Diabetic retinopathy screening practice and associated factors among adults with diabetes mellitus at a tertiary hospital in Addis Ababa, Ethiopia: a cross-sectional study

Background Diabetic retinopathy is a leading cause of preventable blindness. Because it is asymptomatic until substantial damage has occurred, periodic retinal examination is essential for early detection. Evidence on uptake where eye services are co-located with diabetes care in Ethiopia is lacking. This study assessed the prevalence of, and factors associated with, adequate diabetic retinopathy screening practice among adults with diabetes attending Menelik II Comprehensive Specialized Hospital, Addis Ababa. Methods We conducted an institution-based cross-sectional study from December 2023 to February 2024 among adults with type 1 or type 2 diabetes on follow-up for at least three months, selected by systematic random sampling and interviewed with a structured questionnaire. Knowledge and attitude were classified using a modified Bloom's cut-off of 80%, and screening practice as adequate when at least two of three recommended practices were met. Factors associated with adequate practice were identified using multivariable logistic regression. Results Of 404 patients approached, 371 were interviewed and included in the analysis (response rate 91.8%). Adequate screening practice was found in 139 participants (37.5%, 95% confidence interval [CI] 32.7–42.5); 62.0% had adequate knowledge and 72.8% a favorable attitude. Adequate practice was associated with adequate knowledge (adjusted odds ratio [AOR] 5.10, 95% CI 2.81–9.25), a known eye disorder (AOR 3.96, 95% CI 2.11–7.43), higher education (AOR 3.82, 95% CI 1.33–10.95), age 41–65 years (AOR 3.15, 95% CI 1.10–9.03) and being married (AOR 1.73, 95% CI 1.01–2.97). Cost, lack of time and travel distance were the most commonly reported barriers. Conclusion Fewer than four in ten adults with diabetes underwent retinal examination at the recommended frequency despite on-site specialist eye care. The strong association with existing eye disorders suggests that examination is often prompted by ocular problems rather than undertaken for prevention. Strengthening patient education during diabetes follow-up and a direct referral pathway to on-site eye services may improve uptake.