Health policy and eye care services in Jamaica

Opinions of South African optometry students about working in rural areas after graduation

BACKGROUND

Eye and vision problems have been reported to be more prevalent in rural than urban areas; and a large proportion of South Africans live in the rural areas.

AIM

To investigate the opinions of South African optometry students about working in rural areas after completion of their training and to identify factors that may influence their decisions.

METHOD

This was a cross-sectional quantitative study using a survey instrument containing both closed and open-ended, semi-structured questions.

RESULTS

Four hundred and thirty-eight students responded to the questionnaire (85.4% response rate). Overall, many of the respondents did not want to open their first (66%) or second practices (64.6%) in the rural areas. However, most respondents from rural backgrounds reported that they would open their first (77.2%) or second (79.4%) practice in the rural areas. The main reasons cited by the respondents for their unwillingness to work in the rural areas were financial concerns (81.2%), personal safety (80.1%) and poor living conditions (75.3%), with a significantly higher number (p < 0.05) being from urban respondents for the latter two issues only.

CONCLUSION

Many students were not in favour of opening practices in rural areas, but were willing to work for the government or a non-governmental organisation after graduation. Efforts should be made to address financial incentives, safety and living conditions in the rural areas. The results of this study have implications for the future of availability and accessibility of eye care services to those living in the rural and remote areas of the country.

Impact of geographic density of eye care professionals on eye care among adults with diabetes

OBJECTIVE

To examine the impact of the geographic density of eye care professionals (ECPs) on the receipt of annual dilated eye examinations among adults in the United States with diabetes.

METHOD

Data from the 2006 Behavioral Risk Factor Surveillance System were linked to the 2007 Area Resource File to examine the association between the density of ECPs (ophthalmologists and optometrists) per 100,000 people and self-reports of having had a dilated eye examination in the last year. The sample included adults aged 18+ years with diabetes (N = 29,495). Multivariate logistic regression was conducted to estimate adjusted odds ratios of annual dilated eye examinations, while controlling for age, sex, marital status and education, and stratifying by health insurance.

RESULTS

Approximately 10% of respondents with diabetes lived in counties with no ECPs. Prevalence of being uninsured was 7.4% and 15.5% in those with and without dilated eye exams, respectively. After controlling for covariates and stratifying by health insurance, diabetic adults with health insurance cover residing in areas with no ECPs were less likely to report having had a dilated eye examination in the past year than those with 20 or more ECPs/100,000 people (odds ratio 0.72, 95% confidence interval 0.58-0.91).

CONCLUSION

Residence in a county with a low density of ECPs reduced the likelihood of receiving annual dilated eye examinations among insured adults with diabetes. Enhancing the ability of ECPs to reach and care for those in need might better protect vision in people with diabetes. More research is needed to determine the mix of services that produces the best patient outcome.

Utilisation of public eye care services by the rural community residents in the Capricorn district, Limpopo Province, South Africa

Background

Visual impairment and blindness are major health problems worldwide, especially in the rural and remote areas of developing countries. Utilisation of eye care services is essential to reduce the burden of visual impairment and blindness, and it is therefore important that it is monitored.

Objectives

The objectives of this study were to determine the level of utilisation of public eye care services and factors that might have influenced their usage in rural communities, Capricorn district, Limpopo Province, South Africa.

Method

A population-based cross-sectional study design was used. Participants were residents in selected rural villages located within approximately 5 km of six Government hospitals. Following ethical approval and receipt of informed consent, a questionnaire with closed and open-ended questions was used to collect information on the utilisation of eye care services and factors that might influence utilisation. Descriptive statistics and Pearson's Chi-square test were used to analyse and compare the data.

Results

Many (62.7%) of the respondents had used the government eye care services in the past. Over fifty-nine per cent (59.3%) of them were satisfied with the services. Factors reported to influence utilisation (such as monthly income, knowledge of available services and the need for regular eye tests) were positively associated with utilisation of eye care services in this study (p < 0.05).

Conclusion

Utilisation of eye care services was relatively good, but varied significantly between sites. An awareness campaign by government and non-governmental organisations about eye care services may increase utilisation amongst rural communities.