{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:02:42Z","timestamp":1785474162732,"version":"3.56.0"},"reference-count":46,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2019,9,12]],"date-time":"2019-09-12T00:00:00Z","timestamp":1568246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017151","name":"Queen Elizabeth Diamond Jubilee Trust","doi-asserted-by":"publisher","award":["TG002"],"award-info":[{"award-number":["TG002"]}],"id":[{"id":"10.13039\/100017151","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["207472\/Z\/17\/Z"],"award-info":[{"award-number":["207472\/Z\/17\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Eye care provision is currently insufficient to meet the population\u2019s eye health needs in Kenya. Many people remain unnecessarily visually impaired or at risk of becoming so due to treatable or preventable conditions. A lack of access and awareness of services are key barriers, in large part due to their being too few eye care providers in the health system for this unmet need. Methods: A hospital-based, retrospective analysis of patients who attended Kitale eye unit, Trans Nzoia County, Kenya from 1st January 2013 to 31st December 2015. Age and sex standardized hospital attendance rates by residence, age group, and sex were calculated for Trans Nzoia county and each subcounty. The changing trends in attendance rates were estimated by calculating the difference between base year and last year. Incidence rate ratios for attendance for each age-group, sex, and residence were estimated using a multivariable regression model. Results: 20,695 patients from the county were seen in Kitale Eye Unit in 2013, 2014 and 2015. In that period, 8.3% had either uncorrected refractive error, cataracts or glaucoma, the priority VISION2020 diseases, and 61.0% had allergic or other conjunctivitis or normal eyes, which could potentially be managed at primary eye care. During the study period, overall average annual attendance rate increased from 609 to 792 per 100, 000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26\u20131.35). Attendance rates increased more in females than males (34.7% vs. 25.1%, respectively), IRR 1.07 (1.04\u20131.10). Attendance rates increased with increasing age, (highest among the elderly compared to the young). We found that in extreme age groups (&gt;75 years and &lt;15years) females were less likely to attend than males and there was reduced utilization from those based furthest from the hospital. Conclusion: Specialist eye services are heavily utilized by people with conditions that could be managed at the primary health care level. Barriers to accessing eye services were distance and gender, especially among the most vulnerable groups (young and the elderly). Integration of primary and secondary eye care services could lower barriers to essential eye care services to the population whilst lowering pressure on the limited specialist services by ensuring more appropriate utilization.<\/jats:p>","DOI":"10.3390\/ijerph16183371","type":"journal-article","created":{"date-parts":[[2019,9,12]],"date-time":"2019-09-12T10:56:06Z","timestamp":1568285766000},"page":"3371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Utilization of Secondary Eye Care Services in Western Kenya"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9843-4186","authenticated-orcid":false,"given":"Hillary K","family":"Rono MMed","sequence":"first","affiliation":[{"name":"International Centre for Eye Health, Clinical Research Department, London School of Hygiene &amp; Tropical Medicine, London WC1E 7HT, UK"},{"name":"Kitale County and Referral Hospital, Box 98, Kitale 30200, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Macleod","sequence":"additional","affiliation":[{"name":"MRC Tropical Epidemiology Group, London School of Hygiene &amp; Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Bastawrous","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, Clinical Research Department, London School of Hygiene &amp; Tropical Medicine, London WC1E 7HT, UK"},{"name":"The Peek Vision Foundation, London EC2Y 9DT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Wanjala","sequence":"additional","affiliation":[{"name":"Kitale County and Referral Hospital, Box 98, Kitale 30200, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gichangi","sequence":"additional","affiliation":[{"name":"Ophthalmic Services Unit, Ministry of Heath, Box 30016, Nairobi 00100, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Burton","sequence":"additional","affiliation":[{"name":"International Centre for Eye Health, Clinical Research Department, London School of Hygiene &amp; Tropical Medicine, London WC1E 7HT, UK"},{"name":"Moorfields Eye Hospital NHS Trust, London EC1V 2PD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e888","DOI":"10.1016\/S2214-109X(17)30293-0","article-title":"Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: A systematic review and meta-analysis","volume":"5","author":"Bourne","year":"2017","journal-title":"Lancet Glob. 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