|Year : 2018 | Volume
| Issue : 3 | Page : 126-130
Knowledge and attitude toward eye donation among adults, Northwest Ethiopia: A community-based, cross-sectional study
Mohammed Seid Hussen, Gizachew Tilahun Belete
Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
|Date of Web Publication||4-Jan-2019|
Mr. Mohammed Seid Hussen
Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar
Source of Support: None, Conflict of Interest: None
| Abstract|| |
BACKGROUND: In developing countries, the leading cause of childhood blindness is corneal scarring. Although the service of corneal transplantation depends on several factors, availability of potential donors is of paramount importance. Attitude of eligible donors is the main factor that affects corneal supply. However, limited data exist on eye donation. Hence, this study intended to assess the knowledge and attitude toward eye donation and its associated factors.
SUBJECTS AND METHODS: A community-based, cross-sectional study was conducted on 760 adults aged ≥18 years selected using multistage systematic random sampling in Gondar town, Northwest Ethiopia. A face-to-face structured questionnaire interview in home-to-home visit was applied to collect the data. Descriptive and analytical tests were performed. A binary logistic regression was fitted. Those variables with P < 0.05 were considered statistically significant.
RESULTS: This study comprised 760 adults with a median age of 30 years. The proportion of overall level of good knowledge and favorable attitude toward eye donation was 8.4% and 59.9%, respectively. It has been also recognized that attitude was positively associated with educational level of high school (adjusted odds ratio [AOR] = 2.41, 95% confidence interval [CI]: 1.41–4.14) and college/university (AOR = 2.73, 95% CI: 1.53–4.89) and awareness (AOR = 1.50, 95% CI: 1.05–2.03).
CONCLUSIONS: Although the overall level of knowledge about eye donation was poor, the proportion of favorable attitude toward eye donation was fair. Since it was associated with educational level and awareness, it is strategic to follow multidisciplinary approaches to facilitate multi-stakeholder partnerships and to motivate the people to donate their eyes.
Keywords: Attitude, Ethiopia, eye donation, knowledge
|How to cite this article:|
Hussen MS, Belete GT. Knowledge and attitude toward eye donation among adults, Northwest Ethiopia: A community-based, cross-sectional study. Middle East Afr J Ophthalmol 2018;25:126-30
|How to cite this URL:|
Hussen MS, Belete GT. Knowledge and attitude toward eye donation among adults, Northwest Ethiopia: A community-based, cross-sectional study. Middle East Afr J Ophthalmol [serial online] 2018 [cited 2019 Jan 19];25:126-30. Available from: http://www.meajo.org/text.asp?2018/25/3/126/249325
| Introduction|| |
In developing countries, the leading cause of childhood blindness is corneal scarring, which is caused by infectious and noninfectious agents, as in trachoma, xerophthalmia, harmful traditional medicines, leprosy, and trauma., Currently, there are about 8 million corneal blind people in the world. In Ethiopia, trachomatous corneal scarring is responsible for about 12% of blindness.
Although corneal transplantation is the mainstay treatment to rehabilitate vision,, its coverage is being influenced by the availability of domestic eye bank, potential donors, and close relatives' cooperativeness upon the death of the person.
In 2010, 85 domestic eye banks of the United States reported that there were 110,600 corneal donations and 59,271 corneal grafts. In Europe, approximately 20,000 corneal transplantation procedures are performed among 35,000 procured corneas per year. In the United Kingdom, corneal transplantation is performed for more than 3500 people per year.
In Ethiopia, between 130 and 150 corneas are collected every year even if there are more than quarter of a million blind people who need corneal transplantation. This imbalance between demand and supply of corneal graft is continuing as the biggest limiting factor for utilization of the service. The availability of potential donors is very essential to provide corneal transplantation service. This in turn depends on multi-stakeholders' attitude and close relatives' cooperativeness to donate pledged eyes.
