作者：Abiye Mulugeta Alemu , Lindsay A. Nelson , Bonnie Kruft, Jeanette A. Stewart, William C. Stewart 作者单位：1埃塞俄比亚亚的斯亚贝巴，Ras Desta医院; 2美国南卡罗来纳州查尔斯顿，查尔斯顿研究所; 3美国德克萨斯州达拉斯，PRN制药研究公司; 4美国南卡罗来纳州，哥伦比亚，南卡罗来纳大学，北卡罗来纳州眼科研究所
【摘要】目的：探讨埃塞俄比亚的青光眼的流行状况、治疗方式以及患者的心态。方法：观察埃塞俄比亚亚的斯亚贝巴的住院青光眼患者。结果：在研究的415例青光眼患者中， Gurage（33%）人群最常见的为剥脱综合征（17%），而在Amhara/Tigre (6%)人群中，慢性闭角型青光眼为5%，二者间有显著差异性（P=0.006）。患者接受平均1.4±8种药物治疗：52%的患者没有短期的不适症状，36%的患者接受了滤过手术。93%的患者相信他们的主管医师试图给予帮助，89%认为是上帝让其接受治疗，82%感到他们的配偶体谅其病情。有87%的患者注意到社区不体察其病情，这在Gurage人群中更为多见（31%, P<0.0001），而穆斯林人群中有此感受的患者为25%（P=0.01），Amhara/Tigre患者则坚信其医师更关注他们的病痛（94%,P=0.04）。结论：不同类型的青光眼在埃塞俄比亚的不同种族人群中的发病有差异，在Gurage人群以剥脱综合征多见，而慢性闭角型青光眼则在Amhara/Tigre人群中的发病较高。
【关键词】埃塞俄比亚；青光眼；心态；信仰
Epidemiology of glaucoma in central Ethiopia
Abiye Mulugeta Alemu , Lindsay A. Nelson , Bonnie Kruft2, Jeanette A. Stewart3, William C. Stewart
1Ras Desta Hospital, Addis Ababa, Ethiopia
2Charleston Research Company, LLC, Charleston, South Carolina,USA
3PRN Pharmaceutical Research Network,LLC,Dallas,Texas,USA
4Carolina Eye Institute, University of South Carolina, Columbia, South Carolina,USA
Correspondence to: William C. Stewart. PRN Pharmaceutical Research Network, LLC, Dallas, Texas,USA; Carolina Eye Institute, University of South Carolina, Columbia, South Carolina,[email protected]
AbstractAIM: To evaluate the prevalence of glaucoma, treatment patterns and patient attitudes in Ethiopia.
METHODS: A survey was administered to glaucoma patients in hospitals in Addis Ababa, Ethiopia.RESULTS: Of the 415 qualified patients, exfoliative glaucoma (17%) was most commonly found in the Gurage population (33%), whereas chronic angleclosure glaucoma (5%) was found in the Amhara/Tigre (6%) population (P=0.006). Patients were treated with an average of 1.4±0.8 medications: 52% admitted recent noncompliance and 36% had undergone filtering surgery. Patients believed their physician was trying to help them (93%). God wanted them to receive treatment (89%) and their spouse was sympathetic to their disease (82%). Patients noted their community was unaware of their condition (87%) with Muslims [most common in the Gurage population (31%, P<0.0001)] reporting this the most(25%,P=0.01).Amhara/Tigre patients strongly believed their doctors were concerned about them (94%, P= 0.04).CONCLUSION: The prevalence of glaucoma type varies among ethnic groups in Ethiopia with exfoliation more common in the Gurage population and chronic angleclosure glaucoma more frequent in the Amhara/Tigre population.
