DOI: 10.12688/wellcomeopenres.26504.1 ISSN: 2398-502X

Microbial keratitis management through the lens of pharmacy attendants in Siraha district of Nepal: A study of knowledge, attitudes, and practices

Reena Yadav, Sandip Das Sanyam, Abeer H.A. Mohamed Ahmed, David Macleod, Simon Arunga, Abel Ebong, Astrid Leck, Abhishek Roshan, Sanjay K. Singh, Sailesh K. Mishra, Jeremy J. Hoffman, Matthew J. Burton, Tara Mtuy
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Background Microbial keratitis (MK) is endemic in many developing countries including Nepal and is a preventable cause of blindness. Many Nepalese rely on community pharmacies or medical shops as their primary source of healthcare. This study explored the knowledge and experience of private pharmacy workers on the management of MK and ways to engage local pharmacies to improve referral of patients with suspected MK. Methods A mixed methods descriptive cross-sectional study using a knowledge, attitude, and practice (KAP) questionnaire, in depth interviews (IDIs) and focus group discussions (FGDs) was carried out among pharmacy attendants of Siraha district of Nepal. Descriptive analysis was performed on the survey data and qualitative data was analysed thematically. Results Most (87.5%) of the pharmacy attendants did not receive training on eye care. However, 41.4% of the pharmacies receive 1–2 patients per week with eye related problems. Only 13 (8.5%) out of 152 participants were able to identify a cornea ulcer. Pharmacy attendants indicated that steroid eye drops should be used to reduce eye redness (73.3%), and to treat painful eye (69.2%). Although, the pharmacy attendants were willing to initiate timely referral of patients, most of them were not confident in the ability of health post staff to manage MK cases, attributing it to a lack of adequate resources. They emphasised a need for regular training and updates on MK management to improve referrals. The need for coordination between pharmacies, health posts, the eye hospital, and community was suggested to improve the management of MK. Conclusion Pharmacy attendants can play a vital role in improving outcomes for microbial keratitis through appropriate management and timely referrals. Training on microbial keratitis management is needed for pharmacy attendants. They should be sensitised about the adverse effects of steroid use in MK cases and the importance of timely referrals.

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