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Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study
Simon Arunga1,2, Allen Asiimwe3, Eunice Apio Olet4
1Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda.
Wellcome Open Research
|October 24, 2019
Summary
Using traditional eye medicine for microbial keratitis in Uganda leads to delayed presentation and worse visual outcomes. Public health initiatives should encourage seeking conventional care for better results.
Area of Science:
- Ophthalmology
- Public Health
- Medical Anthropology
Background:
- Traditional eye medicine (TEM) is widely used for microbial keratitis (MK) in Africa.
- Concerns exist regarding TEM's association with poorer MK outcomes.
- This study investigated TEM's impact on MK presentation and outcomes in Uganda.
Purpose of the Study:
- To determine the impact of TEM use on the clinical presentation and outcomes of microbial keratitis.
- To explore the reasons behind the use of TEM for MK treatment in Uganda.
Main Methods:
- A mixed-method prospective cohort study was conducted in Southern Uganda.
- Data collected included patient history, TEM use, microbiology, and 3-month visual outcomes.
- Qualitative interviews explored reasons for TEM use among patients, carers, and traditional healers.
Main Results:
- TEM users (188/313) presented later (18 vs. 14 days), had larger ulcers (5.6 vs. 4.3 mm), and worse presenting visual acuity (Log MAR 1.5 vs. 0.6).
- TEM users also showed poorer visual acuity at 3 months (Log MAR 0.6 vs. 0.2).
- Delayed presentation and hospital distance were associated with TEM use, driven by factors like distrust in conventional medicine, poverty, and cultural beliefs.
Conclusions:
- TEM use is linked to significantly worse clinical presentation and outcomes in microbial keratitis.
- Improving primary eye care access and implementing community-based behavioral change initiatives are crucial to reduce TEM use.
