Glaucoma Care in Low-Resource Environments

Abstract This thesis explores the barriers to glaucoma care in low-resource environments within the context of a non-profit organization (Unite For Sight) and partner clinics working in two countries - Ghana and India. The Health Belief and Socio-Ecological Models form the theoretical background of glaucoma care delivery. A literature review looks at barriers to glaucoma care for programs and patients from structural, economic, psychological, and socio-cultural perspectives. Following the literature review, the quantitative and qualitative methods are explained - a de-identified patient dataset to evaluate glaucoma prevalence at outreaches in Ghana, and field work observations from Ghana and India (in the form of blog entries) that elucidate the barriers to glaucoma care. Prevalence of glaucoma is found to be very high at Unite For Sight partner clinic outreaches near Kumasi, Ghana in July 2013 - 28.17% of patients got the diagnosis. The analysis shows glaucoma has an early onset in Ghanaian clinic patients, is asymptomatic (23.60% of patients with normal vision have glaucoma), increases nonlinearly with age, has no relationship to sex, and differs significantly by outreach location, perhaps due to the age distributions at outreaches. The limitations of the data are explored.The qualitative data shows that barriers to glaucoma care occur at three levels - barriers to understanding prevalence, barriers to diagnosis, and barriers to treatment. Each of these occurs via either a structural/economic or psychological/socio-cultural mechanism, for both the program and the patient. Barriers include lack of research on glaucoma, program structure that does not fully address glaucoma, and complex patient barriers to successful glaucoma care.