Original article

Glaucoma awareness among ophthalmic patients at Menelik

II Hospital, Addis Ababa, Ethiopia
Hiwot Degineh1, Abeba T. Giorgis1

Abstract
Background: Glaucoma is one of the main causes of blindness worldwide that has been considered as a major public
health issue. Raising awareness about glaucoma among the general public, ophthalmic patients and health
professionals would be key instrument for early case identification and prevention of blindness.
Objective: To determine the level of awareness and knowledge about glaucoma among patients coming for eye care
service at Menelik II Hospital.
Methods: A hospital based cross- sectional study was conducted among a total of 422 new ophthalmic patients
attending eye department at Menelik II Hospital during April 20 to August 20, 2010. Data on demographics, awareness
and knowledge of glaucoma were collected through face to face interview using a pretested structured questionnaire.
Results: Among the interviewed 28.4% were found to be aware of glaucoma and 75.8% of them had some knowledge
of glaucoma as well. The association between awareness of glaucoma and better educational level was statistically
significant (P < 0.05). The main sources of information for glaucoma were television, posters, radio and relatives and
other people living with glaucoma.
Conclusion: The study has indicated the level of glaucoma awareness and knowledge among ophthalmic patients at
tertiary center. It has also identified higher level of education to be associated with better level of awareness and mass
media to be the main source of information about glaucoma.
Recommendation: The present level of glaucoma awareness and knowledge should be enhanced through provision of
health education and by incorporating glaucoma education into the curriculum of high school and health care
providers. [Ethiop. J. Health Dev. 2013;27(3):230-134]

Introduction For such “silent thief of sight”, raising awareness about

Glaucoma is the leading cause of irreversible blindness glaucoma among the general public, ophthalmic patients
worldwide and it is next to cataract as common cause of and health professionals would be key instrument for
blindness (1-3). In Sub-Saharan Africa glaucoma is more early case identification and prevention of blindness. To
prevalent and thus has been considered as a major public raise glaucoma awareness among the public in general
health issue for the region (4). and glaucoma patients and their families in particular, a
number of activities have been carried out over the
Worldwide, glaucoma is estimated to affect 60.5 million previous three years in the country mainly in the capital
people with 8.4 million being bilaterally blind. The city, Addis Ababa. These included: educational message
magnitude of glaucoma will keep increasing with the transmission through mass Medias, providing brochures
world population growth and increasing number of to glaucoma patients and their families, and posting
ageing people (5). Africans are at 4-5 fold higher risk for posters at ophthalmic centers.
glaucoma (6). A prevalence study for East, Central and
Southern Africa has estimated glaucoma to affect 10,000 The level of awareness about glaucoma among
people with annual incidence of 400 new cases per ophthalmic patients at the center where this study was
million population (7).Glaucoma was found to be one of conducted was 4.5% in 2006, (unpublished data). The
the blinding eye diseases, causing 62, 000 blind people in level was lower (2.4%) among rural communities
Ethiopia according to a national survey in 2006 (8). (Jimma) coming for cataract screening in 2009 (11).
Therefore, this study was designed to determine the level
Due to the symptomless nature of the majority types of of awareness and knowledge about glaucoma among
glaucoma, 90% of affected people in the developing patients coming to tertiary center for eye care service.
countries and 50% in developed world do not know that
they have the disease (9). By the time glaucoma patients Methods
come to attention the stage of the disease could be A hospital based cross-sectional study was conducted
advanced with visual loss. This can be seen from clinical among new ophthalmic patients, age greater than or equal
features of glaucoma patients coming to the glaucoma to 16 years at Menelik II Hospital, from April to August,
clinic at Menelik II Hospital where 62% were either 2010. The Department of Ophthalmology of the Hospital
unilaterally or bilaterally blind and 61% had advanced is a tertiary referral center providing general and sub-
stage of the disease at the time of presentation (10). specialty services and training.

1
Menelik II Hospital, Department of ophthalmology, College of Medicine, School of Health Sciences Addis Ababa
University, P.O. Box 8079, Tel. 0911214688, E-mail [email protected], Ethiopia.
 Glaucoma awareness among ophthalmic patients at Menelik II Hospital, Addis Ababa, Ethiopia 231

