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Table of Contents
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 25-30

Awareness towards eye donation among general population: a cross-sectional study from rural Haryana


1 Associate Professor, Department of Ophthalmology, SHKM Government Medical College, Nuh, Haryana, India
2 Associate Professor, Department of Internal Medicine, SHKM Government Medical College, Nuh, Haryana, India
3 Assistant Professor, Department of Community Medicine, SHKM Government Medical College, Nuh, Haryana, India

Date of Web Publication31-Aug-2018

Correspondence Address:
Abhishek Singh
Assistant Professor, Department of Community Medicine, SHKM Government Medical College, Nuh, Haryana
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Introduction: Understanding the reasons why people do or do not donate the eyes is crucial to address the problem of undersupply of cornea and designing any intervention. Aim of this study was to assess the level of awareness towards eye donation and factors influencing among general population residing in the rural area of Haryana state.
Methods: We conducted a cross-sectional study during September-December 2014. Patients attending OPD for the purpose of seeking care for their common ailments or diseases formed the study population. Total 360 adults were interviewed using pre-designed and pre-tested questionnaire in local language.
Results: Total 76.9% of participants were aware about eye donation. Education, religion and occupation were found to be important predictors for awareness. Sex and age were not significantly associated with awareness. Awareness about eye donation was significantly lower among illiterates (odds ratio 0.14) compared to those who had higher education. Perceived reasons for willingness to donate eyes were pleased to help the blind, doing good to humanity and noble cause. Reasons for unwillingness to donate eyes were, they don’t want his/her body to be buried with disfigurement, religion and family permission.
Conclusion: Willingness to corneal donation of the studied community is relatively good. This rural population is a good target for mobilization for pledges. Motivators for willingness to donate were the feeling of pleasure in helping the blind and the belief that the act of donation is doing good to humanity, while the dislike to separate the eye from the body after death was the main reason for not being willing to donate.

Keywords: awareness, eye donation, general population, India


How to cite this article:
Kaur M, Singh AA, Singh A. Awareness towards eye donation among general population: a cross-sectional study from rural Haryana. J Integr Health Sci 2017;5:25-30

How to cite this URL:
Kaur M, Singh AA, Singh A. Awareness towards eye donation among general population: a cross-sectional study from rural Haryana. J Integr Health Sci [serial online] 2017 [cited 2018 Oct 18];5:25-30. Available from: http://www.jihs.in/text.asp?2017/5/2/25/240241




  Introduction Top


The value of anything is realized only when it is lost, it also holds true for vision. There exists a huge gap between demand and supply of corneas across the globe including India.[1] There is a vast need for donor corneas worldwide to minimize this gap. A shortage of transplantable corneas is the bottleneck in reducing blindness due to corneal opacity. In developing countries like India, alternatives to corneal transplantation are being sought due to a lack of adequate donor corneas.[2] Though all the causes of blindness can’t be cured, corneal blindness can be reverted by corneal transplantation, for which a suitable donor cornea is required at right time.

Besides Cataract, damage to cornea is the second most common cause of blindness and probably the most under-reported and accounts for about 6-8 million cases out of the 45 million cases of blindness in the world.[3] As per the National Program for Control of Blindness (NPCB), prevalence of blindness is 1% in India.[4] As per the Eye Bank Association of India, the current cornea procurement rate in India is 49,000 per year. A large number of donor corneas are unfit for corneal transplantation. Based upon our current ratio of available safe donor eyes, 277,000 donor eyes are needed to perform 100, 000 corneal transplants in a year in our country.[5]

Understanding the reasons why people do or do not donate the eyes is crucial to address the problem of undersupply of cornea and designing any intervention. The health practice of an individual is influenced by the cultural milieu in which one lives. Among many factors that can affect this include religion and traditional beliefs and practices. It is therefore important to understand whether these factors would affect their willingness to donate their organs. India is geographically, culturally, ethnically diverse country. Based on this background, the present study was proposed to assess the level of awareness towards eye donation and factors influencing among general population residing in the rural area of Haryana state.


  Methodology Top


This was a cross-sectional study at Rural Health Training Center (RHTC) of Department of Community Medicine of a medical college in northern India. Study was conducted during September-December 2014. Patients attending OPD for the purpose of seeking care for their common ailments or diseases formed the study population. The sample size was calculated - with an anticipated prevalence of awareness of eye donation of 30.7%,6 5% absolute precision, 95% confidence interval and 10% nonresponse error - as 360 participants.

Specialist eye care was delivered by Department of Ophthalmology to rural community adopted by medical college by means of specialist visit (Senior Resident) at Rural Health Training Center (RHTC) once a week on fixed days. This opportunity was well utilized for the purpose of this study. Simple random sampling method was adopted. After obtaining informed consent, the study participants were explained about the purpose of the study. It was ensured that they understand the questions well. Total 360 adults were interviewed using pre-designed and pre-tested questionnaire in local language (Hindi). Socio-demographic information (age, gender, religion, education, occupation, income, marital status, etc.) was captured along with details about awareness regarding eye donation. Subjects were asked the question “Have you ever heard about eye donation?” Those who said “Yes”, were considered as having awareness and were included for further information. Responses to the questionnaire were kept anonymous and confidential and the guidelines of Helsinki Declaration were followed.

