A systemic review of barriers to accessing paediatric eye care services in African countries

Author: Alrasheed SH.

Geographical coverage: Africa

Sector: Service delivery

Sub-sector: Barriers to accessing to eye care services

Equity focus: Children

Study population: Children residing in Africa

Review type: Other review

Quantitative synthesis method: Narrative review

Qualitative synthesis method: Not applicable

Background: The global estimate reported that 1.4 million children are blind; three-quarters of those children live in developing countries. Childhood visual impairment is a major public health problem globally, especially in rural areas of developing countries.

Objectives:

To review barriers to accessing pediatric eye care services in African countries.

Main findings:

Authors included 29 studies from 10 African countries, including Sudan (n = 4), Swaziland (n = 3), Nigeria (n = 9), Tanzania (n = 4), Kenya (n= 2), Ethiopia (n = 2), Ghana (n = 1), South Africa (n = 1), Egypt (n = 1), Malawi (n = 1) and multi country (n = 1). In terms of study design, the review included cross sectional (n = 5), qualitative (n = 7), quantitative (n = 12), mixed (n = 2), descriptive (n = 2) and comparison studies (n = 1).

Authors found the main barriers to be non-availability, non-accessibility, and non-affordability of eye care services, in addition to pediatric eye care not being a priority agenda in many African health systems. The review also revealed other factors affecting the utilisation of pediatric eye care services, including the public health system, geographic barriers, health benefits, perceptions of parents, lack of knowledge, attitudes, and practices about childhood eye care. Furthermore, authors noted a negative impact of environmental, demographic factors and socio-economic status on accessing pediatric eye care services in African countries.

The authors noted the need for all relevant stakeholders to play a significant role in addressing barriers to child eye care in African countries.

Methodology:

Studies conducted between January 2000 to April 2020, were included if they assessed the barriers to accessing pediatric eye care services in African countries. Furthermore, eligible studies were those that: (1) assessed financial barriers (insurance, income, employment status); and (2) educational barriers (inability to obtain, influence and perceptions, understanding and using information). The accessibility to pediatric eye care services was assessed by exploring five dimensions: 1) availability and accommodation; 2) accessibility; 3) affordability; 4) acceptability; and 5) appropriateness. For these dimensions to ensure accessibility, they need to interact (that is: (1) ability to seek, (2) ability to perceive, (3) ability to reach, (4) ability to pay and (5) ability to engage).

The studies included cross-sectional epidemiology surveys, protective observational studies, qualitative and quantitative studies. The articles were excluded if (1) they were not conducted in African; and (2) studies that did not assess barriers to accessing childhood eye care services. The study also excluded conference papers, meeting abstracts, editorial discussion and studies without basic data collection. The articles included in this review were searched online via databases including Web of Science, PubMed, ProQuest, Scopus, Google Scholar, African Index Medicus and Medline.

No information was provided in relation to assessment of the quality of the included studies (and it does not appear that studies were excluded due to quality concerns).

Applicability/external validity:

The authors note that factors influencing uptake of pediatric eye care services in African countries identified in this review is consistent to findings in other studies.

Geographic focus:

Authors included studies conducted in Africa. They note that there are specific factors in Africa that are likely to mean the issues relating to access to eye care services are different to those encountered in other countries.

Summary of quality assessment:

This review analysed the findings narratively, which was appropriate due to the high heterogeneity of included studies and the exploratory nature of the review. However, major limitations were identified. The authors did not conduct a thorough search of the literature (in terms of time and sources) to ensure that all relevant studies were identified and therefore included in the review. Furthermore, the review does not report the methods used to screen studies for inclusion in the review and extract data of included studies. Critical appraisal of studies was not conducted; therefore, it is not clear which studies are at high risk or low risk of bias and how this may have affected the results reported. Overall, there is “low confidence” in the conclusions about the effects of this review.