Capacity of health facilities to diagnose and manage keratoconus: a Kilimanjaro region case study.

Introduction: Keratoconus (KC), is a corneal disease that causes visual impairment, which diminishes thequality of life (QoL) of affected individuals. Although most eye care practitioners in Tanzania anecdotally report a significant number of patients presenting with KC symptoms,little is known on how KC is managed at differentlevels of the healthcare system.

Purpose: To conduct a survey to assess health facility capacity and optometrists' capability to diagnose and manage KC in Kilimanjaro region, Tanzania.

Methods: A mixed-method, cross-sectional study was conducted. Health facilities providing eye care services and their employed optometristswere purposivelyselected. TheWHO Service Availability and Readiness Assessment (SARA) tool was applied to obtain eye health care service delivery data and in-depth interviews were conducted to investigate optometrists' knowledge on the diagnosis and management modalities of KC at their respective facilities.

Results: Nine multi-level health facilitieswere included in the SARA assessment.The majority of SARA respondents were female (56%) and ten optometrists participated in in-depth interviews. Only 44% of facilities were both ready to provide and had KC services available. Although all optometrists reported being aware of KC, some did not know how to comprehensively diagnose and manage KC. Barriers to optimal patient care were a lack of equipment and supplies and no practitioner training on KC.

Conclusion: Findings indicate a lack of KC service availability and/or inadequate service readiness in the majority of health facilities in Kilimanjaro. Recommended remedies include general KC advocacy and a health leadership intervention to remedy reported facility and human resource deficiencies towards improved KC patient care.