For the purpose of this study, ‘awareness’ was defined as ‘having heard of eye donation’ and ‘willingness’- a subject was willing if he/she was voluntary to pledge to donate eyes. The data was entered and analyzed with the help of Microsoft- Excel and Epi info 7 software. To compare differences between proportions of data sets, Chi- square test was used and p value of less than 0.05 was considered statistically significant.


  Results Top


Out of total 360 study subjects, 244 (67.7%) were in age group 18-40 years. Gender wise, majority (n=116, 58.1%) of the participants were females. Religion wise, majority (n=295, 81.9%) of the participants were Hindus. Total 76.9% of participants were aware about eye donation. On logistic regression education, religion and occupation were found to be important predictors for awareness. Sex and age were not significantly associated with awareness.

Awareness about eye donation was significantly lower among illiterates (odds ratio 0.14) compared to those who had higher education. Hindus were three times (odds ratio 3.60) more aware compared to subjects from other religions. Employed persons were nine times (odds ratio 9.05) more aware compared to unemployed persons. [Table 1]
Table 1: Baseline characteristics and factors associated with awareness of eye donation

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Reasons for willingness to donate eyes were elicited by those aware of eye donation. Majority (70.04%) of subjects donated their eyes, as they were ‘pleased to help the blind’. Second and third most important reasons for willingness to donate eyes were ‘doing good to humanity’ (44.77%) and ‘noble cause’ (38.63%). Other reasons cited were ‘inspired by advertisement on television regarding eye donation’ (19.86%) and ‘it counts for my afterlife’ (10.11%).[Table 2]
Table 2: Reasons given for willingness to donate eyes

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Subjects unaware of eye donation elicited reasons for unwillingness to donate eyes. Majority (63.86%) of subjects were unwilling to donate their eyes, as they don’t want his/her body to be buried with disfigurement. Other frequent reasons were unwillingness to donate eyes were religion and family permission in 33.37% and 26.51% cases respectively. Only 2.4% subjects did not had any reason for unwillingness to donate eyes.[Table 3]
Table 3: Reasons given for unwillingness to donate eyes

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  Discussion Top


In the present study, 76.9% subjects were aware about eye donation. The result of this study is in agreement with previous study from Singapore by Yew et al.[7] while this is in contrast to some other studies like Joshi SD et al. from rural Nepal (30.7%),8 Priyadarshini et al. from South India (50.7%)9 and Bhandary S et al. from Malaysia (69.0%).10 This finding can be attributed to different levels of literacy and education in different populations.

In this study we observed perceived reasons for willingness to donate eyes. One of the important reason was ‘pleased to help the blind’. Other reasons for willingness to donate eyes were ‘doing good to humanity’ (44.77%) and ‘noble cause’ (38.63%). This demonstrates the huge sympathy the people have towards the blind and their readiness for willingness to donate eyes. This is in agreement with the principle of altruism, an unselfish concern for the welfare of others, which is said to be the basic principle why people support organ donation.[11],[12] Another study from Singapore was also in concordance with our observations. The participants similarly cited donating a part of themselves made them feel that they were doing good.[7] This is in contrast to the study by Duggal M et al. from North Western India[4] in which the most important reason indicated was the possibility of “living on” after death, if they donated (94%), followed by doing some good to humanity after death (24.0%).

Similarly in this study we also observed perceived reasons for unwillingness to donate eyes. Majority of subjects were unwilling to donate their eyes, as they don’t want his/her body to be buried with disfigurement. Their belief is that it was important to have an intact body after passing away (dislike to separate the eye from the body). This could be for cultural reasons in our society where utmost respect is given for the dead body and taking a part of it may result in disfigurement of the body, considered doing against the norm. Disfigurement of diseased is directly related to sentiments of family. This has been described as a reason for negative sentiments regarding corneal donation.[13] This is one reason projected for the lower rates of corneal donations than other solid organs.[14] The concern that the body is physically altered in some way during the procurement of cornea may invoke fears about mutilation and a desire to maintain bodily integrity and bury the body whole.[15]

We also observed that other reasons for unwillingness to donate eyes were religion and family permission in 33.37% and 26.51% cases respectively. Muslim subjects were more likely to cite that eye donation is against their religious beliefs as compared with the others. Cultural and religious beliefs may at times be interchangeable and some people may hold strong culturally specific beliefs, which are not linked to any particular religious stance.[16] This issue can be addressed taking help of religious leaders and community stakeholders. Addressing the religious leaders to educate people the basic teachings of their religions in relation to donations may help combat such misunderstandings. Religion was the most common one given in the study done by Dandona R et al.[17], while having eye problem was cited by the participants in the study by Krishnaiah S et al. as the main reason for not being willing.[18]

This study has several strengths. We gave a fair attempt to assess the level of awareness towards eye donation and factors influencing among general population residing in the rural area of Haryana state. Health authorities can utilize the data generated to tailor the interventions in order to mobilize the people for pledges. This study had some limitations. The lack of a qualitative arm for a more detailed assessment of perceptions and attitude of the residents on corneal donation is the major limitation of the study. There is a need to conduct more research to understand how can we mobilize, motivate and utilize the services of stakeholders in improving the eye donation activities. In depth study among the kin of the family members who had donated eyes earlier is also warranted to document the perception.


