Access to Eye Health Care at Tertiary Hospital in Sierra Leone Open Access

Conteh, Imurana (Spring 2019)

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Background: National data (2017) show that Sierra Leone has an estimated prevalence of 0.7% blindness. Up to 90% or more of all blindness is due to onchocerciasis, cataract refractive errors, trachoma and other ocular complications in Sierra Leone; these are preventable conditions if access to appropriate care is available. Ebola survivors frequently have ocular complications including uveitis, glaucoma, cataract, and retinal disease.

Objective: This study seeks to assess the burden of eye disease in three tertiary eye care facilities in Sierra Leone, to determine the difference in eye disease for Ebola survivors and the general population using the three tertiary eye care facilities, and to evaluate the feasibility of a telemedicine approach to identify patients with ocular disease in Sierra Leone.  

Methods: One hundred and thirty-five patients were recruited from three tertiary hospitals in Sierra Leone - Connaught Hospital (n=30), UMC Kissy Hospital (n =56) and Makeni Hospital (49). An in-person questionnaire was administered to each patient. After informed consent was obtained, an exam was given for visual acuity. Photographic imaging was also taken of both anterior and posterior segments of the eye. Questionnaire responses were analyzed using SAS 9.4 while photographic images were graded, converted into log mar visual acuity, and finally converted into Snellen visual acuity.

Results: The top 3 clinically diagnosed conditions across the health facilities were uveitis (36.3%), glaucoma (34.1%) and cataract (13.4%). Ebola survivors had a high prevalence of uveitis (51.9%) followed by glaucoma (33.3%). There was an observed significant relationship in worse eye between the general eye care population 20/166 and Ebola survivors 20/48 (p-value: 0.0090). The top four diagnoses from the anterior segment imaging were cataract (21.9%), pterygium (11.8%), posterior synechiae (7.9%), and uveitis (5.6%).

Discussion: Based on our assessment of the ocular disease burden at the three tertiary facilities, we concluded that there is a high burden of eye disease in Sierra Leone. Uveitis was more common among Ebola survivors, whereas glaucoma was more common among the general population. Telemedicine is a promising model for improving access to high-quality eye care for many Sierra Leoneans who cannot afford access to tertiary facilities in urban areas.

Table of Contents

Chapter 1: Introduction. 1

1.1 Background. 1

1.2 Problem Statement 3

1.3 Purpose Statement 5

1.4 Research Questions. 6

1.5 Definition. 6

Chapter 2: Literature Review.. 8

2.1 Introduction. 8

2.1.1 Challenges of the Free Health Care Initiative. 10

2.2 Global Eye Burden. 11

2.2.1 Genesis of Vision 2020. 12

2.2.2 Challenges of Universal Eye Health Coverage. 13

2.3 Eye Health Services in Sierra Leone. 14

2.3.1 Causes of Blinding and Visual Impairment in Sierra Leone. 16

2.3.2 Attitudes about Blindness in Sierra Leone. 17

2.4 Ebola virus in Sierra Leone. 18

2.4.1 Ebola Disease Ocular Complication (Uveitis) 19

2.5 Telemedicine in Eye Care. 20

2.6 Gaps in the Literature. 23

Chapter 3: Methods. 24

3.1 Overview.. 24

3.2 Population and Sample Size. 25

3.3 Research design. 26

3.4 Procedures and Data Collection. 26

3.5 Plans for data analysis. 27

3.6 Ethics. 28

Chapter 4: Results. 29

4.1 Demographic characteristics of the study population. 29

4.2 Objective 1: To assess the burden of eye disease in three tertiary eye care facilities in Sierra Leone. 32

4.2.1 Distance traveled from patient home to Hospital 37

4.3 Objective 2: To determine the difference in eye diagnoses for Ebola survivors and the general population who use the three tertiary eye care facilities. 38

4.4 Objective 3: To evaluate the feasibility of a telemedicine approach to identify patients with ocular disease in Sierra Leone. 42

4.4.1 Anterior Segment Grading Scheme. 44

4.5 Summary. 45

Chapter 5: Discussion, Public Health Implications and Recommendations. 47

5.1 Discussion. 47

5.2 Limitations. 49

5.3 Public Health Implications. 50

5.4 Recommendations. 51

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