5%) participants knew the importance of regular eye checkup. Only 14 (9.3%) mentioned laser as a treatment option for DR. (Table3)
Table 3: Knowledge of diabetic retinopathy among diabetic patients at Debark hospital, Northwest Ethiopia, 2018
Variable Frequency Percentage
Does diabetes affect the eye? (n=230)
Yes 167 72.6
No 63 27.4
Does diabetes cause blindness?
Yes 151 67.4
No 73 32.6
What Eye condition does diabetes cause? (n=164)
Diabetic retinopathy 44 26.8
Cataract 31 18.9
Glaucoma 11 6.7
Don’t know 78 47.6
What is diabetic retinopathy? (n=164)
It is the same as cataract 6 3.7
It is high sugars in the eye 16 9.8
Changes in the blood vessels of the retina 30 18.2
It is high pressure in the eye 3 1.8
Don't know 109 66.5
Should a person with DM need eye screening? (n =164)
Yes 117 71.3
No 2 1.3
Don’t know 45 27.4
How soon after the diagnosis need eye screening?
Immediately 56 51.4
One year 21 19.2
Five years 32 29.4
What treatment options are available for DR?
Medical 28 18.7
Laser 14 9.3
Surgery 20 13.3
Source of information about diabetic retinopathy
The major sources of information about diabetic retinopathy for the respondents were medical staffs from diabetic clinic and followed by their relatives or friends. (Figure 1)
Eye check-up practice of diabetic retinopathy
Ninety-one (39.6%) [95% CI: 34.3-45.7] participants had good eye check-up practice and 139(60.4%) had poor eye check-up practice regarding diabetic retinopathy. Among those who examined their eyes 65.6% reported that they got dilated fundus examination. (Table 4)
Table 4: Eye check-up practice of diabetic patients at Debark hospital, Northwest Ethiopia, 2018 (n= 230)
Variable Frequency Percentage
Have you ever been referred to check your eyes?
Yes 97 42.2
No 133 57.8
Have your eyes been examined?
Yes 95 41.5
No 134 58.5
How many times have your eyes been examined in the
last one year? (n=95)
None 4 4.2
Once 56 58.9
Twice 24 25.3
3 times 11 11.6
How often did you check your blood sugar level?
Monthly 177 77.0
Every two months 40 17.3
Every three months 13 5.7
The reasons for not getting eye checkup were reported as lack of visual symptoms (didn’t think it necessary) in 56.7% of participants and followed closely by 32.1% who felt they needed to be referred by their physician before getting their eyes examined and lack of convenient facility in 11.2% of participants.
Factors associated with knowledge of diabetic retinopathy
Age, religion, residence, ethnicity, occupation, education, monthly income, type of DM, duration of DM from diagnosis and previous eye disease were significant from the bivariable analysis and entered in to multivariable analysis. The result of the multivariable binary logistic regression analysis showed that, the odds of good knowledge among participants from urban was 2.6 times (AOR =2.65, CI: 1.16-6.07) more as compared to those from rural area. Similarly, the odds of good knowledge among participants who had monthly income of 3501-8000 ETB was 4.5 times (AOR=4.54, CI: 1.31-15.7) more as compared to those who had ≤500 ETB monthly income. The odds of good knowledge among participants having a diabetes duration of [6-12] years was 4.4 times (AOR=4.42, CI: 1.44-13.5) more as compared to participants having a DM duration of ≤2 years. The odds of good knowledge among participants who had previous eye disease was 5.5 times (AOR=5.5, CI: 2.3-13.0) more as compared to those who hadn’t it. (Table 5)
Table 5: Factors associated with knowledge of diabetic retinopathy at Debark hospital, Northwest Ethiopia, 2018 (n= 230)
Variable Knowledge COR (95% CI) AOR (95% CI)
Good poor
Sex
Female 50 61 1.00
Male 59 60 1.2(0.71-2.01)
Age (in years)
18-35 18 40 1.00 1.00
36-50 33 30 2.44(1.16-5.14) 3.16(0.6-16.4)
51-62 26 27 2.14(0.98-4.64) 2.58(0.49-13.6)
≥63 32 24 2.96(1.37-6.38) 3.17(0.5-20.0)
Residence
Rural 31 92 1.00 1.00
Urban 78 29 7.98(4.42-14.3) 2.65(1.16-6.07)*
Religion
Muslim 35 25 1.00 1.00
Orthodox 74 96 0.55(0.3-0.99) 0.79(0.32-2.0)
Ethnicity
Tigre 16 11 1.00 1.00
Amhara 93 110 0.58(0.25-1.31) 0.56(0.13-2.23)