  Conclusion Top


This study highlights that the willingness to corneal donation of the society in this rural area of Haryana is relatively good. This rural population is a good target for mobilization for pledges. Motivators for willingness to donate were the feeling of pleasure in helping the blind and the belief that the act of donation is doing good to humanity, while the dislike to separate the eye from the body after death was the main reason for not being willing to donate.



 
  References Top

1.
Ronanki VR, Sethu SD, Brinda PR, Jalbert I. Awareness regarding eye donation among stakeholders in Srikakulam district in South India. BMC Ophthalmology. 2014;14(1):25.  Back to cited text no. 1
    
2.
Jhanji V, Sharma N, Agarwal T, Vajpayee RB. Alternatives to allograft corneal transplantation. Curr Opin Ophthalmol. 2010; 21(4):301–309.  Back to cited text no. 2
    
3.
Singh MM, Rahi M, Pagare D, Ingle GK. Medical students' perception on eye donation in Delhi. Indian J Ophthalmol. 2007; 55(1):49–53.  Back to cited text no. 3
    
4.
Duggal M, Brar GS, Prasad VS, Gupta A. Public attitudes toward eye donation in Northwestern India. Transplant Proc. 2003; 35(1):19–20.  Back to cited text no. 4
    
5.
Saini JS. Realistic targets and strategies in eye banking. Indian J Ophthalmol. 1997; 45(3):141–142.  Back to cited text no. 5
    
6.
Krishnaiah S, Kovai V, Nutheti R, Shamanna BR, Thomas R, Rao GN. Awareness of eye donation in the rural population of India. Indian J Ophthalmol. 2004;52(1):73-78.  Back to cited text no. 6
    
7.
Yew YW, Saw SM, Pan JC, Shen HM, Lwin M, Yew MS, Heng WJ. Knowledge and beliefs on corneal donation in Singapore adults. British journal of ophthalmology. 2005 Jul 1;89(7):835-40.  Back to cited text no. 7
    
8.
Joshi SD. Eye donation awareness among community people in Nepal. Transplantation. 2010;90:557.  Back to cited text no. 8
    
9.
Priyadarshini B, Srinivasan M, Padmavathi A, Selvam S, Saradha R, Nirmalan PK. Awareness of eye donation in an adult population of Southern India - a pilot study. Indian J Ophthalmol. 2003;51(1):101-04.  Back to cited text no. 9
    
10.
Bhandary S, Hanna R, Rao KA, Rao LG, Lingam KD, Binu V. Eye donation - Awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia. Indian J Ophthalmol. 2011;59(1):41-45.  Back to cited text no. 10
    
11.
Rubens AJ. Racial and ethnic differences in students' attitudes and behavior toward organ donation. J Natl Med Assoc. 1996; 88(7):417-421.  Back to cited text no. 11
    
12.
Thompson VLS. Educating the African- American community on organ donation. J Natl Med Assoc. 1992; 85(1):17-19.  Back to cited text no. 12
    
13.
Tandon R, Verma K, Vanathi M, Pandey RM, Vajpayee RB. Factors affecting eye donation from postmortem cases in a tertiary care hospital. Cornea. 2004 Aug 1;23(6):597-601.  Back to cited text no. 13
    
14.
Lawlor M, Kerridge I. Anything but the eyes: Culture, identity, and the selective refusal of corneal donation. Transplantation. 2011: 92(11):1188-90.  Back to cited text no. 14
    
15.
Lawlor M, Kerridge I, Ankeny R, Dobbins TA, Billson F. Specific unwillingness to donate eyes: the impact of disfigurement, knowledge and procurement on corneal donation. American Journal of Transplantation. 2010 Mar 1;10(3):657-63.  Back to cited text no. 15
    
16.
Irving MJ, Tong A, Jan S, Cass A, Rose J, Chadban S, Allen RD, Craig JC, Wong G, Howard K. Factors that influence the decision to be an organ donor: a systematic review of the qualitative literature. Nephrology Dialysis Transplantation. 2011 Dec 21;27(6):2526-33.  Back to cited text no. 16
    
17.
Dandona R, Dandona L, Naduvilath TJ, McCarty CA, Rao GN. Awareness of eye donation in an urban population in India. Clinical & Experimental Ophthalmology. 1999 Jun 1;27(3-4):166-9.  Back to cited text no. 17
    
18.
Krishnaiah S, Kovai V, Nutheti R, Shamanna BR, Thomas R, Rao GN. Awareness of eye donation in the rural population of India. Indian journal of ophthalmology. 2004 Mar 1;52(1):73.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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