In some studies, it was reported that relational ties, religious beliefs, cultural influences, family influences, body integrity, and previous interactions with the health-care system are the potential factors for organ donation in developed countries. However, there is limited study regarding organ donation and the factors that influence it in developing countries. Therefore, this study aimed to assess the knowledge and attitude toward eye donation which helps devise strategies to meet the need of the community.
| Subjects and Methods|| |
The study was conducted on 760 adults living in Gondar town, Northwest Ethiopia, from February 15 to March 25, 2016, using cross-sectional study design. Those participants with binocular corneal scar were excluded. The total planned sample size was 845, determined using single proportion population formula by considering 95% confidence level, proportion of good attitude toward eye donation of 50%, a margin of error of 5%, design effect of 2, and 10% for nonresponse rate. The study participants were selected using multistage systematic random sampling technique. The data were collected using structured questionnaire, which was developed after literature review. The questionnaire consisting of items regarding knowledge about eye donation, attitudes, and sociodemographic details was used. The questionnaire was validated by doing pretest on 5% of the sample before the actual data collection period. Data were collected by trained B. Sc. optometrists through a face-to-face structured questionnaire interview in home-to-home visit. The participants were approached to participate through personal communication after ethical clearance was received from School of Medicine Ethical Review Committee, University of Gondar. During the data collection, the aim of the study was described for all eligible participants and they also had full right to discontinue or refuse to participate. Then, written informed consent was obtained from each willing participant.
“Attitude” was assessed using 3-point Likert scales with six items and the score points varied from 6–18 points. Thus, the overall attitude was categorized as good attitude if the score greater than the median value and as poor if the score was less than the median value. In addition, “knowledge” was assessed using 10 questions; each correct response had score of 1 and wrong response score of 0. The scores varied from 0–10 points, and participants' overall knowledge was categorized using modified Bloom's cutoff point, as good if the score was between 80%–100% (8–10 points), as moderate if the score was between 50% and 79% (6–7 points), and as poor if the score was <50% (0–5 points). After the data were collected and checked for completeness, they were entered into EpiData version 3.1, whcih is a Windows 95/98/NT/2000 based program (32 bit) designed by Jens M. Lauritsen & Michael Bruus and then exported to Statistical Package for Scocial Science Version 20, which is property of International Bussinuss machines(copyright of IBM corporation and Its licensors 1989, 2011) for the analysis to determine the proportions and association between dependent and independent variables using binary logistic regressions. Those variables with P < 0.05 were considered statistically significant.
| Results|| |
This study consisted of 760 adults, which represents 90% response rate. The median age of the participants was 30 years. The majority of the study participants (86%) were Christians followed by Muslims (14%). Regarding completed education level, nearly 70% of the study participants completed high school and above [Table 1].
|Table 1: Sociodemographic and economic characteristics of study participants, Gondar town, Northwest Ethiopia, 2016 (n = 760)|
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Among a total of 760 study participants, 429 (56.4%) of them had awareness about eye donation. The median knowledge score point for those who had awareness was 5.0 ± 1.6. The majority of study participants knew that a living person can pledge to donate eyes (88.3%), but it is not permissible to donate eyes while being a live (77.2%). Furthermore, more than two-third of the participants did not know the optimal time to retrieve the eye after the death of person and which part of the eye can be donated. Overall, the majority of the participants (59.4%) had average knowledge followed by poor level of knowledge (32.2%) about eye donation [Table 2].
|Table 2: Knowledge about eye donation among adults in Gondar town, Northwest Ethiopia, 2016|
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Among 760 study participants, more than 85% of the respondents felt that eye donation is a pleasure act and noble work. Regarding disfigurement and religious concern, 67.1% and 66% of the participants supported that eye donation does not cause disfigurement and not against their religious doctrine, respectively. Overall, the majority the respondents (59.9%) had favorable attitude toward eye donation and median attitude score point of 16 points [Table 3].