Marital status
Single 22 29 1.00
Married 68 75 1.19(0.62-2.27)
Others 19 17 1.47(0.62-3.47)
Education
Can’t read & write 26 63 1.00 1.00
Can read & write 16 29 1.3(0.6-2.8) 0.8(0.27-2.41)
Elementary (1-8) 15 12 3.0(1.2-7.3) 1.3(0.34-4.86)
Secondary (9-12) 14 9 3.7(1.4-9.7) 1.52(0.40-5.82)
College and above 38 8 11.5(4.7-27.9) 1.62(0.36-7.23)
Occupation
Farmer 17 60 1.00 1.00
Private 30 24 4.4(2.06-9.43) 3.15(0.93-10.6)
Government 36 11 11.5(4.8-27.3) 2.36(0.54-10.2)
Housewife 13 19 2.4(0.9-5.8) 0.81(0.25-2.66)
Retired 13 7 6.5(2.2-19.0) 1.3(0.25-6.84)
Monthly income (in ETB)
≤500 18 70 1.00 1.00
501-850 10 13 2.99(1.13-7.92) 1.86(0.52-6.73)
851-3500 32 27 4.6(2.22-9.55) 1.61(0.56-4.58)
3501-8000 49 11 17.3(7.52-39.8) 4.54(1.31-15.7)*
Type of DM
Type 1 16 20 1.00 1.00
Type 2 65 24 3.38(1.51-7.59) 2.76(0.66-11.5)
Don’t know 28 77 0.45(0.21-0.99) 0.71(0.18-2.67)
Duration of DM (in years)
≤2 17 47 1.00 1.00
3-5 18 37 1.34(0.6-2.9) 2.16(0.7-6.63)
6-12 40 24 4.6(2.2-9.7) 4.4(1.4-13.5) **
13-25 34 13 7.2(3.1-16.8) 2.6(0.7-9.7)
Previous eye disease
Yes 63 20 6.9(3.7-12.7) 5.5(2.3-13.0)***
*p<0.05, **p<0.01, ***p<0.001, Others= Widowed & Divorced
Factors associated with eye check-up practice of diabetic retinopathy
Age, residence, marital status, occupation, educational level, knowledge of type of DM, monthly income, duration of DM, previous eye disease and knowledge of DR were significant onbivariable binary logistic regression model. In the multivariable binary logistic regressionanalysis duration of DM, previous eye disease and knowledge of DR were significantly associated with good eye checkup practice. The odds of good eye check-up practice among participants with a diabetes duration of [13-25] years was nearly 4 times (AOR=3.77, CI: 1.05-13.5) more as compared to participants with a DM duration of ≤ 2 years. The odds of good eye check-up practice among participants having previous eye disease was 2.4 times (AOR=2.47, CI: 1.09-5.62) more as compared to those who hadn’t it. The odds of good eye checkup practice among participants who had good knowledge of DR was 17 times (AOR=17.5, CI: 5.97-51.3) more as compared to those who had poor knowledge. (Table 6)
Table 6: Factors associated with eye checkup practice of DR at Debark hospital, Northwest Ethiopia, 2018
Variable Eye checkup practice COR (95% CI) AOR (95% CI)
Good poor
Sex
Female 44 67 1.00
Male 47 72 0.99(0.58-1.68)
Age (in years)
18-35 10 48 1.00 1.00
36-50 31 32 4.65(2.0-10.7) 4.04(0.99-14.9)
51-62 21 32 3.15(1.31-7.56) 1.49(0.31-7.09)
≥63 29 27 5.15(2.18-12.1) 1.4(0.27-7.3)
Residence
Rural 34 89 1.00 1.00
Urban 57 50 2.98(1.72-5.16) 1.01(0.39-2.25)
Religion
Muslim 26 34 1.00
Orthodox 65 105 0.81(0.44-1.47)
Ethnicity
Tigre 13 14 1.00
Amhara 78 125 0.67(0.25-1.5)
Marital status
Single 14 37 1.00 1.00
Married 56 87 1.7(0.84-3.43) 0.63(0.18-2.25)
Others 21 15 3.7(1.45-9.08) 1.85(0.38-9.08)
Occupation
Farmer 22 55 1.00 1.00
Private 19 35 1.35(0.64-2.86) 0.46(0.12-1.76)
Government 23 24 2.39(1.12-5.1) 0.41(0.09-1.92)
Housewife 14 18 1.94(0.82-4.57) 0.90(0.25-3.19)
Retired 13 7 4.64(1.63-13.2) 1.15(0.2-6.63)
Education
Can’t read & write 30 59 1.00 1.00
Can read &write 12 33 0.71(0.32-3.27) 0.36(0.11-1.23)
Elementary (1-8) 11 16 1.35(0.56-3.27) 0.62(0.16-2.45)
Secondary (9-12) 12 11 2.14(0.85-5.43) 1.42(0.36-5.66)
College and above 26 20 2.55(1.23-5.3) 0.55(0.13-2.38)
Monthly income (in ETB)
≤500 19 69 1.00 1.00
501-850 13 10 4.72(1.79-12.4) 3.85(0.99-14.9)
851-3500 19 40 1.72(0.81-3.63) 0.61(0.19-1.93)
3501-8000 40 20 7.26(3.46-5.36) 1.76(0.49-6.33)
Type of DM
Type 1 10 26 1.00 1.00
Type 2 50 39 3.33(1.44-7.73) 1.2(0.24-5.93)
Don’t know 31 74 1.09(0.47-2.53) 1.04(0.21-5.13)
Duration of DM (in years)
≤2 10 54 1.00 1.00
3-5 17 38 2.41(1.0-5.85) 2.36(0.73-7.68)
6-12 33 31 5.74(2.49-13.2) 2.9(0.96-8.77)
13-25 31 16 10.4(4.2-25.8) 3.77(1.05-13.5)*
Previous eye disease
Yes 54 29 5.53(3.08-9.93) 2.47(1.09-5.62)*
No 37 110 1.00 1.00
Knowledge of DR
Good 75 34 14.4(7.4-28.1) 17.5(5.97-31.3) ***
*p<0.05, **p<0.01, ***p<0.001, Others= Widowed & Divorced