Determinants of Primary Open Angle Glaucoma: Review of records of patients attending University Teaching Hospital, Lusaka, Zambia
Background: Primary open angle glaucoma (POAG) has continued to cause high disease burden globally and Zambia is no exception. We investigated the prevalence and socio-demographic determinants of POAG based on records of clients attending the eye clinic at University Teaching Hospital (UTH), Lusaka.
Methods: Data stem from serial hospital population based stored patients' records at the UTH eye clinic from 2008 to 2011 (n= 71,347). These records were examined for completeness in terms demographic information (specifically age, sex, residence and ethnicity) as well as ocular details that included the diagnosis based on full ocular examination and intra-ocular pressure. All the records that did not have any of this information were labelled as incomplete and excluded from final analysis. Multivariate logistic regression, stratified by age group and gender, was used to examine the association between demographic factors with POAG.
Results: Of the 71,347, 11.2% (7,968) did not turn up for appointments and 4.7% (3,323) records could not be found, hence the de facto eligible records that met the minimum eligibility criteria for the study 60,056 representing 84.1%. The aged ranged from 15 to 90 with a median age 47 years (IQR 42, 55). The prevalence of POAG was 4.2% (95% CI, 2.7%, 6.2%), distributed as 1.8% (95% CI 1.1, 2.9) in males and 2.4% (95% CI 1.9, 3.9) for females. The main determinants of POAG were age, sex, education and diabetic retinopathy. Females were more likely to have POAG than males (55.5% vs. 44.5%; OR 1.36, 95%CI 1.1,1.8); Similarly groups older than 55 years than younger (62.3% vs. 37.7%, P<0.001), with lower education status (45.9% vs 54.1. , P< 0.001) and those with diabetic retinopathy than without (34.0%, vs. 64.0%; OR1.2, 95%CI 0.9,1.39) had higher likelihood of POAG.
Conclusion: We found convincing evidence of POAG burden in the studied records. This finding suggests that POAG may be prevalent in the general population. This calls for setting up of both population as well as hospital based surveillance systems so as to know the exact national burden as it evolve over time. Such systems should incorporate health promotional sensitisation to promote early diagnosis as an ethical responsibility given the weight of disability associated with POAG.
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