|Table 3: Attitude toward eye donation among adults in Gondar town, Northwest Ethiopia, 2016 (n = 760)|
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On applying bivariate analysis, attitude toward eye donation was positively associated with middle age, marital status, higher educational level, greater monthly income, and having previous awareness. In a multivariable logistic regression, higher educational level and awareness were remained associated with attitude toward eye donation. Regarding educational level, those who completed high school and college/university were 2.41 (adjusted odds ratio [AOR] = 2.41, 95% confidence interval [CI]: 1.41–4.14) and 2.73 (AOR = 2.73, 95% CI: 1.53–4.89) times more likely to have good attitude toward eye donation than those who have no formal education, respectively. In addition, those who had awareness were 1.50 times more likely to have good attitude than participants not heard of eye donation before (AOR = 1.50, 95% CI: 1.05–2.03) [Table 4].
|Table 4: Binary logistic regression showing associated factors for attitude toward eye donation among adults, Gondar town, Northwest Ethiopia, 2016|
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| Discussion|| |
In the present study, about 59.9% of the participants had favorable attitude toward eye donation though a small proportion of participants had good level of knowledge. The remaining 40.1% of the participants have poor attitude regarding eye donation resulted from fear of their religion, disfigurements, ill treatment of body by others, delaying of funeral activities, and seeking of further information to make decisions. This implicates that eye donation is a multidisciplinary issue, which consisted of religious, cultural, and social values.
In this study, 56.4% of the participants had heard of corneal donation which is higher than the study done in Central Ethiopia (30.9%), but it was lower than the studies done in Malaysia (69%), Nigeria (75.9%), Singapore (80.7%), and Bhopal, India, (98%). The difference might be resulted from variation in study population characteristics and study design. Regarding detailed knowledge of eye donation, nearly more than half of the participants (59.4%) scored moderate knowledge on eye donation, but only 8.4% of them had good knowledge on eye donation. This result was lower than the study done in Belagavi city, India, in which 87% of the students had average and above knowledge on eye donation. Overall, this comparison indicates that greater efforts need to be exerted to increase public awareness about eye donation.
Another main concern of this study was that attitude on eye donation, in which more than 85% of the respondents agreed that eye donation is a pleasure act and noble work. A similar finding was also reported from a study conducted in Singapore and Wolkite town, Ethiopia, in which 92.9% and 73.7% of participants stated that donating eyes made them feel that they were doing good, respectively. Regarding religious issues, two-third of the participants supported that eye donation is not against their religious doctrine. Regarding attitude, 59.9% of the respondents had favorable attitude toward eye donation, which was also lower the study done in Belagavi city, India, in which 71.5% of the participants had a favorable attitude on eye donation.
On applying a multivariable logistic regression, higher educational level and awareness were positively associated with attitude toward eye donation. Regarding educational level, those who completed high school and college/university were 2.41 and 2.73 times more likely to have good attitude toward eye donation than those who have no formal education, respectively. This result was supported by the studies conducted in adult population of India, in Nanjing, China, and in Jimma University, Ethiopia, in which those who had higher educational level had favorable attitude on eye donation. The possible reason why higher educational status was positively associated with good attitude of eye donation is that individuals having higher educational status may have detailed knowledge about organ donation and subject matter, so their attitude toward it will be more favorable. This explanation is in line with the studies conducted in Singapore, Mangalore, India, and Washington, US. Overall, educational level of an individual may influence his/her attitude to donate eyes.
In addition, those who had awareness were 1.50 times more likely to have good attitude than participants not heard of eye donation. It was also revealed by other studies conducted in Central Ethiopia, in Jimma University, and in adult population of Singapore. Overall, the required information about eye donation must address religious, cultural, and procedural issues so that it is not straightforward to get favorable attitude about it without investing tremendous efforts. This further implicates that having comprehensive information is a precursor to develop good attitude toward eye donation and designing multidirectional awareness creation program will be one of the approaches to facilitate multi-stakeholder partnership as well as to motivate the community.
