UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF MEDICINE DEPARTMENT OF OPTOMETRY

A RESEARCH PROPOSAL SUBMITTED TO UNIVERSITY OF GONDAR, COLLEGE

OF MEDICINE AND HEALTH SCIENCES COMPREHENSIVE SPECIALIZED
HOSPITAL, SCHOOL OF MEDICINE, DEPARTMENT OF OPTOMETRY FOR
PARTIAL FULFILMENT OF THE REQUIREMENT FOR MASTER'Ss DEGREE IN
CLINICAL OPTOMETRY.

APRIL, 2024 GONDAR, ETHIOPIA

Principal investigator Wubalem Addis

Phone 0996654633

Email wubalemaddis2017@gmail.com

Advisors 1.Mr. Merkineh Markos (Bsc, Msc in

Clinical Optometry)
2.Ms. Hirut Gebremeskel (Bsc, Msc in
Clinical Optometry)

Full title Willingness to donate cornea and associated

factors among adults in Addis Ababa city,
central Ethiopia 2024

Study area Addis Ababa city, central Ethiopia

Study period May 1 to June 1, 2024

Total budget required

Acknowledgment
I would like to express my deepest gratitude to Mr.Merkineh Markos (BSc, MSc in
Clinical Optometry) and Ms. Hirut Gebremeskel (BSc, MSc in Clinical Optometry)
for their assistance, constructive comments, and guidance for the whole process in
developing this thesis proposal.

I would like to extend my gratitude to the University of Gondar, College of Medicine

and Health Sciences, Comprehensive and Specialized Hospital, School of Medicine,
and Department of Optometry in appreciation for the opportunity to develop this
thesis proposal.

2
Table of contents
Acknowledgment............................................................................................................2

Table of contents............................................................................................................3

List of tables...................................................................................................................5

List of figures.................................................................................................................6

Summary........................................................................................................................7

1. Introduction................................................................................................................8

1.1 Statement of the problem.........................................................................................8

1.2. Literature review...................................................................................................10

1.2.1 Burden of corneal blindness............................................................................10

1.2.2. Proportion of willingness to donate eyes among adults.................................10

1.2.3 Factors Associated with willingness to donate cornea....................................11

1.2.3.1 Socio-demographic factors...........................................................................11

1.2.3.2 Family-related factors...................................................................................12

1.2.3.3 Knowledge-related factors............................................................................12

1.2.3.4 Information-related factors...........................................................................12

1.2.3 Conceptual framework.....................................................................................13

1.3. Justification of study.............................................................................................14

2. OBJECTIVES..........................................................................................................15

2.1. General Objective..............................................................................................15

2.2. Specific Objectives............................................................................................15

3. METHODS AND MATERIALS.............................................................................16

3.1. Study Design......................................................................................................16

3.2. Study Period and Study Area.............................................................................16

3.3 Population...............................................................................................................16

3.3.1 Source Population............................................................................................16

3
 3.3.2 Study Population..............................................................................................16

3.4. Inclusion and Exclusion Criteria...........................................................................16

3.4.1. Inclusion Criteria............................................................................................16

3.4.2. Exclusion criteria............................................................................................16

3.5. Sample Size and Sampling Procedure...................................................................17

3.5.1. Sample Size Determination............................................................................17

3.5.2. Sampling Technique and Procedure...................................................................19

Nifas silk......................................................................................................................20

3.6 Variables of the Study............................................................................................21

3.6.1 Dependent Variable.........................................................................................21

3.6.2 Independent Variables.....................................................................................21

3.7. Operational definitions..........................................................................................22

3.8. Data Collection Tool, Procedure, and Quality Assurance.................................23

3.8.1. Data Collection Tool and Procedure...............................................................23

3.8.2 Data quality assurance.....................................................................................23

3.9 Data Processing and Analysis.............................................................................23

3.10 Ethical Consideration...........................................................................................24

3.11 Dissemination and Utilization of Results.............................................................24

4. WORK PLAN..........................................................................................................25

5. BUDGET BREAKDOWN.......................................................................................27

References....................................................................................................................28

7. NNEXES..................................................................................................................30

4
List of tables
Table 1 . Sample size calculation for associated factors of willingness to donate
eyes ..............................................................................................................17

Table 2 . A GANNT chart showing a work plan to determine magnitude of

willingness to donate cornea and associated factors among adults in Addis
Ababa city, central Ethiopia, 2024. .............................................................24

Table 3 . Budget breakdown for willingness to donate cornea and associated

factors ..........................................................................................................26

5
List of figures
Figure 1 . Conceptual framework for willingness to donate cornea and associated
factors at Addis Ababa, 2024.......................................................................13

Figure 2 Schematic presentation of sampling technique and procedure for

willingness to donate eyes and associated factors among adults in Addis
Abeba city, central Ethiopia, 2024...............................................................20

6
Summary
Background: Corneal diseases have been recognized as a major cause of blindness in
developing countries like Ethiopia. Visual rehabilitation by corneal transplantation is
a major treatment option for those who are already blind due to corneal diseases. In
Ethiopia, there is an imbalance between corneal transplant needs and corneal tissue
donation. Therefore, this study aimed to assess the magnitude of willingness to donate
cornea and its associated factors, which help to develop appropriate strategies that can
address this undersupply and unmet need.