KEYWORDS: Ethiopia; glaucoma; attitudes; religion
INTRODUCTION
Glaucoma has been shown by numerous epidemiological studies to be a leading cause of blindness worldwide, ranging from 12% of the population > 40 years of age among various regions[14]. Of those with glaucoma, primary openangle glaucoma is generally the most prevalent type. However, the predominant type of glaucoma, as well as the variance of the proportion of patients with secondary glaucomas, varies by region. For example, lowtension glaucoma has been shown to be the leading type of glaucoma in both Japan and South Korea[5,6]. In addition, in Southeast Asia in Indian and Chinese populations chronic angleclosure glaucoma has been noted to be equal, or greater in prevalence, to primary openangle glaucoma[7, 8]. It is important to identify the causes of glaucoma regionally for the purpose of educating physicians and the public and to allocate treatment resources appropriately.
Ethiopia is an Eastern African country that is an important commercial center with an approximate population of 74,777,981 (https://www.cia.gov/cia/publications/factbook/). The country consists of a complex composition of more than 80 ethnic groups of which the Amhara/Tigre and Oromo ethnic groups represent approximately twothirds of the population. Ethiopia is almost evenly divided between Muslim and Christian communities. Unfortunately, very little information is available regarding the types of glaucoma, or attitudes towards this disease, in Ethiopia generally or within individual ethnic or religious groups.
The purpose of this survey was to evaluate the prevalence of the type of glaucoma, treatment patterns and patient attitudes towards community support systems based on ethnicity and religion in Ethiopia.
MATERIALS AND METHODS
Patients This survey was conducted in Addis Ababa, Ethiopia, the capital and largest city, which is located centrally within the country with a population of approximately three million. Three government hospitals with ophthalmology departments were chosen for this survey (RasDesta Hospital, Menellik II Hospital and All Africa Leprosy, Tuberculosis & Rehabilitation Training Centre). The hospitals draw patients primarily from the major ethnic groups from Ethiopia (Amhara/Tigre, Oromo and Gurage) as well as the two major religions (Christian and Muslim).
Patients included in this study were chosen consecutively and were known to have glaucoma of any type as demonstrated by: typical optic disc damage (i.e. optic disc rim thinning, notching or saucerization, or the presence of peripapillary nerve fiber layer hemorrhage), and potentially associated with typical glaucomatous visual field damage (i.e. nasal step, or paracentral, Seidels or arcuate scotoma, or deep diffuse depression). The diagnosis of glaucoma was determined by dilated ophthalmoscopy and manual visual field testing (Goldmann perimetry).
Patients excluded from this study were those without glaucomatous optic disc or visual field changes and normal intraocular pressure or those with elevated pressures without the presence of glaucomatous optic disc or visual field damage (ocular hypertension). Patients were also excluded who did not desire to participate in the study, could not cooperate or understand the questions due to either language or cognitive skills.
Methods The survey was developed to evaluate the prevalence of different glaucoma types, treatment patterns and patient attitudes towards community support systems. After Ethics Committee approval and obtaining informed consent, the survey was administered by one of the investigators (AMA). The survey was read aloud to each patient because most of the patients either: arrived to clinic late and this method was the most time efficient manner to administer the test, their vision was compromised or they were illiterate. The survey questions were written in English, but translated verbally by the investigator (AMA) into the respective ethnic group language. The same investigator recorded the responses to each question. The survey questions were developed at PRN Pharmaceutical Research Network, LLC (WCS) specifically for this study. All surveys were performed between July and November 2006.
Statistics The sample size was planned prospectively for this study, since this was a descriptive, noncomparative survey, it was not powered. However, subanalyses were performed on each question based on the major religions and ethnic groups included in this trial.
The following tests were used to analyze the results between ethnic and religious groups. A oneway ANOVA was used to evaluate age and duration of diagnosis.[9] A Mann Whitney U test was used to analyze ranked data and a Chisquare test to analyze nonranked data or ranked data involving more than two columns. A Chisquare or Fishers exact test was used, as appropriate, to evaluate data in a 2×2 table[9, 10]. All statistical tests were nonpaired, twosided and used a Pvalue of 0.05.Table 13 and the significant factors for the religion and ethnic group subanalyses are shown in Table 4.
