COECSA, Journal, Ophthalmology
Health education and awareness about diabetic retinopathy among patients attending diabetic clinics in tertiary and regional hospitals in Tanzania
Download PDF Article


Diabetes mellitus
Diabetic retinopathy
Diabetes education


How to Cite

Mafwiri MM, Mwakyusa N, Shilio B, Lutale JK. (2023). Health education and awareness about diabetic retinopathy among patients attending diabetic clinics in tertiary and regional hospitals in Tanzania. The Journal of Ophthalmology of Eastern, Central and Southern Africa, 15(01). Retrieved from


Objective: To assess the level of diabetes education, diabetes eye-care delivery knowledge and awareness
about diabetic retinopathy among patients attending diabetes clinics in selected regional and tertiary
hospitals in Tanzania.

Materials and Methods: A cross-sectional study was conducted in 6 regional and all 4 zonal tertiary referral
hospitals in Tanzania. A semi-structured questionnaire was administered to about 413 systematically
sampled patients to explore their demographics, diabetes health education, awareness about diabetic
retinopathy and eye-care, and challenges encountered when accessing diabetic eye care services.

Results: A total of 413 patients were recruited. Seventy one (8.6%) patients were type-1, and 336 (81.3%)
type-2. Two hundred and fifty five (61.8%) had diabetes for 1-10 years. Three hundred and twenty two
(77.9%) had received diabetes education. Receiving diabetes education was significantly associated with
level of education (p<0.0001), residential region (p<0.0001) and occupational status (p<0.007). Nurses
and doctors were the leading providers of diabetes education reported by 243 (75.5%) and 196 (47.5%)
patients. Radio, television, brochures/posters, relatives and friends were the least mentioned sources
of diabetes education. Education messages delivered were diabetic diet (390, 94.4%); control of: blood
sugar (226, 54.7%), blood-pressure (49, 12%); eye-care (62, 15%), feet-care (62,15%) and 45 (11%) exercise.
Twenty four (5.8%) patients were aware about the need for yearly eye examination. One hundred and
twenty three (29.8%) had previous eye examination. Shortage of staff in facilities providing diabetes-care;
inadequate drugs and equipment for monitoring blood sugar were the main challenges.

Conclusions and recommendations: Although diabetes education is provided to most patients
attending diabetes clinics in Tanzania, patients have limited awareness about diabetic complications
in particular diabetic retinopathy including the need for yearly eye examination which would make
strategies to implement health promotion and prevention of diabetic retinopathy blindness difficulty.
Strategies to improve diabetes education are required.

Download PDF Article


Mugusi F, Rashid S, Whiting D, Edwards R,

Alberti KG, et al. Rural and urban differences

in diabetes prevalence in Tanzania: the role of

obesity, physical inactivity and urban living.

Trans R Soc Trop Med Hyg. 2000; 94(6):637-644.

Wild S, Roghia G, Green A, Sicre R, King H.

Global prevalence of diabetes. estimates for the

year 2000 and projection for 2030. Diabetic Care.

; 27: 1047- 1053.

McLarty DG, Swai AB, Kitange HM, Masuki G,

Mtinangi BL, Kilima PM, et al. Prevalence of

diabetes and impaired glucose tolerance in rural

Tanzania. Lancet. 1989; 1(8643):871-875.

Ruhembe CC, Mosha TC, Nyaruhucha CM.

Prevalence and awareness of type 2 diabetes

mellitus among adult population in Mwanza city.

Tanzania J Health Res. 2014; 16(2):89-97.

Tesfaye S, Gill G. Chronic diabetic complications in

Africa. African J Diab Med. 2011; 19 (1): 89-97.

Pacolin D, Mariotti SP. Global estimates of visual

impairment: 2010. BJO. 2012; 96: 614-618.

Cleland CR, Burton M, Hall C, Hall A, et al.

Diabetic retinopathy in Tanzania: prevalence and risk

factors at entry into a regional screening programme.

Trop Med Int Health. 2016; 21(3): 417–426.

Diabetic Retinopathy Study Group.

Photocoagulation treatment of proliferative

diabetic retinopathy: the second report of diabetic

retinopathy study findings. Ophthalmology. 1978;

(1): 82-106.

Burgess PI, Msukwa G, Beare NA. Diabetic

retinopathy in sub-Saharan Africa: meeting the

challenges of an emerging epidemic. BMC Med.

Jul 2;11: 157. doi: 10.1186/1741-7015-11-157.).

Whiting DR, Hayes L, Unwin NC. Diabetes in

Africa. Challenges to healthcare for diabetes in

Africa. J Cardiovasc Risk. 2003; 10:103–110.

WHO, World Health Report 2002: Reducing

risks, promoting healthy life. Geneva: WHO 2002.

World Health Organization: VISION 2020 Action

Plan 2006-2010.

Mafwiri M, Mwakyusa N, Shilio B, Sanyiwa

A, Lutale J, Dhalla K, Makupa W. Situational

analysis of infrastructure and human resources

for diabetic retinopathy services in Tanzania.

J Ophthalmol East, Central and South Afr. 2014;

(2): 49-58.

Winter I, Yorston D. Diabetic retinopathy:

everybody’s business. Community Eye Health J.

; 24 (75): 1-3.

Mashige KP, Notshweleka A, Moodley S ,

Rahmtoola FH , Sayed SB, Singh S, Sardiwalla Z.

An assessment of the level of diabetic patients’

knowledge of diabetes mellitus, its complications

and management in Durban, South Africa. S Afr

Optom. 2008; 67 (3): 95-105.

Nyamu, DG. Knowledge on diabetes mellitus

among diabetic patients attending Kenyatta

National Hospital outpatient clinic. URI:http://

e r epos i tory.uonbi . a c .ke :8080/xmlui /

handle/123456789/15919. 2008.

Gulabani M, John M, Isaac R. Knowledge of

diabetes, its treatment and complications amongst

diabetic patients in a tertiary care hospital.

Indian J Comm Med. 2008; 33(3): 204–206. doi:


Mwangi MW. Knowledge and awareness of

diabetic retinopathy amongst diabetic patients in

Kenyatta National Hospital. Intern J Humanities

Social Sci. 2011; 1(21) [Special Issue]: 140.

Heisler M, Pietee JD, Spencer M, Kieffer E, Vijan

S. The relationship between knowledge of recent

HbA1c values and diabetes care understanding

and self-management. Diabetes Care. 2005;

:816–22. [PubMed].

Tham KY, Ong JJ, Tan DK, How KY. How much

do diabetic patients know about diabetes mellitus

and its complications? Ann Acad Med Singapore.

; 33: 503–509. [PubMed].


Download data is not yet available.