|Year : 2014 | Volume
| Issue : 4 | Page : 184-188
Eye health seeking habits and barriers to accessing curative services among blind beggars in an urban community in Northern Nigeria
Aliyu Hamza Balarabe1, Ramatu Hassan2, Olatunji O Fatai3
1 Department of Ophthalmology, Federal Medical Centre, Birnin-Kebbi, Nigeria
2 Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria
3 Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
|Date of Web Publication||7-Oct-2014|
Aliyu Hamza Balarabe
Department of Ophthalmology, Federal Medical Centre, P.M.B 1126, Birnin-Kebbi, Kebbi State
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: The aim of the following study was to determine the types of intervention sought by the blind street beggars and assess the barriers to accessing available eye care services.
Methods: This cross-sectional study was conducted among consenting blind street beggars in Sokoto, Nigeria between May and June, 2009. A semi-structured interview was conducted to probe issues on historical antecedents of the blindness and the eye heath seeking behavior including the use of traditional eye medications. Assessment of barriers to accessing curative services among the blind persons was explored. Questions were asked and the individual responses were recorded in the questionnaire under the appropriate sections.
Results: Two hundred and two of 216 (94.7%) of the examined subjects were found to be blind and included in the analysis. The principal cause of blindness was corneal opacity. Overall 82% of the blindness was due to avoidable causes with majority irreversibly blind. Only 38 subjects (18.8%) sought for intervention in hospitals, others resorted to self-medication (42.1%), medicine store (31.2%) and traditional facility (7.9%). Those that accessed treatment at a hospital did so mainly at a primary health center (50.0%) and General Hospitals (34.2%). The barriers to accessing treatment at the hospital were mainly due to "not taken to any hospital" by the parents/relatives (50.3%) and "services not available" (25.2%).
Conclusion: Most respondents resorted to ocular self-medication particularly traditional eye medicines. We advocate for a provision of affordable, accessible and qualitative eye care services with a strong health education component on avoidable causes of blindness.
| Abstract in French|| |
Objectif: Le but de cette ιtude est de dιterminer les types d'intervention demandιe par les mendiants aveugles de rues et d'ιvaluer les obstacles ΰ l'accθs aux soins oculaires disponibles.
Mιthodes: Cette ιtude transversaux a ιtι menιe auprθs de consentants mendiants aveugles de rues ΰ Sokoto (Nigeria) entre mai et juin 2009. Une interview de semi-structured a ιtι rιalisιe pour sonder les questions sur les antιcιdents historiques de l'aveuglement et la lande d'yeux cherchant le comportement, y compris l'utilisation de mιdicaments pour les yeux traditionnels. Ιvaluation des obstacles ΰ l'accθs aux services curatifs parmi les personnes aveugles a ιtι explorιe. Questions ont ιtι posιes et les rιponses ont ιtι enregistrιes dans le questionnaire sous les sections appropriιes.
Rιsultats: Deux cent deux de 216 (94,7 %) de l'examen de sujets se sont avιrιs pour κtre aveugle et inclus dans l'analyse. La principale cause de cιcitι a ιtι l'opacitι de la cornιe. Dans l'ensemble, 82 % de la cιcitι ιtait due ΰ des causes ιvitables avec majoritι irrιversiblement aveugle. Seulement 38 sujets (18,8 %) a demandι d'intervenir dans les hτpitaux, d'autres ont eu recours ΰ self-medication (42,1 %), magasin de mιdecine (31,2 %) et l'installation traditionnelle (7,9 %). Ceux qui ont accιdι ΰ un hτpital fait donc principalement ΰ un centre de soins de santι primaires (50,0 %) et des hτpitaux gιnιraux (34,2 %). Les obstacles ΰ l'accθs aux soins ΰ l'hτpital ont ιtι principalement en raison de "ne pas prise ΰ n'importe quel hτpital" par les parents/parents (50,3 %) et les "services non disponibles" (25,2 %).
Conclusion: La plupart des rιpondants ont eu recours ΰ des remθdes traditionnels en particulier oculaires self-medication. Nous plaidons pour une prestation de services de soins ophtalmologiques abordables, accessibles et qualitative avec une composante d'ιducation santι forte sur les causes de cιcitι ιvitables.
