A new study by the International Centre for Eye Health (ICEH) has highlighted health inequality in Kenya, revealing that adults 18-24 are three times less likely to access eye care than those over 65.

Globally, more than one billion people currently live with sight loss that is easily preventable or treatable with highly cost-effective interventions like spectacles and cataract surgery. Ninety percent of those affected live in low- and middle-income countries (LMICs).

To address this, people must be able to reach eye care services for treatment. However, previous research has shown that in Africa, 43% of all follow-up health appointments are missed, leaving many without the healthcare they need. Research is therefore needed to see who is missing out on healthcare and why.

This study looked at Meru County in Kenya, a high-altitude region on the slopes of Mount Kenya with a population of 1.55 million, with people mostly working in agriculture.

In recent years, the area has benefitted from a comprehensive eye care programme, the Vision Impact Programme, which includes a digital examination and referral system (Peek Vision). This system creates an environment conducive to research, as people being screened for eye care can be tracked throughout the full healthcare journey.

To see which groups were being left behind, the researchers developed a series of sociodemographic questions for people involved in the programme, based on international guidelines and existing widely used surveys. The questions, which covered factors such as age, gender, income and health insurance were then embedded within the programme software.

Between April and July 2023, the study recorded sociodemographic data for 4,240 people identified as having an eye problem, finding that only 46% of them then went on to attend treatment. This was despite all treatment in the programme being free.

In order to determine who constituted the people missing, the researchers analysed the factors recorded in the questionnaire, finding strong associations between non-attendance and age, gender and occupation.

Within these factors further insights were found, with men less likely than women, younger adults less likely than older adults, and those in manual jobs or sales and services less likely to access care than others.

Age was by far the strongest predictor overall, with the youngest cohort (18-24) three times less likely to have reached a referral appointment than the oldest (65+), even after adjusting for gender, occupation, and severity of eye condition.
The authors noted the results contrasted with evidence from other countries that suggests women, widows and those in rural areas faced the most barriers to accessing services. The researchers hypothesised that younger adults in Kenya may be less likely to be in formal jobs or with paid sick leave, and therefore face higher financial opportunity costs when taking time out to attend a clinic.

This research provides key insights into the people being left behind within eye care, and provides an evidence base for future research into the barriers faced by the groups identified. Finding out this information could lead to changes to services that allow more people to reach care. The authors intend to do this as part of a wider research project currently being undertaken by ICEH.

Publication: Allen L N, Karanja S, Gichangi M, Bunywera C, Rono H, Mcleod D, Kim MJ, Tlhajoane M, Burton MJ, Ramke J, Bolster NM, Bastawrous A. Access to community-based eye services in Meru, Kenya: a cross-sectional equity analysis. Int J Equity Health 23, 170 (2024). https://doi.org/10.1186/s12939-024-02244-x