Evaluation of Diabetic Retinopathy Management in the Gaza Strip
Marian Jameel Soliman Saba
ماريان جميل سليمان سابا
Introduction: Diabetic Retinopathy (DR) affects approximately one- third of people with diabetes mellitus, and can lead to visual impairment and blindness if not detected and treated in time. DR has major health and economic implications globally, especially in countries like Palestine where the diabetes mellitus prevalence is significantly increasing. The study aimed to assess the management of DR in the Gaza Strip to improve the quality of the provided services and thus improve patients’ overall outcomes. Methods: The study design is a mixed method that includes both qualitative and quantitative data collection. The quantitative design is descriptive analytical cross-sectional. The quantitative data were collected from patients with diabetes mellitus previously diagnosed with DR regardless the DR grade, who utilized DR services at one of the study settings which are the three main hospitals offering ophthalmic services. In total,404 patients participated in the quantitative study. The qualitative data were collected through five focus groups discussion with patients with diabetes mellitus suffering from DR, and also in-depth interviews were carried out with five ophthalmic service providers who are expert in DR treatment. Analysis of quantitative data was conducted using SPSS program, the analysis involved conducting different types of statistical tests. For qualitative data, an open coding thematic analysis method was used. Results: The results of the study showed that 88.1% of the study participants were suffering from type 2 diabetes mellitus compared to 11.9% of them were suffering from type 1 diabetes mellitus. The mean years of suffering from diabetes mellitus was13.07 years. 51.5% of participants had another family member with diabetes mellitus mainly a mother and a father. A total of 56.1% of participants described themselves as either overweight or obese. About 40% of participants had another co-morbidity, mainly hypertension and 15.3% of study participants suffered from other diabetes mellitus complications, mainly from peripheral neuropathy. Most of the study (90%) participants took their medication regularly. Regarding DR, the mean years of suffering from DR was 4.23 years. For laboratory analysis, 86.1% of the study participants conducted laboratory analysis annually, 89.9% of them received feedback about their lab test results, only 42.3% of participants reported having controlled HbA1c levels compared to 53.6% were uncontrolled and 4.1% of them didn’t know. Of the study participants, 71% reported the absence of full insurance coverage and that they still have to pay for the services. The mean participants’ level of awareness about DR was 86.8%. Only 51.6% of participants reported that services met their expectations. The mean waiting time was 57.02 minutes, and the weighted mean of patient-provider interactions was 77.4%. Regarding patient satisfaction with the provided services, the mean of satisfaction was 75.56% and it was significantly associated with age, gender and working status. While the mean of retinopathy-dependent quality of life (RetDQoL) was 67.91%, and it was significantly associated with marital status, years of schooling, and working status. Conclusions: Despite having a good patient level of awareness about DR, less than half of the participants had controlled HbA1c levels, which is the main factor in preventing diabetes mellitus complications, including DR. Patients were given awareness about DR after being diagnosed with it. This could be explained by the limited focus on diabetic self-care, insufficient education about possible diabetic complications prevention, limited screening programs, inadequate contact time with primary healthcare providers, and an inadequate number of specialized healthcare providers to deal with the DR. In addition to the absence of proper guidelines to manage DR in governmental hospitals. Timely and regular screening and appropriate interventions, and follow up could delay, or prevent progression toward complete loss of vision.