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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 57  |  Issue : 4  |  Page : 289-293

Knowledge, attitude, and practice regarding eye donation in patients attending outpatient department of tertiary care hospital of Western India


Department of Ophthalmology, C. U. Shah Medical College and Hospital, Surendranagar, Gujarat, India

Date of Submission29-Aug-2019
Date of Acceptance17-Sep-2019
Date of Web Publication26-Dec-2019

Correspondence Address:
Dr. Aruna K R Gupta
Department of Ophthalmology, C. U. Shah Medical College and Hospital, Dhudrej Road, Surendranagar - 363 001, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_80_19

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  Abstract 


Aims and Objectives: The aim of the study is to assess the knowledge, attitude, and practice regarding eye donation in patients attending outpatient department of a tertiary care hospital. Materials and Methods: The data were collected by the questionnaire method from 500 patients waiting in outpatient department of ophthalmology. The questionnaire included questions pertaining to demographic profile, literacy, occupation, awareness about eye donation, willingness to donate, reasons for not pledging, and the sources of information. Results: Percentage of awareness of eye donation was equal in males and females. Significantly less awareness of eye donation was found in illiterate individuals (P < 0.0001) and Muslims (P < 0.0001). 66.6% participants were aware of eye donation and eye camps were the major source of information. 51.50% were willing to pledge their eyes. Lack of awareness was the major reason for not willing to pledge in 32.91% participants. Chi-square analysis between “awareness” and “willingness” groups showed that age group, gender, residency, and occupations were independent factors contributing to willingness to donate, while religion and education showed significant association between awareness and willingness (P < 0.05). Participants who were initially not aware about eye donation (33.6%), after being counseled showed positive responses of willingness to pledge. Conclusion: The data showed that most of the people were aware about eye donation and were willing to donate their eyes; however, the attitude and practice showed mixed responses. Participants had misconceptions about eye donation. Therefore, to reduce the burden of avoidable corneal blindness effective measures should be taken by ophthalmologists, physicians, and especially religious leaders to educate and motivate people for eye donation.

Keywords: Attitude, awareness, eye donation, knowledge, willingness


How to cite this article:
Gupta AK, Tripathi J. Knowledge, attitude, and practice regarding eye donation in patients attending outpatient department of tertiary care hospital of Western India. TNOA J Ophthalmic Sci Res 2019;57:289-93

How to cite this URL:
Gupta AK, Tripathi J. Knowledge, attitude, and practice regarding eye donation in patients attending outpatient department of tertiary care hospital of Western India. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2020 Jul 14];57:289-93. Available from: http://www.tnoajosr.com/text.asp?2019/57/4/289/273983




  Introduction Top


In India, it is estimated that there are approximately 6.8 million people who have vision <6/60 in at least one eye due to corneal diseases; of these, about a million have bilateral involvement.[1],[2] It is expected that the number of individuals with unilateral corneal blindness in India will increase to 10.6 million by 2020.[2] According to the National Programme for Control of Blindness estimates, there are currently 120,000 corneal blind persons in the country. It is estimated that there is an addition of 25,000–30,000 corneal blindness cases every year in the country.[3]

Corneal blindness in a large proportion of cases is avoidable. Corneal transplantation is the only method for sight restoration for patients having corneal blindness. The source of transplantable cornea can be obtained from the general population. This, however, is dependent on people willing to pledge their eyes for donation and relatives willing to honor that pledge upon the death of that person.

As restoration of vision for corneal blindness is possible through corneal grafting, this has led to a sustained multipronged drive to raise awareness regarding eye donations and corneal transplantation. Based on the present availability of safe donor eyes and utilization rates, it is estimated that 270,000 donor eyes are required to perform 100,000 corneal transplants per year in India, and this is approximately four times the present availability of donor eyes.[4] Currently, the utilization rate of donor cornea ranges between 25% and 60%.[5] There is a limited supply of quality donor corneas. To enhance the procurement of corneal donations further raising the level of public awareness on eye donation is important.

The eye bank of the tertiary care hospital in Western India, where this study was conducted was setup in 2009, and it has been ever since involved in promotional activities to increase awareness, besides harvesting, and preserving donor eyes. The eye bank is relatively new, so this study was undertaken by the authors to determine the awareness about eye donations in the population the hospital serves so that the future strategy for awareness activity could be framed and the counseling done during study would provide an opportunity to actually educate the study participants regarding eye donation. The aim of the study was to assess the knowledge, attitudes, and practice of corneal donation in patients attending outpatient department of the tertiary care hospital.


  Materials and Methods Top


A cross-sectional study was conducted on 500 participants, who were the patients visiting the outpatient department of ophthalmology, of the tertiary care medical college hospital, between October 2018 and April 2019. The study was approved by the Institutional Ethics Committee and written informed consent was obtained from the participants. The prevalidated questionnaire was prepared in English and the local language to be used as per the participant's convenience. The initial questions pertained to demographic profile, literacy, occupation of the participants, and the main body of questions dealt with awareness about eye donation, willingness to donate/pledge eyes, the reasons for donating/pledging or not opting to donate/pledge, and the sources of information of their awareness.