Mots-clιs: Accθs aux services curatifs, barriθre, les mendiants aveugles, habitude de recherche santι, Nigιria
Keywords: Accessing curative services, barrier, blind beggars, health seeking habit, Nigeria
|How to cite this article:|
Balarabe AH, Hassan R, Fatai OO. Eye health seeking habits and barriers to accessing curative services among blind beggars in an urban community in Northern Nigeria. Ann Afr Med 2014;13:184-8
|How to cite this URL:|
Balarabe AH, Hassan R, Fatai OO. Eye health seeking habits and barriers to accessing curative services among blind beggars in an urban community in Northern Nigeria. Ann Afr Med [serial online] 2014 [cited 2020 Feb 25];13:184-8. Available from: http://www.annalsafrmed.org/text.asp?2014/13/4/184/142289
| Introduction|| |
The VISION 2020: The Right to Sight; a global initiative for the elimination of avoidable blindness by the year 2020 was launched in 1999. The vision seeks to eliminate the main causes of avoidable blindness by the year 2020 in order to give all people in the world the Right to Sight.  The guiding principles for VISION 2020 program are an integrated, sustainable, equitable and excellent eye care services. Despite this initiative, some blind individuals are noted to congregate and beg around some major streets in urban communities in Northern Nigeria. This attitude may be related to their eye health seeking habits or as a result of challenges in accessing eye care services.
Health seeking behavior refers to the sequence of remedial actions that individuals undertake to rectify perceived ill-health.  It is initiated with symptom definition, whereupon a strategy for treatment action is devised. Treatment choice involves a myriad of factors related to illness type and severity, pre-existing beliefs about illness causation, the range and accessibility of therapeutic options available and their perceived efficacy, convenience, opportunity costs, quality of service, staff attitudes as well as the age, gender and social circumstances of the sick individual. 
It is known that about 80% of blindness is avoidable,  implying that 8 out of 10 blind street beggars might possibly have a treatable or a preventable cause of blindness. The remaining with unavoidable causes of blindness could as well be properly rehabilitated in such a manner that they live a near normal life without having to resort to street begging. Blind persons with treatable or preventable blindness might not resort to street begging with sight restorative intervention.
The scenario above re-enacted during the Nigerian national survey of blindness and low vision.  A 58-year-old messenger, working in a State Ministry in the North-Eastern region of Nigeria had lost his sight and subsequently his job. He became a street beggar, being led about by his son. However, after being persuaded to have his eyes examined, he was diagnosed to be bilaterally blind from cataract. He subsequently underwent a successful cataract surgery at a state specialist hospital. Within 2 weeks of the procedure, he returned to work with the ministry, while his son also returned to his full-time work as a butcher.
The objective of this study was to determine the health seeking behavior and the barriers to accessing eye care services among the blind street beggars in Sokoto North local government area (LGA) of Sokoto state, Nigeria.
| Methods|| |
The cross-sectional study was conducted in Sokoto North LGA, which constitutes a segment of the Sokoto city metropolitan area and has a population of 226, 397.  The study was carried out over a period of 6 weeks from May to June, 2009. Institutional consent for the study was obtained from the University of Ilorin Teaching Hospital Ethical Committee. Approval for the commencement of field work was obtained from the LGA authority.
The blind street beggars have been noticed to congregate around eight major streets of the LGA to beg. The list of blind persons in these areas was obtained from the local traditional head of the blind (Sarkin Makafi) who gave the general consent for the study and also assisted in mobilizing the subjects. Blind subjects who consented were included in the study.
Data were collected by interviewing the subjects who met the inclusion criteria (blind street beggars that consented) using a semi structured questionnaire which captured the demographic data that included name, age, sex and educational attainment of the subjects. A semi-structured interview was conducted to probe issues on historical antecedents of the blindness and the eye health seeking behavior including the use of traditional eye medications. Assessment of barriers to accessing curative services among the blind persons was explored. Questions were asked and the individual responses were recorded in the questionnaire under the appropriate sections. The questionnaire was administered by one of the authors AHB.
The questionnaire was pretested on blind subjects begging in a nearby LGA and modifications made as required. Ophthalmic clinical examination was conducted with the aid of a pen torch and a ×2.5 magnifying loupe, Snellen E chart and an ophthalmoscope where appropriate by one of the authors AHB. The detailed ocular examination has been sent for publication as the study formed part of a large survey conducted to determine the causes of blindness among beggars in the study area.
Data were subsequently computed into Epi-info 2000, cleaned and analyzed by a statistician. Analysis was carried out using simple frequencies. Test of statistical significance was performed using the statistical program of the Epi-info 2000. Further analysis was carried out using cross tabulations wherever necessary. Test of significance was set at P < 0.05.
| Results|| |
Response rate and demographic data
A total of 216 (94.7%) subjects were examined out of the 228 subjects that were enumerated. However, 202 subjects were found to be blind after examination and were therefore included in the analysis. The age and sex distribution of the study sample is as shown in [Table 1]. The age range was from 8 to 78 years. The mean age was 49 years (standard deviation ± 12.2). Persons 46-60 years of age constituted the highest percentage (44.6%). One hundred and seven (53.0%) subjects were males while 95 (47.0%) were females. Male: Female ratio was 1.1:1. One hundred and ninety one subjects (94.6%) constituting the overwhelming majority had none formal education.
|Table 1: Age and sex distribution of blind street beggars in Sokoto North LGA|
Click here to view
Characteristics of the blindness
The principal cause of blindness was corneal opacity with measles, malnutrition, neonatal conjunctivitis and trachoma as the underlying causes. Overall 82% of the blindness was due to avoidable causes with majority irreversibly blind.
