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The impact of microbial keratitis on quality of life in Uganda
  1. Simon Arunga1,2,
  2. Geoffrey Wiafe2,
  3. Esmael Habtamu3,4,
  4. John Onyango2,
  5. Stephen Gichuhi5,6,
  6. Astrid Leck7,
  7. David Macleod8,
  8. Victor Hu9,
  9. Matthew Burton10
  1. 1Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK, UK
  2. 2Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
  3. 3London School of Hygiene and Tropical Medicine International Centre for Eye Health, London, UK
  4. 4Carter Center, Addis Ababa, Ethiopia
  5. 5Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
  6. 6Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
  7. 7ITD/CRU, LSHTM, London, UK
  8. 8Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
  9. 9International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
  10. 10Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Simon Arunga; Simon.Arunga{at}


Background Microbial keratitis (MK) is a frequent cause of sight loss in sub-Saharan Africa. However, no studies have formally measured its impact on quality of life (QoL) in this context.

Methods As part of a nested case–control design for risk factors of MK, we recruited patients presenting with MK at two eye units in Southern Uganda between December 2016 and March 2018 and unaffected individuals, individually matched for sex, age and location. QoL was measured using WHO Health-Related and Vision-Related QoL tools (at presentation and 3 months after start of treatment in cases). Mean QoL scores for both groups were compared. Factors associated with QoL among the cases were analysed in a linear regression model.

Results 215 case-controls pairs were enrolled. The presentation QoL scores for the cases ranged from 20 to 65 points. The lowest QoL was visual symptom domain; mean 20.7 (95% CI 18.8 to 22.7) and the highest was psychosocial domain; mean 65.6 (95% CI 62.5 to 68.8). At 3 months, QoL scores for the patients ranged from 80 to 90 points while scores for the controls ranged from 90 to 100. The mean QoL scores of the cases were lower than controls across all domains. Determinants of QoL among the cases at 3 months included visual acuity at 3 months and history of eye loss.

Conclusion MK severely reduces QoL in the acute phase. With treatment and healing, QoL subsequently improves. Despite this improvement, QoL of someone affected by MK (even with normal vision) remains lower than unaffected controls.

  • microbial keratitis
  • bacterial keratitis
  • fungal keratitis
  • blindness
  • quality of life
  • uganda

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  • Contributors AS, AL, VHH, DM and MJB designed the study. All authors contributed to the conducting of the study. AS, DM and MJB analysed the results. All authors contributed to the draft of manuscript and editing of the final paper.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

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