Although the methodological approaches of the study assured the representativeness of the result for the target population, missing of street adults from the study was considered as a limitation.
| Conclusions|| |
Although the overall level of knowledge about eye donation was poor, the proportion of favorable attitude toward eye donation was fair. Since it is associated with educational level and awareness, it is strategic to follow multidisciplinary approaches to facilitate multi-stakeholder partnerships and to motivate the people to donate their eyes.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: A global perspective. Bull World Health Organ 2001;79:214-21.
Gelaw Y, Ambaw F. Socio-demographic correlates of attitude towards corneal donation among health science students and academic staff of Jimma University. Ethiop Med J 2010;48:41-7.
Berhane Y, Worku A, Bejiga A, Adamu L, Alemayehu W, Bedri A, et al
. Prevalence and causes of blindness and low vision in Ethiopia. Ethiop J of Health Dev 2008;21:204-10.
Yadav SK, Patil SB, Narasannavar AB, Angolkar M. Knowledge and attitude regarding eye donation among undergraduate nursing students of Belagavi city: A cross-sectional study. Int J Interdiscip Multidiscip Stud 2015;2:17-23.
Rajan MS. Surgical strategies to improve visual outcomes in corneal transplantation. Eye (Lond) 2014;28:196-201.
Rao GN, Gopinathan U. Eye banking: An introduction. Community Eye Health 2009;22:46-7.
Healio. Eye Banks World Wide Increasing Standards Expanding Mission. Available from: http://www.healio.com
. [Last accessed on 2016 Apr 17].
European Eye Bank of Associatrion. Eye Donation. Available from: http://www.eebaeu
. [Last accessed on 2016 May 05].
Gaum L, Reynolds I, Jones MN, Clarkson AJ, Gillan HL, Kaye SB, et al.
Tissue and corneal donation and transplantation in the UK. Br J Anaesth 2012;108 Suppl 1:i43-7.
Irving MJ, Tong A, Jan S, Cass A, Rose J, Chadban S, et al.
Factors that influence the decision to be an organ donor: A systematic review of the qualitative literature. Nephrol Dial Transplant 2012;27:2526-33.
Gessesse G, Tilahun Y. Willingness to donate eyes and associated factors among adults in a rural community in Central Ethiopia. J Ophthalmol East Cent South Afr 2013;17:20-4.
Bhandary S, Khanna R, Rao KA, Rao LG, Lingam KD, Binu V, et al
. Eye donation – Awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia. Indian J Ophthalmol 2011;59:41-5.
] [Full text]
Okoye OI, Maduka-Okafor FC, Eze BI. What does the medical student know about eye donation/corneal transplant? The University of Nigeria Scenario. West Indian Med J 2010;59:41-4.
Yew YW, Saw SM, Pan JC, Shen HM, Lwin M, Yew MS, et al.
Knowledge and beliefs on corneal donation in Singapore adults. Br J Ophthalmol 2005;89:835-40.
Kumar S, Shukla US, Agarwal P. Awareness and knowledge on eye donation among students at Bhopal. Natl J Community Med 2012;3:685-9.
Priyadarshini B, Srinivasan M, Padmavathi A, Selvam S, Saradha R, Nirmalan PK, et al
. Awareness of eye donation in an adult population of Southern India. A pilot study. Indian J Ophthalmol 2003;51:101-4.
] [Full text]
Chu T, Wang LN, Yu H, Zhang RY. Awareness of cornea donation of registered tissue donors in Nanjing. Chin Med Sci J 2013;28:20-7.
D'silva F. knowledge and attitude towards eye donation among adolescents of a nursing institute in Mangalore. Int J Adv Res 2015;3:727-31.
Cárdenas V, Thornton JD, Wong KA, Spigner C, Allen MD. Effects of classroom education on knowledge and attitudes regarding organ donation in ethnically diverse urban high schools. Clin Transplant 2010;24:784-93.
[Table 1], [Table 2], [Table 3], [Table 4]