An Evaluation of Practitioner Competency and Practices in Diagnosing and Managing Keratoconus in Malawi: A...

This study assessed eye care practitioners' competencies, clinical practices, and barriers related to KC diagnosis and management in Malawi. A national cross-sectional study was conducted among eye care practitioners in Malawi. Data were collected using a structured questionnaire assessing demographics, self-reported competency in KC diagnosis and management, clinical practices, service availability, and barriers to care. Data analysis was conducted using Stata version 15 and R version 4.5.1. A total of 110 practitioners participated (response rate: 58.5%). The mean age was 35.4 ± 7.4 years, and optometrists constituted 60.9% of respondents. Diagnostic competency scores were consistently higher than management competency scores across knowledge, skills, and experience domains. Higher educational attainment was independently associated with diagnostic competency, with undergraduate (aOR = 3.3; 95% CI: 1.13-9.63) and postgraduate practitioners (aOR = 6.6; 95% CI: 1.91-22.62) demonstrating greater odds of competency than diploma holders. Equipment shortages were significantly associated with facility type (p = 0.035), while other barriers showed no significant variation across regions or levels of care. Eye care practitioners in Malawi reported moderate competency in KC diagnosis and management, with stronger confidence in diagnosis than management. Strengthening practitioner training, improving access to diagnostic technologies, and enhancing affordability of contact lens services may improve KC care delivery and visual outcomes.