Health care seeking behaviour for visual dysfunction among motor vehicle drivers in Osun State, Southwest Nigeria

Introduction Visual impairment is recognized as a public health problem worldwide. People and generally drivers do not often go for routine medical or eye examination based on varied reasons. This study assessed health care seeking behaviour for visual dysfunction among motor vehicle drivers in Osun state, Southwest Nigeria. Methods This was a comparative cross-sectional study among 120 male commercial and 120 government drivers, selected using multi-stage sampling technique in Osogbo, Osun State. Data on knowledge, attitude and health seeking behavior of drivers for visual dysfunction and barriers for not seeking medical treatment was collected using a pre-tested semi-structured questionnaire. Questions on awareness about visual functions and attitude of the respondents concerning visual problems were scored. Two sample independent t-test was used to elicit association between mean age/knowledge of government and commercial drivers and health seeking behavior for visual dysfunction. Results The mean age of government and commercial drivers was 44.53years ± 8.51 and 38.52years ± 8.60 respectively. The mean knowledge (p<0.001) and attitude (p=0.001) differences of government and commercial drivers were associated with health seeking behavior for visual dysfunction. Of the 120 government drivers, 24 (20.0%) were aware of their current visual problems. Of the 24, government drivers, 10 (47.6%) visited the hospital for treatment. Busy workplace schedule (n = 5, 20.8%) and lack of awareness of visual defects ((n= 3, 12.5%) by commercial drivers were identified barriers for not seeking medical treatment for visual dysfunction. Conclusion Knowledge and attitude towards visual dysfunction were higher among the government drivers compared to commercial counterparts. Government drivers had better health seeking behavior for visual dysfunction as compared to their commercial counterparts. We recommended routine eye medical check-up for early detection of visual dysfunction in motor vehicle drivers.


Introduction
Visual impairment and blindness due to ocular diseases is recognized as a significant public health problem worldwide with devastating effect on the quality of life of individuals [1,2]. According to World Health Organization, 285 million people are visually impaired globally, with 90% of this population living in developing countries [3].
Refractive error, cataract and glaucoma are increasingly being recognized worldwide as a significant cause of avoidable visual disability, as evidenced by their inclusion in the priority areas of the global initiative "VISION 2020": The Right to Sight" to eliminate avoidable blindness [4]. Good vision is a fundamental component of safe driving, being one of the most important sensory factors for this activity, accounting for about 95% of all sensory requirements [5].
Drivers with good vision have an advantage over those with poor vision. Refractive error is a commonly reported ocular morbidity among drivers [6][7][8]. In Africa and generally in Nigeria, drivers do not often go for routine medical or eye examination. The vast majority attend hospitals when the condition becomes worse and after trying self-medications without success [9]. The problem of low uptake of eye care services in developing countries has been given lower priority compared to the need for resource provision. Evidence shows that even when eye care services are available, they are under utilised by potential beneficiaries [10][11][12]. Studies have accessed visual functions of commercial and those in public institutions respectively in relation to road traffic accidents, prevalence of visual dysfunction and barriers to utilization of eye care services [6][7][8][13][14][15] Sampling: the sample size was calculated using the formula for comparing two groups: [17].
Where n is the minimum sample size, Zα critical ratio at significance level of 5%, Zβ Statistical power for one-sided test at 90%, P0 Average of the 2 prevalence in the 2 comparison groups and d difference between P1and P2. The minimum sample size was 112 for each group. However, 10% of the minimum sample size was added to make about 124 in order to adjust for non-response and improperly filled questionnaires. One hundred and twenty respondents were eventually selected for each group giving a total sample size of 240 respondents and response rate of 96.8%. Verbal consent was obtained from the respondents. All information gathered was kept confidential; participants were identified using only serial numbers. Data was stored securely in password-protected computer.

