Eye Care Utilization among Older Subjects with Visual Impairment in Northwest Ethiopia


Purpose: To find out the level of eye care service utilization and its determinants among the elderly visually impaired populations while visiting ophthalmic outreach locations in North[1]Western Ethiopia, 2021.

Methods: An ophthalmic outreach-based cross-sectional study was conducted on 852 visually impaired older people. Participants were selected by using a systematic random sampling method from January to July 2021. Data were collected by using an interviewer-administered questionnaire and an ocular examination. The collected data were entered into the Epi Info 7, and analyzed using SPSS 20. A binary logistic regression was fitted.

Results: A total of 821 participants, with a response rate of 96.5%, were included in the study. The utilization of eye care services within the past two years prior to the study was 21.1% (95 % CI: 18.2–23.9). Having systemic disease (AOR = 3.2, 95% CI: 1.5–7.0), being a spectacle wearer (AOR = 4.5, 95% CI: 2.0–9.4), having visual impairment at distance (AOR = 2.9; 95% CI: 1.5–5.6), being blind (AOR = 2.9; 95% CI: 1.5–5.6), duration of visual impairment ≤1 year (AOR = 2.5; 95% CI: 1.3–4.9) were all significantly associated.

Conclusion: In this study, utilization of eye care services was low. Being visually impaired at distance, being blind, recent onset of visual impairment, being a spectacle wearer, and having systemic disease were all related to the use of eye care services. The commonest barriers to utilization of eye care services were financial scarcity and long distances between eye care facilities.


Eye Care Services; Ethiopia; Visual Impairments

1. Bourne R, Steinmetz JD, Flaxman S, Briant PS, Taylor HR, Resnikoff S, et al. Trends in prevalence of blindness and distance and near vision impairment over 30 years: An analysis for the Global Burden of Disease Study. Lancet Glob Health 2021;9:e130–e143.

2. WHO. WHO launches first world report on vision. 2019.

3. Mashige K, Martin C. Utilization of eye care services by elderly persons in the northern Ethekwini district of KwaZulu-Natal province, South Africa. Afr Vision Eye Health 2011;70:175–181.

4. Kumari R, Singh KP, Dubey G, Awasthi AA, Srivastava MR, Garg P, et al. Chronic impediment in utilization of eye-care services. J Ophthalmol Res 2020;3:45–56.

5. Robin AL, Nirmalan PK, Krishnadas R, Ramakrishnan R, Katz J, Tielsch J, et al. The utilization of eye care services by persons with glaucoma in rural south India. Trans Am Ophthalmol Soc 2004;102:47–54.

6. Morka ED, Yibekal BT, Tegegne MM. Eye care service utilization and associated factors among older adults in Hawassa city, South Ethiopia. PLoS One 2020;15:e0231616.

7. Kimani K, Karimurio J, Gichuhi S, Sheila M, Nyaga G, Wachira J, et al. Barriers to utilization of eye care services in Kibera and Dagoreti Divisions of Nairobi. Kenya; 2008.

8. Adimassu NF, Asefa NL, Anibesei DH, Belete G. Poor eye care service utilization among adults in Gondar City, Northwest Ethiopia. EC Ophthal 2018;9:647–657.

9. Arinze OC, Eze BI, Ude NN, Onwubiko SN, Ezisi CN, Chuka-Okosa CM. Determinants of eye care utilization in rural South-Eastern Nigeria. J Community Health 2015;40:881–890.

10. Li LS, Ge ZY, Lohfeld L, Zhou K, Zhou WH, Cui LL, et al. Knowledge, attitudes and practices related to seeking medical eyecare services by adults with moderate-tosevere visual impairment in rural Yueqing, Wenzhou, China: A cross-sectional survey. Int J Ophthalmol 2020;13:1115–1123.

11. Ahmad K, Zwi AB, Tarantola DJ, Azam SI. Eye care service use and its determinants in marginalized communities in Pakistan: The Karachi marine fishing communities eye and general health survey. Ophthalmic Epidemiol 2015;22:370–379.

12. Elliott AF, Heskett M, Spiker C, McGwin G Jr, Owsley C. Low rates of eye care utilization among visually impaired subsidized senior housing residents. Aging Ment Health 2021;25:360–366.

13. Morales LS, Varma R, Paz SH, Lai MY, Mazhar K, Andersen RM, et al. Self-reported use of eye care among Latinos: The Los Angeles Latino Eye Study. Ophthalmology 2010;117:207–215.e1.