Sample size calculation: Since there was no published than 0.05 was considered statistically significant.
data on the level awareness about glaucoma in Ethiopia,
sample size was made assuming awareness level of 50%. The study was ethically approved by the research and
Accordingly, by using confidence interval of 95% and publication committee of the Department of
margin error of 5% with non-response rate of 10%, a Ophthalmology, College of Health Sciences, Addis
sample size of 422 patients was calculated for the study. Ababa University. Informed verbal consent was also
obtained from each interviewed patient. Brief
Routinely, referred ophthalmic patients enter the information on glaucoma and importance of screening
hospital’s triage, where the first patient-ophthalmic nurse was given to participants who had not been aware of the
interaction occurs. The ophthalmic nurse registers the disease.
patients’ name, age, sex and address and let them get
their new charts and give appointments to be seen at their Operational definition: awareness and knowledge were
respective general or specialty clinic according to their defined as having heard and understanding of glaucoma
eye problem. While the patients were waiting at a waiting respectively. Knowledge was further classified as good,
area on their appointment day, every morning the first fair and poor using Indian classification with
author (interviewer) selected every 5th patient from the modification (12). A patient was considered to have good
triage registration book and used a lottery method to pick knowledge when she/he was able to describe glaucoma
the first of the five listed patients. After identifying the as a blinding eye disease, increased eye pressure, causing
name of patients for interview, each patient was briefed eye nerve damage or visual field loss. In addition, she/he
about the purpose of the study first and then requested for should able to mention at least one risk factor for
willingness to be interviewed at a nearby out-patient glaucoma (increased eye pressure, old age or family
examination room. Any patient who was unwilling or history) and one treatment option. Fair knowledge was
absent for the interview was replaced by a patient next to considered when a patient described glaucoma as an eye
him/her on the list. disease causing blindness without further description and
The patients were interviewed using brief open-ended could not mention at least one risk factor or therapy. A
questionnaires. The questionnaire was in Amharic, patient was considered to have poor knowledge when
official language of the country, with necessary he/she described glaucoma as an eye disease only.
modification based on pre-test. The questionnaire
included socio-demographic characteristics, sources of Results
glaucoma information and queries enabling to assess A total of 422 patients above age 16 were interviewed
knowledge of the disease. “What is glaucoma? Is during the study period. The sex proportion of the
blindness from glaucoma reversible? What are the risk participants was found to be almost equal with male to
factors for glaucoma? And what are the treatment options female ratio 1.1:1. The mean age was 41.1 (SD + 16.6),
for glaucoma” were some of the questions asked to assess median 40.5 and ranging 16- 81 years. A large number of
knowledge of glaucoma among patients who were the participants, 186 (44.1%), had educational level of
already aware of glaucoma. Grade 1 to 12, while 116 (27.5%) and 120 (28.4%) were
educated above grade 12 and non-literate respectively.
Data was cleaned, edited, coded and analyzed using Among the study participants 120 (28.4%) were found to
SPPS version 15.0 for calculating proportion, means, be aware of glaucoma. The level of glaucoma awareness
cross tabulation and x2 tests. The relationship between in relation to age, gender, was not statistically significant
awareness of glaucoma and demographic factors such as (p-value, 0.09 and 0.87 respectively), whereas, the
age, gender and education was assessed using bivariate awareness was positively associated with educational
analysis and Chi-square test. A two-tailed 'P' value of less level above 12 grade (P < 0.05) (Table -1).

Table 1፡ Awareness of glaucoma in relation to socio-demographic characteristics

of study participants, Menelik II Hospital, Addis Ababa, Ethiopia, 2010.(n=422)
Characteristics Aware Not aware Total P –value
Age
<40 years 53 156 209 0.09
≥40 years 67 146 213
Sex
Male 61 156 217 0.87
Female 59 146 205
Education
Not literate 10 110 120 0.00
1-12 50 136 186
>12 60 56 116

The main sources of information about glaucoma were accounting for 35 (29.2%), 26 (21.7%), 16 (13.3%) and
television, posters posted at ophthalmic centers, radio and 14 (11.7%) respectively; while the rest 29 had different
relatives and other people living with glaucoma sources (Table2). Among patients who could remember
Ethiop. J. Health Dev. 2013;27(3)
232 Ethiop. J. Health Dev.

the time since they have become aware of glaucoma, 112 (3.3%) were aware before 3 years preceding the study.
(93.4%) said it was within the past 3 years, whereas 4

Table 2: Source of information of glaucoma verses duration of glaucoma awareness among

aware participants, Menelik II Hospital, Addis Ababa, Ethiopia, 2010 (n=120)
Duration of glaucoma
Source of Information <3 years awareness Total
≥3 Do not
years remember
Television 35 0 0 35
Posters 26 0 0 26
Radio 14 1 1 16
Relatives & other 10 2 2 14
people with glaucoma
Health education 11 0 0 11
Health professional 8 1 0 9
Others 8 0 1 9
Total 112 4 4 120

Table 3 shows the four types of questions asked to assess mentioned for the question “What are the risk factors for
glaucoma knowledge among the 120 patients who were glaucoma?” by 108 (90%). Only 6 (5%) and 5 (4.2%)
aware of glaucoma and their responses. Ninety (75%) of were able to mention elevated eye pressure and aging as
those who were aware were found to have knowledge of risk factors respectively. Regarding the question on
glaucoma. Glaucoma as an eye disease causing blindness options of glaucoma treatment, majority, 89 (74.4%), did
was mentioned by 64 (53.3%), association of glaucoma not know about options at all; whereas 14 (11.6%), 6
with both elevated eye pressure and causing blindness by (5%) and 11 (9.2%) mentioned medical, surgical and
13 (10.3%) and elevated eye pressure only by 10 (8.3%). both medical and surgical, respectively. Based on the
However, 29 (24.2%) were not sure what glaucoma is, definition utilized to grade knowledge, 11 (12.1%), 16
even if they were aware of it. Irreversibility of glaucoma (17.6%) and 64 (70.3%) had good, fair and poor
blindness was known by 59 (49.2%); while 54 (45%) did knowledge respectively.
not know what can happen. Any risk factor could not be