Results
One hundred and twenty out of one hundred and twenty-four questionnaires were returned, properly filled and analyzed, giving a (45.0%). There was significant difference in the level of knowledge for both groups (p=0.000). The mean difference of educational status among the government and commercial drivers with regards to knowledge of visual dysfunction were found to be statistically significant (p=0.000). The mean age difference for government and commercial drivers across the age groups was also found to be statistically significant (p=0.000) ( Table 2). Government drivers 108 (90.0%) had more positive attitude concerning visual problems compared to the commercial drivers 17 (14.2%). The difference in respondents' attitude concerning visual problems in both study groups were statistically significant (p=0.000). The mean difference of educational status among the government and commercial drivers with regards to attitude towards visual dysfunction were found to be statistically significant (p=0.000). The mean monthly income difference for government and commercial drivers across the age groups was also found to be statistically significant (p=0.000) ( Table   3) The mean knowledge and attitude differences of the government and commercial drivers with regards to visual dysfunction as demonstrated by their health seeking behaviours were found to be statistically significant (p=0.000) ( Table 4).

Discussion
The mean age of 39 years in the commercial drivers is similar to what was reported [15] in a previous study and 45 years in government drivers which was lower than another study conducted on drivers in public institution in Ibadan [18]. The older age observed among government drivers could be because they are required to be educated at the time of recruitment into civil service. The mean ages in both study groups is however, in keeping with an active work force that the respondents belong to as commercial and public institution driving is a demanding occupation. Safe driving is a function of driver's age. With increasing age, there is a decline in sensory cognitive function. It has been reported that older drivers have more accidents per mile than their younger counterparts [19]. The level of education of respondents showed that less than a quarter of government drivers had post-secondary education whereas less than a tenth of commercial drivers had post-secondary education, similar finding was found in studies conducted in south western part of Nigeria [7,13]. Government drivers were significantly better educated than commercial vehicle drivers and this may explain why they also had more periodic eye examination than commercial vehicle drivers since their level of health awareness may be higher. Another reason for better educational attainment and more frequent eye check may be because government drivers are often of higher socioeconomic status. In relation to income, more of the government drivers earned above 18,000 naira than the commercial drivers. This presupposes that the government drivers have more financial capability to attend to their health matters as compared to their commercial counterparts. The mean differences of age, educational status and monthly income among the government and commercial drivers showed that government-employed drivers were more knowledgeable on visual dysfunctions as compared to their commercial counterparts. The knowledge gap on visual functions and awareness of dysfunctions between government and commercial drivers could explain the conduct of survey with emphasis on the commercial drivers [6,7,[13][14][15]. Also, this difference was statistically significant mostly because of improved knowledge of government-employed drivers generally about visual functions. The high level of knowledge among the government-employed drivers could be as a result of the fact that majority of the government drivers have heard of these eye problems through sensitization and awareness programs concerning the eye conducted by experts, organized by the state government and also by non-governmental organizations dealing with matters relating to the eye of which their commercial counterpart was not privy to.
Government drivers had a better positive attitude towards visual dysfunction as compared to their commercial counterparts, awareness of visual defects and willingness to be treated was found to be more common with findings similar to a study in Ibadan, southwest Nigeria [8]. The mean differences of age, educational status and monthly income among the government and commercial drivers showed that government-employed drivers were of a better positive attitude towards visual dysfunctions as compared to their commercial counterparts. Concerning respondents' health seeking behavior for visual dysfunction, more than half of government drivers as compared to about a fifth of commercial drivers have had eye examination done before the conduct of the study. This was however, quite low and surprisingly in agreement with some other studies [6,7,13,[20][21][22][23][24][25][26] due to the fact that majority of drivers don't even do eye test before obtaining license. About half of the government drivers that had previous eye examination were attributed to official reasons, possibly as part of pre-employment medical examination for newly employed workers. This was commendable and should continue to be observed.
Also, two out of ten government drivers were aware of visual problems in them, whereas none of the commercial drivers were aware of visual problems in them. This finding was also in agreement with studies conducted in the southwestern part of Nigeria [13,18,27,28]. We found that government drivers had good health care seeking behaviour as compared to their commercial counterparts. This was reflected in their knowledge and attitude towards visual dysfunctions which later played out in their health seeking behavior as it relates to their visual function. Busy schedule at workplace and ignorance of visual status were barriers that prevented some of the government drivers from going to the hospital. This finding was similar to studies conducted in Plateau State [14] and Ghana [15]. The mobile nature of the commercial and government drivers was put into consideration and data collection was done during the road transport workers meetings for commercial drivers and departmental meeting of government drivers.

Conclusion
Our study revealed that knowledge and attitude towards visual dysfunction was significantly higher among the government drivers than their commercial counterparts. Also, some of the government drivers were aware of their visual problems; however, none of the commercial drivers was aware of any visual problem in them.