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Shilpa Gulati, Pete Setabutr, Weerachart Kilenthong, Khun Varunee Khueapradit, Duangmontree Rojdamrongratana, Manchima Makornwattana, Thasarat S. Vajaranant; Eye Care in Rural Thailand: Barriers to Access. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1551.
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© ARVO (1962-2015); The Authors (2016-present)
Based on a recent epidemiologic survey, the prevalence of visual impairment and blindness is higher in the rural northeastern region of Thailand, compared to the national rate. In the economically disadvantaged provinces of Mahasarakam and Kalasin in northeastern Thailand, we examined factors associated with having an eye exam, including knowledge of an ocular condition requiring care, or awareness that eye care is covered by the national Universal Coverage Scheme (UCS), a 30 baht ($0.84) co-payment per visit health insurance.
In this cross-sectional study, trained field workers visited adults at their homes in Mahasarakam and Kalasin between July and September 2015. The adults were parents of a random sample of children enrolled in 45 local early childhood education centers, who participated in a home interview for the Reducing Inequality Through Early Childhood Education study (conducted by Research Institute for Policy Evaluation and Design at the University of the Thai Chamber of Commerce). Field workers administered surveys regarding personal general health, eye health and awareness regarding availability of care. VA with best available correction was measured by a standardized iPad application, Eye Chart Pro (DOK LLC, Texas). Moderate visual impairment (MVI) was defined as VA < 20/70 in a better-seeing eye (WHO criteria).
Prevalence of MVI in this sample was 3.0%. Of 198 study participants, 61.6% had never had an eye exam; of the remaining 76 participants, nearly a quarter (23.7%) had their last exam over five years ago. Among 128 subjects not recently examined, 75.8% responded that this was because they didn’t think they needed eye care. Few attributed this to cost, time, or distance (4.7%, 12.5%, and 0.8% respectively). Of 40 participants with diabetes, none endorsed knowledge of retinopathy. The majority (86%) of participants felt the price of UCS care was affordable, however more than half (58%) were not aware that eye care was covered.
While the UCS has improved access to medical care in Thailand since its adoption in 2001, our pilot survey suggests limited knowledge of the availability of eye care, and of personal eye health, among this rural population. Future studies are needed to better characterize the epidemiology of ocular conditions, and public awareness of avoidable causes of visual impairment and blindness in rural Thailand.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Trained field worker tests vision at a study subject's home.
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