|Year : 2015 | Volume
| Issue : 3 | Page : 142-146
The perception of senior hospital staff on the role of eye care providers in Zaria, Nigeria
Emmanuel Raphael Abah1, Peter Yisa Jiya2, Dominic Chinda1, Onyemocho Audu3, Garba Farouk1, Istifanus Anekoson Joshua4
1 Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
2 Department of Cornea and Anterior Segment, National Eye Centre, Kaduna, Nigeria
3 Department of Epidemiology and Community Medicine, Benue State University Teaching Hospital, Makurdi, Nigeria
4 Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
|Date of Submission||27-Mar-2015|
|Date of Acceptance||21-May-2015|
|Date of Web Publication||3-Sep-2015|
Emmanuel Raphael Abah
Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Shika-Zaria
Background: Patients or their relations usually seek the opinion of hospital staff after self-treatment, patent medical vendors' prescriptions or other first line treatment has failed. It is therefore, critical for them to have a fair idea of the role of different cadre of eye care providers to enable them offer appropriate help and referral. This study assessed the perception of senior hospital workers on the Role of Eye Care Providers in Zaria. Materials and Methods: This was a cross-sectional descriptive study using a stratified sampling technique. A structured questionnaire was administered to each of 428 hospital staff in Ahmadu Bello University Teaching Hospital Shika-Zaria in July, 2013. The results were analyzed using SPSS version 20.0 statistical package. Results: The study population (428) comprised of 177 nurses, 108 doctors, 85 administrative staff, 37 laboratory scientists, 10 pharmacists, and 11 health information officers. The male:female ratio was 1.2:1 while the age range was 20-59 years with a mean age of 33 ± 5.7 years. Three hundred and thirty-seven (78.7%) of the respondents were familiar with the role of the ophthalmologist and 309 (72.2%) with that of the ophthalmic nurse. About half of the respondents were familiar with the role of the other cadre of eye care providers: 222 (51.9%) understood the role of a Community Health Officer, 215 (50.2%) understood that of the optometrist and 214 (50.0%) understood the role of the optician. Conclusion: Senior hospital workers were quite familiar with the role of an ophthalmologist and an ophthalmic nurse, but they need to be educated more about the role of the other cadre of eye care providers.
Keywords: Eye care providers, hospital staff, perception, role, Zaria
|How to cite this article:|
Abah ER, Jiya PY, Chinda D, Audu O, Farouk G, Joshua IA. The perception of senior hospital staff on the role of eye care providers in Zaria, Nigeria
. Sub-Saharan Afr J Med 2015;2:142-6
|How to cite this URL:|
Abah ER, Jiya PY, Chinda D, Audu O, Farouk G, Joshua IA. The perception of senior hospital staff on the role of eye care providers in Zaria, Nigeria
. Sub-Saharan Afr J Med [serial online] 2015 [cited 2020 Apr 9];2:142-6. Available from: http://www.ssajm.org/text.asp?2015/2/3/142/164424
| Introduction|| |
Of the estimated 314 million people who are visually impaired, more than 90% live in developing countries; approximately one-fifth of these live in Africa.  More than three-quarter of visual impairment are avoidable; these could be prevented or treated by appropriate trained health care workers with relevant infrastructural support. 
The major goal of vision 2020; the right to sight, is to make high-quality eye care services available, accessible and affordable to all through a sustainable delivery system, and one of the key prerequisite is the development of adequate, appropriate human resources.  However, manpower shortage has been identified as one of the major difficulties in the prevention of blindness in Africa. ,,,
Eye care workers for more than two decades have been categorized and there is a ratio of these personnel to population.  These include the ophthalmologist, optometrist, ophthalmic nurse, optician (dispensing optician), and Community Health Officer (CHO) who constitute an ideal eye team. A classical model for a community of 500,000 people consists of: 1 ophthalmologist, 2 optometrists, 2-3 opticians, and 6 ophthalmic nurses. , The ophthalmologist is the head of the eye care team and is expected to educate and supervise the activities of the other health professionals responsible for eye health.  In order to achieve this satisfactorily, there is need to operate a patient-centered eye care delivery system with the most efficient use of staff and resources without increasing costs. Furthermore, patient education is critical to the success of any patient-centered eye care delivery system,  patients have the right to know what the roles of various eye care providers are so that they can make informed choice.
Having the "right mix" of the different cadre would have a positive impact on the cost and effective service delivery. ,, Most eye care delivery system in developing countries including Nigeria, lacked appropriate planning ,, and this results in the disproportionate number of the various cadre. A shift to team building that will ensure available health care workers to perform optimally is needed to guarantee improved outcome.