Table 3: Response to glaucoma knowledge assessing questions by aware participants,

Menelik II Hospital, Addis Ababa, Ethiopia, 2010 (n=120)
Response Frequency Percentage
What is glaucoma?
Eye disease causing blindness 64 53.3
Note sure 29 24.2
Increased eye pressure
and causing blindness 13 10.3
Increased eye pressure 10 8.3
Causing visual field loss 2 1.7
Causing eye nerve damage 1 0.85
Others 1 0.85
Is blindness from glaucoma
reversible
Yes 7 5.8
No 59 49.2
Not sure 54 45
What are the risk factors for
glaucoma?
Increased eye pressure 6 5.0
Old age 5 4.2
Family history 1 0.8
I don’t know 108 90
What are the treatment options
for glaucoma?
Medical 14 11.6
Surgical 6 5
Both 11 9.2
I don’t know 89 74.2

Ethiop. J. Health Dev. 2013;27(3)

 Glaucoma awareness among ophthalmic patients at Menelik II Hospital, Addis Ababa, Ethiopia 233

Discussion it. Comparing to this study, a report from Nepal (18) that
Glaucoma is one of the leading causes of irreversible involved 211 patients who came to eye clinics, reported
blindness in Sub-Saharan Africa, which is further higher (60.6%) level of awareness, but low knowledge
compounded by poor awareness and knowledge in the level (5.5% of the total). Knowing glaucoma is not only a
region (4). Increasing awareness in the public in general blinding disease, but also causes irreversible blindness by
and the people at risk in particular is instrumental for 77 (64.2%) and 59 (49.2%) of the glaucoma aware
case detection and to prevent the needless irreversible participants of this study are additional good indicators
blindness of the disease. that the disease was recognized as a serious problem.
Knowing who are at risk for glaucoma may alarm and
The current level of glaucoma awareness (28.4%) is make them seek attention and enable early case detection.
better as compared to the data (4.5%) from the same However, 90% of the aware did not know any of the risk
center in 2006 (unpublished) and from the report of factors for glaucoma, an indication of area for the
rural communities of Jimma (2.4%), who came for emphasis during education.
outreach eye care service in 2009 (11). In the current
study, 93% of the participants were aware of glaucoma Using the definition for grading the level of knowledge,
during the previous three years could be due to the the majority (60%) of patients had poor level. In the
awareness activities that have been delivered through future, glaucoma knowledge among ophthalmic patients
different means. However, there is no doubt about the and the public in general may be increased if public
need for further raising the level not only among the oriented glaucoma education, availability of reading
ophthalmic patients but also in the general public. materials and public literacy level increases.

Awareness level may not be expected to be similar in Limitations of the study were considered to be the
urban and rural communities for various reasons as possibility of recall bias on the duration of glaucoma
demonstrated in this and that of Jimma studies. Similarly awareness. And the studied population who had better
the reports from Indian studies that have shown 2.3% chance or might pay more attention to hear and get
and 0.33% to be the awareness level among urban and information about eye diseases could not represent the
rural communities respectively (13, 14). On the other actual awareness in the public.
hand, reports from developed countries, USA and
Australia have shown glaucoma awareness to be 75% Conclusions
and 95% respectively in their population based The study has indicated the level of glaucoma awareness
epidemiological surveys (15, 16). and knowledge among ophthalmic patients at tertiary
center. It has also identified higher level of education to
The studies from Jimma and India have showed that the be associated with better level of awareness and mass
awareness of glaucoma increases with higher educational media to be the main source of information about
level (11, 13) which was consistent with our study. glaucoma.
Educated people may get information from Medias,
literature and they may pay more attention to health Recommendations
related issues. The present level of glaucoma awareness should be
enhanced through provision of health education at eye
Regarding the source of information about glaucoma, care campaign programs and health institutions, using
mass media (TV and radio), poster at ophthalmic centers, mass media and by incorporating glaucoma education
and relatives and other people living with glaucoma, into the curriculum of high school and health care
were reported as the main sources of information in this providers. Further study is required to assess the level of
study. This can be seen in relation to that of rural Indian awareness at the general public and to identify the better
study in which mass media (TV) was reported as a main source of information to increase the level of awareness.
source of information (13) and German study where
friends were reported as main source of information Acknowledgements
(17). Raising public awareness using public media could We would like to acknowledge all participants of the
be the best means as they can access millions of ears and study who kindly volunteered to answer to the interview
eyes at a time and cover large areas. Health education questions. We are also grateful to Dr Abebe Bejiga and
was the other source of information. If glaucoma is Dr Kassahun Kiros for their valuable inputs and
incorporated with regular eye health education, large comments.
number of ophthalmic patients and their attendees can be
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