Table 1Patient characteristics (略)Table 2Patient treatment(略)Table 3Patient attitudes (略)Table 4Factors significant for religion or ethnicity(略)
We also performed a multivariant linear regression analysis separately for religion or ethnicity to test for statistical associations of these two parameters to individual questions that showed a significant difference by Chi square, Mann Whitney U or ANOVA testing.
RESULTS
Patients We included 415 willing, consecutive, qualified patients in this study. No qualified patients were excluded from this study.
The survey drew most heavily from the Amhara/Tigre (n=228.55%), Oromo (n=103.25%) and Gurage (n=58.14%) ethnic groups (5% other ethnic groups). In addition, while primary openangle glaucoma was the most prevalent type of glaucoma (n=278.67%), both chronic angleclosure (n=20.5%) and exfoliation glaucoma (n=71.17%) were represented in a strong minority of patients. The survey results for all patients are shown in Of the qualified patients: the average age was 59.5±12.5 years; 61% patients were male and 38% were female; 20% had systemic hypertension, 13% had diabetes and 1% had heart disease; and 8% patients had a family history of glaucoma. The average length of followup was 3.5± 3.7 years.
In regards to treatment, patients were treated with an average of 1.4±0.8 medications, of whom 52% admitted some level of noncompliance throughout the previous month. Thirtysix percent of patients had undergone filtering surgery (mostly trabeculectomy, 31%) with or without associated cataract extraction.
In regards to patient attitudes toward their support groups, generally: patients strongly believed their physician was trying to help them (93%) and most indicated their spouse was sympathetic (82%), but that their community was not aware of their condition (87%). Patients overwhelmingly believed God wanted them to receive treatment (89%).
Subanalysis Based on Ethnicity and Religion There were a greater percentage of Muslims (n=18.31%, P < 0.0001) in the Gurage populace. In contrast, the Amhara/Tigre and Oromo populations demonstrated the highest prevalence of Christians (range 8795%). Patient and treatment characteristics generally were similar among the two religious and three ethnic groups. There were, however, a greater percentage of exfoliation patients (n=19.33%, P = 0.006) in the Gurage populace. In contrast, the Amhara/Tigre and Oromo populations demonstrated the highest prevalence chronic angleclosure (range 56%).
Further, several statistical differences occurred in responses to the survey based on religion or ethnicity. A statistically greater number of Muslims than Christians indicated their community was aware of their glaucoma (P = 0.01). In contrast, patients in the Amhara/Tigre ethnic group expressed stronger belief that their doctor had a concern for them than the other population groups (P = 0.04).
Multivariant Linear Regression The multivariant linear regression analyses showed religion a risk factor for glaucoma type (P=0.036) and religion was a risk factor for community awareness (P = 0.023).
DISCUSSION
Several previous studies have evaluated the prevalence of low vision and blindness in Ethiopia[1115]. Alemayehu and associates surveyed a rural population of approximately 61000 in Central Ethiopia and showed a prevalence of blindness of 1.1%[11] . Of these individuals, 872 patients were later examined and the causes of the visual loss was found to be corneal (32%), cataract (25%), atrophied globe(s) (20%) or glaucoma (17%).
Zerihun and Mabey evaluated low vision in 7423 patients in the Jimma zone and found a prevalence of blindness of 0.85% and low vision of 1.7%. Cataract and aphakia (52.4%), corneal opacity and phthisis bulbi (25.4%), and glaucoma (9.5%) were the major causes of vision loss[12]. Further, Melese and coworkers evaluated 2693 patients in the Gurage zone and noted a prevalence of blindness of 7.9% and low vision of 12.1%.[13] Cataract (46.1%), trachoma (22.9%), and glaucoma (7.6%) were the major causes of vision loss.
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