Regional Disparities and Determinants of Visual Impairment Among Diabetic Patients in Ethiopia.

Abstract

<h4>Background</h4>The increasing prevalence of diabetes in Ethiopia has led to a rising burden of its complications, particularly Visual Impairment (VI). This systematic review and meta-analysis aimed to determine the pooled prevalence, identify associated risk factors, and evaluate geographic disparities of VI among diabetic patients in Ethiopia.<h4>Method</h4>A comprehensive literature search was conducted across multiple electronic databases up to January 30, 2024. Data was extracted with an Excel Sheet and analyzed using RevMan 5.4 and <b>R statistical software (version 4.5.1)</b>. A random-effects model was used to estimate the pooled prevalence and to perform subgroup analyses by geographic region and publication period. Risk factors were pooled to generate adjusted odds ratios (AORs).<h4>Results</h4>The analysis included 11 studies with 4,204 diabetic patients. The overall pooled prevalence of VI was 29.32% (95% CI: 18.92%, 39.71%). Subgroup analysis revealed profound and statistically significant geographic disparities (Test for subgroup differences: χ² = 274.10, df = 4, <i>p</i> < 0.0001), with the prevalence ranging from 7% (95% CI: 0.05, 0.11) in Oromia to 70% (95% CI: 0.65, 0.75) in Tigray. The pooled estimates for Amhara and SNNP regions were 27% (95% CI: 0.18, 0.39) and 21% (95% CI: 0.11, 0.37), respectively. Key factors significantly associated with increased odds of VI were older age (60-80 years; AOR = 3.55, 95% CI: 1.23, 10.28), diabetes duration > 3 years (AOR = 3.47, 95% CI: 2.43, 4.95), poor glycemic control (AOR = 3.18, 95% CI: 2.20, 4.59), and inadequate physical activity (AOR = 2.74, 95% CI: 1.89, 3.97).<h4>Conclusion and recommendation</h4>There is a high and geographically heterogeneous burden of visual impairment among diabetic patients in Ethiopia. The identified risk factors are largely modifiable. We recommend implementing region-specific public health interventions that prioritize promoting physical activity, optimizing glycemic control, and managing diabetes duration effectively to mitigate the risk and disparity of visual impairment.