Title : Barriers to essential eyecare service by visually impaired people and the impact of war in fragile conflict-affected tigray region, Ethiopia
Abstract:
Background: Ethiopia faces a high burden of blindness and visual impairment, yet access to eyecare services remains limited, particularly in conflict-affected areas like Tigray. The two-year long war in Tigray has devastated healthcare infrastructure, further exacerbating service inaccessibility. This study aimed to investigate the barriers preventing visually impaired individuals in Tigray from seeking and accessing eyecare services, with the goal of informing locally relevant, post-conflict health strategies.
Methods: A cross-sectional, mixed-method study was conducted between September and December 2024 across the southern, eastern, and central zones of Tigray. A total of 1,073 adults aged 40 years and above were assessed for visual impairment (monocular or binocular acuity ≤6/18) through mobile screening campaigns. Quantitative data were collected via structured questionnaires and analyzed using multivariable binary logistic regression to identify predictors of delayed eyecare-seeking behavior (defined as >1 year). Qualitative data were collected through focus group discussions (FGDs) and key informant interviews (KIIs) and analyzed thematically to explore perceived barriers.
Results: Participants had a mean age of 63.5 years; over half (51.5%) were 65 or older. The majority were male (57.1%), illiterate (68.7%), farmers (59.2%), and urban residents (78.2%). Levels of vision loss included blindness (52%), severe (10%), moderate (32%), and mild impairment (6%). Most participants (90.8%) reported that vision problems interfered with daily life, and 83.1% noticed a change in vision.
Delayed eyecare visits were common (63.9%), especially among those with more severe impairments. Factors significantly associated with delay included older age (AOR: 1.5; 95% CI: 1.1–2.0), economic hardship (AOR: 1.5; 95% CI: 1.1–2.1), and poor accessibility (AOR: 1.8;
95% CI: 1.3–2.4). The most cited barriers were economic (82.4%), personal (33.4%), and accessibility-related (27.6%), with 6.7% citing security concerns.
Qualitative findings echoed these results, highlighting transportation challenges, cultural beliefs, and economic hardship as major barriers. War-related destruction of infrastructure, loss of health workers, and persistent supply shortages further hindered eyecare service delivery.
Conclusion: This study highlights significant barriers to eyecare access among visually impaired populations in Tigray, rooted in economic hardship, poor accessibility, cultural factors, and war- related infrastructure collapse. Rebuilding healthcare systems, increasing community awareness, and addressing economic constraints are critical steps toward restoring equitable eyecare services in post-conflict settings.
