| dc.description.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. | en_US |
