EVALUATING THE CAPACITY FOR EARLY KERATOCONUS DIAGNOSIS AND MANAGEMENT IN NYANZA AND WESTERN KENYA HOSPITALS

Abstract

Keratoconus is a corneal disorder characterized by progressive thinning. Early detection is often missed due to limited advanced diagnostic equipment, its underutilization and inadequate practitioner knowledge. Few studies have explored the disease. This study aimed to assess the capacity for diagnosis and management of early keratoconus in hospitals across Nyanza and Western Kenya and the specific objectives were: assessment of equipment availability, equipment’ working condition, utilization of equipment, and practitioners’ knowledge in early keratoconus diagnosis and management. In this study which was conducted across private and public hospitals in Nyanza and Western Kenya, observational cross-sectional design was employed. A total of 143 Eyecare practitioners participated in the study and census approach was used. Data was collected using a questionnaire, and analyzed using SPSS version 29. The study found that the basic equipment was readily available including retinoscopes (95.5%) and ophthalmoscopes (88.1%), compared to advanced equipment such as tomographers (10.4%). Level 6 hospitals had the highest equipment availability. Public hospitals had more basic equipment, while private hospitals had more advanced equipment. Several available equipment was in poor working conditions. These included the contact lens fitting-set (46.1%), corneal topographer (35.2%) and pachymeter (19.1%). The advanced equipment such as contact lens fitting-set depicted low utilization rates (31.0%). However, the basic equipment showed higher utilization rates including distance visual acuity chart (91.8%) and trial lens/phoropter (89.9%). The public hospitals had higher utilization rates for basic equipment, while private hospitals had higher utilization rates for advanced equipment. There was a significant association between equipment availability and its utilization, with distance visual acuity chart p=0.0333, trial lens/phoropter p=0.0029 and slit-lamp p=0.0028. Less than half of the eyecare practitioners (36.6%) had good knowledge, (60.4%) fair knowledge and (3.0%) poor knowledge for early keratoconus diagnosis. Equally, (36.6%) had good knowledge, (61.2%) fair knowledge and (2.2%) had poor knowledge for early keratoconus management. There was a significant association (p=0.006) between knowledge in the management of early keratoconus and the qualification level of the Eyecare practitioners, and significant difference for knowledge of risk factors (p=0.0322), and progressive keratoconus (p=0.0186), between private and public hospitals. In conclusion, the study found that basic diagnostic equipment was widely available, while advanced tools were scarce and underutilized. A significant proportion of practitioners lacked adequate knowledge in diagnosing and managing early keratoconus. The study recommends improving access to advanced diagnostic tools, and training in early keratoconus detection and management, to address this gap.