Health seeking habit and barriers to accessing curative services
One hundred and sixty three subjects (81.2%) had not accessed treatment at any hospital. The remaining subjects (18.8%) that accessed treatment at a hospital did so mainly at a primary health center (50.0%) and General Hospitals (34.2%). Only six respondents (15.8%) accessed treatment at an eye clinic of a tertiary health institution [Table 2].
|Table 2: Access to health services by the blind beggars in Sokoto North LGA|
Click here to view
Those that did not access treatment in the hospital obtained treatment elsewhere [Table 3]. The majority of the subjects used traditional eye medicine [Table 4]. The barriers to accessing treatment are as shown in [Table 5].
|Table 3: Types of intervention sought by the blind Beggars in Sokoto North LGA|
Click here to view
|Table 4: Use of traditional medicines by the blind street beggars in Sokoto North LGA|
Click here to view
|Table 5: Barriers to accessing curative services by the blind street beggars in Sokoto North LGA|
Click here to view
Further analysis revealed no statistically significant difference between access to hospital treatment and irreversible blindness (P = 0.6). One hundred and fifty five subjects (94.5%) of those that did not access treatment at a hospital were irreversibly blind. Similarly, 35 subjects (92.1%) of those that accessed treatment at a hospital were equally incurably blind.
| Discussion|| |
The majority of the participants resorted to ocular self-medication patronizing medicine stores or trado - medical facilities while overwhelming majority uses traditional eye medicines during the course of their eye ailments. The practice of using ocular self-medications has been reported in Nigeria.  The majority, uses herbs and antimony for their eye ailments which is in keeping with previous studies that most subjects in Africa and India uses more of plant than animal products as traditional remedies. ,,,
Persons with no access to curative services constituted the majority in this study. Even those that accessed treatment did so mainly at primary health centers and General Hospitals. Only six people have been to an eye clinic for treatment. This may explain why the difference between accessing curative services in a hospital and irreversible blindness was not statistically significant; moreover the studied cohort went to hospital late. Access to eye care service can be measured by the travel time required by public transportation to reach the nearest eye care provider. , Non-affordability and poor accessibility of the services have been identified as important causes of the high prevalence of blinding eye diseases.  Previous studies had revealed that lack of accessible eye care is a critical barrier to the successful elimination of avoidable blindness. , People need access to eye care services that are effective in the prevention of disease or in its detection at early, treatable stage.  In a part of the western Nigeria, the majority of eye care services are located in the urban areas and far from reach of the rural dwellers; therefore leaving many rural areas underserved. Consequently, people in the rural areas with avoidable and treatable eye conditions are largely unattended to while city facilities remain underutilized. , This has resulted in many rural communities still relying on alternative sources of care including traditional healers and patent medicine vendors, who serve as frontline health workers.  A major barrier to eye care services in the rural areas of the world is poor conditions of the roads ,, and this result in poor accessibility.
The barriers to accessing treatment at a hospital were reported to be as a result of services not being available or blind persons not being taken to any of the available health facilities by their parents/relatives. Availability of eye care services varies from country to country in many regions of the world and the number of eye care providers per million-population in the richest countries may be nine times more than in the poorest countries.  Even within a country, availability of services may vary from one region to another, from district to district, even from one community to another. Poor practitioner-to-patient ratios, absence of eye-care personnel, inadequate facilities, poor state funding and lack of educational programs have been considered as the hallmarks of eye care in Africa, with preventable and treatable conditions being the leading causes of blindness.  The current picture of evenly distributed available health services in Sokoto state was not the case 30 years ago when the average subject in this study became blind. Other barriers were due to cost of treatment or lack of awareness of the available health facilities. This finding is comparable to what was obtained in an earlier study in Sokoto state.  The barriers also have some similarities to factors observed in other barrier studies in Nigeria, ,,, and elsewhere. , In many rural areas of the world, poverty is a major issue, hence residents are not able to afford the cost of eye care services and therefore conditions which could have been treated at an early stage are not attended to and may result in low vision and irreversible blindness. 