The vision 2020, which has been advanced for the American Health System includes access to care, patient-centered care, information driven care, as well as automatic and affordable insurance for all.  This is a holistic approach which put the patients at the center of eye care. Our patient must have this access to the right information, so that it becomes more difficult to mislead them. If they make the right choice of a qualified eye care practitioner, the outcome will be better; while ocular morbidity from inappropriate consultations and wrong management will be minimized. 
Since senior hospital workers are also among the first contacts for patients and their relations seeking expert attention from qualified eye care practitioners, they need to have a fair idea of the role of different cadre of eye care providers in eye care delivery to be able to offer useful guide to patients. This study assessed the Perception of Senior Hospital Workers on the Role of Eye Care Providers in Zaria, Nigeria.
| Materials and methods|| |
Ahmadu Bello University Teaching Hospital (ABUTH), Shika-Zaria is a Tertiary Health Institution which provides the following services: general outpatient services, specialized and sub-specialist care, and 24 hour accident and emergency services among others. In addition, inpatient care is offered in the main clinical specialties. It is a 540 bed hospital and has been designated center of radiotherapy and oncology. The staff strength is 2892. The target population for the study is made up of nurses, doctors, administrative staff, laboratory scientists, health information managers, and pharmacists. The Department of Ophthalmology provides emergency ophthalmic medical and surgical services, routine general ophthalmic and subspecialty surgical services, inpatient care with 50 bed spaces, outpatient care consisting of general ophthalmic clinic and subspecialty clinics (pediatrics, oculoplastic, glaucoma, vitreoretinal, and cornea/refractive surgery). It also provides optical services including refraction, optical dispensing, and low vision aids. Special investigations such as optical coherence tomography, automated perimetry, pachymetry, ocular scan (A and B), and intraocular lens power master are also available. The services also include community outreach cataract services and outpost for training of senior resident doctors. The department currently has 2 professors/chief consultants, 5 consultants/senior lecturers, 11 senior registrars/lecturer II, 8 registrars, 2 optometrists, 5 opticians, 25 ophthalmic nurses, and 10 hospital attendants.
It was a cross-sectional descriptive study using a stratified sampling technique. A structured questionnaire was administered to each of 428 senior hospital staff in the Departments of Nursing services, Pharmacy, Laboratory services, Health information, Administration and Doctors from outpatient clinics of ABUTH Shika-Zaria, July 2013. The results were analyzed using (Statistical Package for Social Sciences (SPSS) version 20.0) statistical package taking cognizance of variables such as sociodemographic characteristics of respondents, the role of eye care providers as understood by respondents, and the eye care provider who attended to those last seen with eye complaints. The variables were tested using the Chi-square.
This consisted of 177 nurses, 108 doctors, 85 administrative staff, 37 laboratory scientist, 11 health information managers, and 10 pharmacists giving a total of 428.
Correct role was defined for each provider as follows:
- Ophthalmologist: A medical doctor who is a specialist in the management of medical and surgical eye diseases including optical correction of visual problems.
- Optometrist: An individual trained to manage refractive/optical eye problems. Helps ophthalmologists to check patients for glasses (refraction)/prescribes glasses.
- Ophthalmic nurse: A registered nurse trained in the care of patients with eye diseases. Assists the ophthalmologists in clinic theatre, ward etc., manage simple eye conditions and assist in eye health education.
- Optician: An individual with technical experience in the handling of prescription of spectacles. Fit glasses to frames/dispense glasses, contact lenses etc.
- CHO: Works at the primary level. Gives first aid and refer patients to secondary or tertiary health facilities. Concerned primarily with the prevention of blindness at community level.
Sample Size and Sampling Technique
A cross-sectional descriptive study using a stratified sampling technique was employed. The minimum sample size was calculated using the formula  n = Z2pq/d 2 , Z = standard normal deviate at 95% confidence interval, p = prevalence (assumed to be 50%, no record of prevalence from similar study), q = complimentary probability (1-p), d = degree of precision assumed to be 0.05.  Hence with the assumption that 50% of senior hospital staff have good understanding of the role of various cadre of eye care providers in eye care delivery and 5% degree of precision at 95% confidence interval, which is = 1.96 2 × 0.5 × 0.5/0.5 2 = 384
Considering a nonresponse rate of 10%, the desired minimum sample size 428 was used.
Using stratified sampling technique with proportionate allocation, a structured questionnaire was administered to each of 177 nurses, 108 doctors, 85 administrative staff, 37 laboratory scientist, 11 health information managers, and 10 pharmacists who were the 428 study population.
Data Collection Tool
The data were collected using structured questionnaire that were pretested. The information collected were: Sociodemographic characteristics (age, gender, and profession), knowledge of eye care professionals and their roles in eye care delivery, previous history of eye problems and the eye care provider that managed it.
The data were keyed into SPSS version 20.0 after cleaning. We took cognizance of the measured variables. The test statistics was Chi-square and the results were presented in table and charts.