14. Ja E, Go OO. Barriers to utilization of eye care services in rural communities in Edo State, Nigeria. Borno Med J 2014;11:98–104.

15. Melese M, Alemayehu W, Friedlander E, Courtright P. Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia. Trop Med Int Health 2004;9:426–431.

16. Vela C, Samson E, Zunzunegui MV, Haddad S, Aubin MJ, Freeman EE. Eye care utilization by older adults in low, middle, and high income countries. BMC Ophthalmol. 2012 Apr;12:5.

17. Aljied R, Aubin MJ, Buhrmann R, Sabeti S, Freeman EE. Eye care utilization and its determinants in Canada. Can J Ophthalmol 2018;53:298–304.

18. Fotouhi A, Hashemi H, Mohammad K. Eye care utilization patterns in Tehran population: A population based crosssectional study. BMC Ophthalmol 2006;6:4.

19. Chou CF, Sherrod CE, Zhang X, Barker LE, Bullard KM, Crews JE, et al. Barriers to eye care among people aged 40 years and older with diagnosed diabetes, 2006–2010. Diabetes Care 2014;37:180–188.

20. Kovai V, Krishnaiah S, Shamanna BR, Thomas R, Rao GN. Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India. Indian J Ophthalmol 2007;55:365–371.

21. Ntsoane M, Oduntan O. A review of factors influencing the utilization of eye care services. Afr Vision Eye Health 2010;69:182–192.

22. Owsley C, McGwin G, Scilley K, Girkin CA, Phillips JM, Searcey K. Perceived barriers to care and attitudes about vision and eye care: Focus groups with older African Americans and eye care providers. Invest Ophthalmol Vis Sci 2006;47:2797–2802.

23. Thompson AC, Thompson M, Sanislo SR, Lin RC, Sanislo SR, Moshfeghi DM, et al. Barriers to eye care service utilization and potential strategies to improve follow-up in patients with glaucoma, AMD, and diabetic retinopathy. Invest Ophthalmol Vis Sci 2012;53:1432.

24. Assefa NL, Admas AW, Adimasu NF. Prevalence and associated factors of visual impairment among adults at Debre Berhan town, North Shewa, Ethiopia. BMC Ophthalmol 2020;20:316.

25. Cheng F, Shan L, Song W, Fan P, Yuan H. Distance- and near-visual impairment in rural Chinese adults in Kailu, Inner Mongolia. Acta Ophthalmol 2016;94:407–413.

26. Marmamula S, Keeffe J, Challa R, Mohd J, Khanna RC. Near-vision impairment and effective near-vision spectacle coverage in two districts in Telangana, India: A population-based cross-sectional study. BMJ Open 2021;11:e047131.

27. Thapa SS, Berg RV, Khanal S, Paudyal I, Pandey P, Maharjan N, et al. Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: The Bhaktapur Glaucoma Study. BMC Ophthalmol 2011;11:2.

28. Marmamula S, Giridhar P, Khanna RC. Utilization of eye care services among those with unilateral visual impairment in rural South India: Andhra Pradesh Eye Disease Study (APEDS). Int J Ophthalmol 2017;10:473– 479.

29. Kyaw K, Nanthamonkolchai S, Munsawaengsub C. Eye care seeking behavior on prevention of blindness among elderly in urban area of Magway Township, Myanmar [IJOES]. Int J Ophthalmol Eye Sci 2018;6:351–357.

30. Katibeh M, Sabbaghi H, Kalantarion M, Nikkhah H, Mousavi B, Beiranvand R, et al. Eye care utilization in a community-oriented mobile screening programme for improving eye health in Iran: A cluster randomized trial. Ophthalmic Epidemiol 2020;27:417–428.

31. Barrenechea-Pulache A, Portocarrero-Bonifaz A, Hernández-Vásquez A, Portocarrero-Ramos C, MoscosoCarrasco J. Determinants of eye care service utilization among Peruvian adults: Evidence from a nationwide household survey. Ophthalmic Epidemiol 2021:1–10.

32. Chheda K, Wu R, Zaback T, Brinks MV. Barriers to eye care among participants of a mobile eye clinic. Cogent Med 2019;6:1650693.

33. Ilechie AA, Otchere H, Darko-Takyi C, Halladay AC. Access to and utilization of eye care services in Ghana. Int J Health Res 2013;6 :7–14.

34. Rono MMed HK, Macleod D, Bastawrous A, Wanjala E, Gichangi M, Burton MJ. Utilization of secondary eye care services in western Kenya. Int J Environ Res Public Health 2019;16:3371.