Therefore a strong public awareness campaign is needed, in order to discourage the use of traditional medicines and ocular self-medications and encourage access to qualitative eye care services at affordable rates.
| Acknowledgments|| |
We thank the traditional head of the blind in Sokoto state, the LGA authority and the blind subjects who participated in this study.
| References|| |
|1.||VISION 2020: The Right to Sight. Report on World Sight 2002. Executive document. Vol. 1. p. 1-22. Accessed online at www.who.int/ncd/Vision 2020, October, 10, 2002. |
|2.||Rahman M, Islam MM, Sadhya G, Latif MA. Disease pattern and health seeking behaivior in rural Bangladesh. Faridpur Med Coll J 2011;5:32-7. |
|3.||Christman N. The health seeking process. Cult Med Psychiat 1977;1:1357-68. |
|4.||Thylefors B. A global initiative for the elimination of avoidable blindness. Indian J Ophthalmol 1998;46:129-30. |
|5.||A Vision for the Future; The Nigerian National Blindness and Low Vision Survey; Preliminary Report Pamphlet. National Programme for the Prevention of Blindness (NPPB), Abuja, Nigeria. 2008. p. 1-3. |
|6.||National Population Commission Office. Projected 2005 Population Census Based on 1991 Census. Abuja, Nigeria: Population council, Abuja, 2007 |
|7.||Omolase CO, Mahmoud AO, Afolabi AO, Omolase BO. Ocular self-medication in Owo, Nigeria. Niger J Postgrad Med 2008;11:8-15. |
|8.||Eze BI, Chuka-Okosa CM, Uche JN. Traditional eye medicine use by newly presenting ophthalmic patients to a teaching hospital in south-eastern Nigeria: Socio-demographic and clinical correlates. BMC Complement Altern Med 2009;9:40. |
|9.||Prajna NV, Pillai MR, Manimegalai TK, Srinivasan M. Use of traditional eye medicines by corneal ulcer patients presenting to a hospital in South India. Indian J Ophthalmol 1999;47:15-8. |
|10.||Mutombo TK. Assessing the use of TEM in Bukavu ophthalmic district, DRC. J Community Eye Health 2008;21:66. |
|11.||Foster A, Johnson GG. Traditional eye medicines - Good or bad news? Br J Ophthalmol 1994;78:807. |
|12.||Ntsoane MD, Oduntan OA. A review of factors influencing the utilization of eye care services. S Afr Optom 2010;69:182-92. |
|13.||Silva JC, Bateman JB, Contreras F. Eye disease and care in Latin America and the Caribbean. Surv Ophthalmol 2002;47:267-74. |
|14.||Di Stefano A. The challenge of leadership for the new millennium. Am J Optom 2002;73:339-49. |
|15.||Fafowora OF. Prevalence of blindness in a rural ophthalmically underserved Nigerian community. West Afr J Med 1996;15:228-31. |
|16.||Ashaye A, Ajuwon AJ, Adeoti C. Perception of blindness and blinding eye conditions in rural communities. J Natl Med Assoc 2006;98:887-93. |
|17.||Palagyi A, Ramke J, du Toit R, Brian G. Eye care in Timor-Leste: A population-based study of utilization and barriers. Clin Experiment Ophthalmol 2008;36:47-53. |
|18.||Cochrane GM. Access, affordability and appropriate optometric eye care. S Afr Optom 1995;54:42-3. |
|19.||Muhammad N, Mansur RM, Dantani AM, Elhassan E, Isiyaku S. Prevalence and causes of blindness and visual impairment in sokoto state, Nigeria: Baseline data for vision 2020: The right to sight eye care programme. Middle East Afr J Ophthalmol 2011;18:123-8. |
|20.||Muhammad N. Rapid assessment of cataract surgical services in Birnin-Kebbi LGA of Kebbi State. A Dissertation Submitted to the National Postgraduate Medical College of Nigeria for the Award of Fellowship Diploma; November, 2006. |
|21.||Rabiu MM. Cataract blindness and barriers to uptake of cataract surgery in a rural community of northern Nigeria. Br J Ophthalmol 2001;85:776-80. |
|22.||Kyari F, Gudlavalleti MV, Sivsubramaniam S, Gilbert CE, Abdull MM, Entekume G, et al. Prevalence of blindness and visual impairment in Nigeria: The National Blindness and Visual Impairment Study. Invest Ophthalmol Vis Sci 2009;50:2033-9. |
|23.||Odugbo OP, Mpyet CD, Chiroma MR, Aboje AO. Cataract blindness, surgical coverage, outcome, and barriers to uptake of cataract services in Plateau State, Nigeria. Middle East Afr J Ophthalmol 2012;19:282-8. |
|24.||Johnson JG, Goode Sen V, Faal H. Barriers to the uptake of cataract surgery. Trop Doct 1998;28:218-20. |
|25.||Fletcher AE, Donoghue M, Devavaram J, Thulasiraj RD, Scott S, Abdalla M, et al. Low uptake of eye services in rural India: A challenge for programs of blindness prevention. Arch Ophthalmol 1999;117:1393-9. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]