Ethical clearance was obtained from the Ethical Committee of ABUTH, Zaria and a written informed consent was obtained from each participant. All hospital workers belonging to any of the cadre of eye care providers and all those who did not consent were excluded in the study.
| Results|| |
A total of 428 senior hospital staff were studied. This was made up of 177 nurses, 108 doctors, 85 administrative staff, 37 laboratory scientists, 11 health information managers, and 10 pharmacists. The male:female ratio was 1.2:1, the age range of 20-59 years and the mean age was 33 ± 5.7 years [Table 1].
Three hundred and thirty-seven (78.7%) of the respondents were familiar with the role of the ophthalmologist and 72.2% (n = 309) with that of the ophthalmic nurse. About half (50%) of them were familiar with the role of the other cadre of eye care providers: 222 (51.9%) understood the role of a CHO, 215 (50.2%) understood that of the optometrist and 214 (50.0%) understood the role of the optician [Table 2].
|Table 2: The role of eye care providers as understood by the respondent (n = 428)|
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Of the 50% of the respondents who wrongly defined the role of the optician, 8.4% (n = 18) perceived them to be physicians like the ophthalmologist. Two hundred and sixteen respondents (50.5%) had a past history of eye complaint. Seventy-five percent of them visited the ophthalmologist (n = 162) then the optometrist, ophthalmic nurse, an optician in descending order. Only one respondent visited the CHO (0.5%) [Table 3].
|Table 3: Eye care provider who attended to those last seen with eye complaint (n = 216)|
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| Discussion|| |
There are insufficient healthcare providers to supply eye care services to the millions of people living with visual impairment in developing countries.  This implies that patients are likely to encounter some difficulties in accessing these providers. Hence, other health workers have an important role to play in guiding patients and their relatives in their choice of health care provider.
The respondents in this study were senior hospital staff (doctors, pharmacists, nurses, laboratory scientists, health information officers and administrative officers). They were expected to have good understanding of the role of eye care providers, especially those in clinical services. Expectedly, they had a very good understanding of the role of an ophthalmologist in eye care delivery (78.7%).Their knowledge of the role of an ophthalmic nurse was also good (72.2%). However, just about half of them understood the role of the other eye care providers optometrist (50.2%), optician (50.0%), and CHO (51.9%) [Table 2].
We found a relatively weak understanding of the role of optometrist and opticians across the cadre of respondents. Sixty-five percent of doctors understood the role of an optometrist correctly and about the same number also understood the role of an optician (63.9%). Sixty percent of pharmacists understood the role of both correctly. For nurses, 51.9% and 54.8% understood the role of the optometrist and that of the optician, respectively. The understanding of the role of an optometrist and that of the optician was quite weak among the laboratory scientists 21.6% and 37.8%, respectively. Only few health information officers understood the role of the optometrist and the optician (36.3% and 27.3% respectively). For administrative officers the understanding of the role of an optometrist and the optician was low (36.4% and 29.4% respectively).
It is obvious that there is need to educate all the respondents about the role of the optometrist and opticians in eye care delivery. Furthermore, the role of all the eye care providers was poorly understood by the administrative staff [Table 2]. This was expected because they are nonclinical staff. The correct understanding of the role of eye care providers was also weak across the board for laboratory scientists [Table 2]. This is probably because they are not in regular contact with patients and other health professionals.
On the other hand, doctors, pharmacists and nurses had excellent understanding of the role of ophthalmologists and ophthalmic nurses in eye care delivery [Table 2]. They also had good understanding of the role of the other eye care providers. The health information officers also had a good understanding of the role of ophthalmologist (72.7%) and a fair understanding of that of the ophthalmic nurse (54.5). This fair knowledge may be related to their proximity to patients, doctors and nurses.
On the whole, the understanding of the role of eye care providers by these senior hospital staff was fair compared to previous studies conducted among under graduates in Western Nigeria which was 25.7%, 18.7%, 18.7%, and 23.0% for ophthalmologist, optometrist, ophthalmic nurses, and opticians respectively. Unfortunately, similar studies are very few, so comparative analysis is limited.
A total of 216 respondents had a past history of eye complaint and were seen by a different cadre of the eye care workers. Seventy-five percent of them visited the ophthalmologist, 11.1% optometrist, 6.9% ophthalmic nurse, 6.5% optician, and 0.5% CHO [Table 3]. This pattern is good but can still be improved upon.
| Conclusions|| |
Senior hospital workers are quite familiar with the role of an ophthalmologist and an ophthalmic nurse, but they need to be educated more about the role of the other eye care providers.
| Recommendations|| |
There should be public education and reorientation of senior hospital workers on the roles of various eye care providers in eye care delivery. This will enable them offer a useful guide to patients and their relations.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]