“Awareness” was defined as having heard about eye donation. “Knowledge” was considered as having understanding regarding the details of different aspects of eye donation such as process of pledging of eyes, who can donate eyes, when can eyes be donated, and what steps are to be taken after death to donate the eyes. Only those participants who were aware of eye donation were asked about their willingness to pledge eyes for donation. “Attitudes” of the respondents regarding eye donation was determined through questions regarding opinions on issues such as the willingness to donate and influence of religion and other factors on eye donation. “Practice” was determined by the observation that after counseling, whether the participant agreed to fill the pledge form and whether the participant agreed to motivate other family members/friends to fill the pledge form for eye donation. Only adult (above 18 years) participants were included in the study.

Data were entered into Excel sheet and analyzed using SPSS software version 18 (SPSS Inc., Chicago, Ill., USA). Proportions and percentages were used for descriptive statistics. Chi-square test was used for inferential statistics. P < 0.05 was considered statistically significant.


  Results Top


[Table 1] shows the sociodemographic profile of the participants. Out of the 500 participants, 342 (68.4%) were male and 158 (31.6%) female. The mean age of participants was 38.17 years (standard deviation 7.6 years), and the range was 18–90 years. The ethnic distribution was 430 (86%) Hindus, 63 (12.6%) Muslims, and 7 (1.4%) others. One hundred and eighty-three participants (36.6%) had completed only primary education, 162 participants (32.4%) had completed secondary education, 99 participants (19.8%) were graduates, 40 (8%) were postgraduates, while 16 participants (3.2%) chose to not answer this question. Two-hundred and twenty participants (44%) belonged to urban population and 275 (55%) were from the rural population, while 5 participants did not reveal their residential status.
Table 1: Sociodemographic profile of participants (n=500)


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An “awareness camp” was mentioned as the most common source of information for 38.55% participants (40.4%), followed by newspapers (20.48%), television (18.07%), banners (13.55%), and in 1.81%, it was through other person/sources [Table 2].
Table 2: Source of information on eye donation (n=332)


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About 66.6% participants were aware about eye donation [Table 3]. The knowledge that eyes are to be collected within 6–8 h of death was known to only 154 (46.38%) participants and 118 (35.54%) knew that eyes could be collected despite most existing medical ailments. Only 106 (31.2%) participants knew that only cornea could be transplanted. Seventy-six (22.84%) participants had already pledged for eye donation. One hundred and seventy-one (51.50%) participants were willing for their eye donation.
Table 3: Knowledge regarding eye donation (n=332)


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Out of 161 unwilling participants [Table 4], lack of awareness was seen in 29 (32.91%) participants, 42 (26.08%) disliked the idea of separating the eyes from the body, and 29 participants (18.4%) had objection by family members. Ten (6.21%) participants thought that eyes are unsuitable for eye donation because of health problem, while 11 (6.83%) participants had the misbelief that they would be born blind in their next birth. Seventeen participants (10.54%) answered that it was against their religious belief.
Table 4: Attitude toward eye donation (n=161)


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[Table 5] shows the relationship between awareness and willingness for eye donation with various other variables. Chi-square analysis between awareness and willingness shows that age group, gender, residency, and occupations are independent factors contributing to willingness to donate eyes, while religion and education show significant association between awareness and willingness (P< 0.05).
Table 5: The relationship between awareness and willingness for eye donation with various variables


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One hundred and sixty-eight participants who were initially not aware about eye donation and after being counseled showed positive responses of willingness to donate.


  Discussion Top


In this study, it was observed that of the 500 participants, 66.6% (229 males and 103 females) were aware about eye donation, but only 22.84% of them had pledged their eyes. In other similar studies, awareness varied from as low as 44%[6] to as high as 95.6%.[7] Awareness was 90.6% and 69% in study by Tata et al.[8] and Bhandary et al.,[9] respectively. A study by Priyadarshini et al.[10] showed an awareness of 50.69% among the patients attending two outreach clinics in Southern India. The difference in awareness maybe because of the area of study setting which may influence the knowledge of eye donation in different regions. The medical college hospital where this study was conducted is in a semi-urban location, and 55% of the participant was from rural areas.

Our data suggest that participants from Muslim community and other religion were less aware of eye donation compared to the participants from Hindu community, and this difference was highly significant. Literacy had a significant influence on level of awareness about eye donation, but only a few had actually taken the steps of pledging their eyes. Females were less willing to pledge their eyes even though they were equally aware of eye donation. Awareness of eye donation and willingness to pledge eyes was significantly higher above 40 years of age when compared to the age group of <40 years.

The study found that awareness camp was the most common source of information for 38.55% participants, while other studies found that mass media in the form of television[6] and newspapers[7] were important sources of information on eye donation.

