Ocular manifestations and associated factors among traditional eye medicines users attending the eye clinic at Mulago National Referral Hospital, Uganda
MetadataShow full item record
Background: Over the past decades there has been a phenomenal increase in the use of Traditional Eye medicines (TEM) worldwide. The limited resources and availability of eye care services in developing nations are some of the factors that compel the patients to use TEM before seeking conventional treatment. TEM therapy is often associated with poor ophthalmic treatment outcomes in otherwise treatable eye diseases. Reports in Uganda and at Malago National Referral Hospital (MNRH) show that Traditional eye medicine (TEM) use is a significant problem and contributes to the burden of visual loss and blindness in some patients, however, no study has been done to determine the types, ocular manifestations, and associated factors of ocular manifestations of TEM users at Mulago Hospital. Aim: To determine the types of traditional eye medicine, ocular manifestations, and factors associated with ocular manifestations among patients attending Mulago national referral hospital eye department Methods and Materials: The study was a hospital-based cross-sectional study on 182 participants who were confirmed to have used TEM and presented at MNRH ophthalmic outpatient clinics from June to August 2021. Participants who met the inclusion criteria were consecutively enrolled in the study. Informed consent or assent by parents/guardians of children participants were obtained from all study participants. All participants were interviewed using a structured questionnaire to capture the history of use of TEMs, types, sources, and all relevant sociodemographic factors in the study population. A detailed ophthalmic examination was performed to determine the ocular manifestations associated with TEM use. Data were entered into electronic Epi Data version 4.2 and analyzed using the STATA version 15.0. Baseline characteristics were summarized using means with their standard deviations and medians with the 25th and 75th percentiles for numerical variables and proportions for categorical variables, modified Poisson regression with robust standard errors was used for the analysis of factors associated with ocular manifestation among TEM use. Results: A total of 182 participants were recruited, of which (males: 53.3%, n=97; females: 46.7%, n=85). The mean age was 36±21SD years and ranged from 0.2 years to 76 years. The most frequently used type of TEM were plant products (47.8%, n=26), followed by chemical(inorganic) substances (21.4%, n=18). TEM was most frequently prescribed by non-traditional healers (64%, n=116). The most frequent clinical reasons for use of TEM included tearing (62.6%, n=114). itching (50.5%, n=92) and photophobia (44.5%, n=81) while ease and availability of TEM (56.6%), limited access to health facilities (51.5%), and ignorance of the toxic effects (50.5%) were the main social reasons for using TEM. Of 182 TEM users evaluated, (70%, n=127) had ocular manifestations associated with TEM, the most frequent ocular manifestations found were conjunctivitis (53.9%, n= 98), followed by corneal ulcer (28%, n=51) and endopthalmitis (5.5%, n=10). Ocular manifestations were significantly associated with living in the urban areas (p< 0.006) and participants who reported ease and availability of TEM (p < 0.001). Conclusion and recommendations: Plant-based products were the most frequently used types of TEM and were often prescribed by non-traditional healers. A large proportion of the TEM users were found with potentially sight-threatening ocular manifestations. Urban dwellers and ease of availability of TEM were strongly associated with ocular manifestations. We, therefore, recommend urban community education and ophthalmologic clinics outreaches for the target population to reverse the trend. We should also have a high index of suspicion of TEM use among patients presenting with conjunctivitis in our clinics and manage such patients cautiously and appropriately. Plant products commonly used as TEM should be evaluated further.