In this study, 46.38% were aware that the ideal time for donation was within 6 h of death, which is similar to study by Bijapur and Vallabha,[7] who reported it as 36.9%. In study by Tata et al.,[8] it was as high as 76.3%. whereas in study by Priyadarshan et al.,[10] it was only 4.34%, which denotes very less awareness.

In this study, only 118 (35.54%) knew that eyes can be donated in spite of existing diseases. Two hundred and fifty-eight (77.71%) were of the opinion that it was necessary to transport the dead person (donor) to the hospital. 85.54% felt that this process would significantly delay the funeral arrangement, and many of the participants had the opinion that it would cause disfigurement of the donor's face (79.0%). These findings suggest that there were unwanted misconceptions regarding eye donation and they should be removed.

In this study, only 76 (22.84%) participants had pledged for eye donation. Lack of awareness (32.91%) was the main reason for not pledging eyes, 42 participants (26.08%) disliked the idea of separating the eyes from body, 29 participants (18.01%) had objection raised by family members and 10 (6.21%) participants thought that eyes are unsuitable for eye donation because of health problem, and 17 participants (10.54%) answered that it was against their religious belief.

In the present study, the relationship between awareness and willingness for eye donation with various variables [Table 5] was assessed. Males were found to be more aware and willing for eye donation. Unwillingness among females may be because of their family ties and perceived necessity to seek permission from family members before pledging their eyes. The younger age group was more willing to donate eyes compare to older age group. Persons from Hindu community were more willing to donate eyes compared to other religious communities for religious reasons. In the study by Bijapur and Vallabha.,[7] it was found that although majority were willing to pledge their eyes only 36.9% were willing to donate eyes of their relatives who might be seriously ill, whereas in study by Sulatha[9] the willingness to donate eyes was seen in 34.42%.

Data from this study suggest that additional efforts are needed to improve awareness of eye donation.

[Table 5] shows the relationship between awareness and willingness for eye donation with various variables. Chi-square analysis between awareness and willingness shows that age group, gender, residency, and occupations are independent factors contributing to willingness to donate eyes, while religion and education show significant association between awareness and willingness (P< 0.05).

About 33.6% participants were not aware about eye donation but after being counseled showed positive responses for pledging their eyes for donation. Thus, more public education is needed to change their attitude toward eye donation and make it more favorable, and this would lead to an increase in the number of corneas available for transplantation. To reduce the burden of avoidable corneal blindness, ophthalmologists, physicians, and especially religious leaders have to educate and motivate people for eye donation.


  Conclusion Top


The findings of this study show that most of the people were aware about eye donation and most of them were willing to donate their eyes; however, the attitude and practice showed mixed responses. Participants had misconceptions in their knowledge about eye donation. To reduce the burden of avoidable corneal blindness, effective measures should be taken by ophthalmologists, physicians, and especially religious leaders to educate and motivate people for eye donation. Utilizing the findings of this study, we need to make a strategy to promote and deliver specific programs to increase awareness regarding eye donation. Thus, this will lead to increase in local donor cornea collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. National Programme for Control of Blindness. Report of National Programme for Control of Blindness. India: World Health Organization; 1986-89.  Back to cited text no. 1
    
2.
Dandona R, Dandona L. Corneal blindness in a Southern Indian population: Need for health promotion strategies. Br J Ophthalmol 2003;87:133-41.  Back to cited text no. 2
    
3.
National Programme for Control of Blindness. Available from: http://www.pbhealth.gov.in/pdf/Blindness.pdf. [Last accessed on 2019 Jul 21].  Back to cited text no. 3
    
4.
Saini JS. Realistic targets and strategies in eye banking. Indian J Ophthalmol 1997;45:141-2.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Raychaudhuri A, Raychaudhuri M, Banerjee AR. Availability of donor corneal tissue for transplantation. Trop Doct 2004;34:99-101.  Back to cited text no. 5
    
6.
Maiya GR, Kiran KG, Badiger S. Assessment of awareness and perception regarding eye donation among selected patients attending field practise area of a tertiary care hospital in Mangalore: A cross-sectional study. Int J Community Med Public Health 2018;5:2920-5.  Back to cited text no. 6
    
7.
Bijapur VM, Vallabha K. Knowledge, attitude and practice patterns regarding eye donation, eye banking and corneal transplant in a tertiary care hospital. J Krishna Inst Med Sci Univ 2015;4:94-103.  Back to cited text no. 7
    
8.
Tata S, Philip SE, Jagtap M, Mulla RI. Survey on knowledge and attitude about eye donation among caregivers of admitted patients at tertiary care hospital, Karad. Int J Sci Res 2018;7:391-6.  Back to cited text no. 8
    
9.
Bhandary S, Khanna R, Rao KA, Rao LG, Lingam KD, Binu V. Eye donation – Awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia. Indian J Ophthalmol 2011;59:41-5.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Priyadarshini B, Srinivasan M, Padmavathi A, Selvam S, Saradha R, Nirmalan PK. Awareness of eye donation in an adult population of Southern India. A pilot study. Indian J Ophthalmol 2003;51:101-4  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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