Objectives: To determine the magnitude of willingness to donate cornea and

associated factors among adults in Addis Ababa City central Ethiopia 2024.

Methods and materials: A community-based cross-sectional study will be conducted

on 1296 adults by using multistage sampling techniques in Addis Ababa city from
May 1/2024- June 1/2024. Then a pretested and structured interviewer-administered
questionnaire will be used to collect data. Data entry will be done by using
Epidemiological Information version 7 and will be exported to Statistical Package for
Social Sciences version 20 for analysis. Summary statistics, frequencies, and cross-
tabulations will be performed for the descriptive analysis of the data. Bi-variable,
multi-variable logistic regression models and Odds ratio with a 95% interval will be
carried out and multi-variable logistic regression will be used to determine the
association between dependent variables and independent variables.. Variables with a
P–value <0.05 will be considered as statistically significant.

Work plan and budget: The study will be performed from May 1 to June 27, 2024,
with a total estimated budget of 29,593.10 Ethiopian birr.

7
1. Introduction
1.1 Statement of the problem
Worldwide, corneal blindness is the second most prevalent ocular condition,
especially in developing countries. Bilateral corneal blindness accounts for 12% (4.9
million) of 39 million blind (1). In Ethiopia, from the overall blindness, 19.3% of
blind cases are attributed to corneal blindness. It mainly results from trachoma,
Xerophthalmia, use of harmful traditional eye medicines, onchocerciasis, and ocular
trauma (2). This condition affects the overall productivity of productive age groups.

Corneal transplant remains the gold standard treatment for corneal blindness and it is
the most common transplant performed worldwide with an overall success rate of
85% (3). A corneal donation is an act of high-level kindness to humanity and society
which involves the will of a person to consent to removing one’s eyes from the body
after death (4). It is purely voluntary and donation is possible only after persons
realize their social responsibility towards the corneal blind.

Corneal donation is a key factor for a sustainable corneal transplant service and eye
banking. However, willingness to donate eyes is a complex process with sociocultural
barriers (5).

According to a global survey done on corneal transplant and eye banks; the ratio
demand/supply is 70:1 worldwide and only 37.5% have adequate access to corneal
transplants. Data from Page 3/18 of this survey showed that a high number of people
who have no access to corneal transplant services found in Africa and many countries
of Asia (5)According to the Eye Bank Association of India, the current cornea
procurement rate in India is 22,000 per year. Based upon India's current ratio of
available safe donor eyes, the country needs 277,000 donor eyes to perform 100,000
corneal transplants in a year in India (6).

In Ethiopia, between 130 and 150 corneas are harvested yearly (7). However, there
are more than 300,000 blind people due to corneal disease. This shows that there is a
potential imbalance between demand and supply of corneal grafts. According to the
studies conducted in different parts of the world, increasing the magnitude of
willingness to donate eyes and eyes of close relatives is essential to prevent
transplanted corneal tissue scarcity (7).

8
Although some studies regarding willingness to donate cornea are done in Ethiopia,
the evidence is limited because most of them are hospital-based and done in a specific
group. Thus, it is difficult to generalize based on those studies. Therefore, it is
important to determine the magnitude of willingness to donate cornea and associated
factors in a community of diverse cultures and socioeconomic backgrounds. The main
aim of this study is to determine the magnitude of willingness to donate cornea to
adults at the community level in Addis Ababa city and the findings of this study will
help to develop strategies that can address undersupply and unmet needs.

9
1.2. Literature review
1.2.1 Burden of corneal blindness
In 2010, a global estimation revealed by the World Health Organization (WHO) that
39 million people were blind (<3/60) and 285 million people had moderate to severe
visual impairment, out of this there are about 4.9 million people globally who are
blind due to corneal disease (8).

In Ethiopia, the burden of blindness due to corneal disease is 19.3% (2).

1.2.2. Proportion of willingness to donate eyes among adults

A multiple number of studies have been conducted across the world to evaluate the
magnitude of willingness to donate cornea. In a cross-sectional study conducted in
India's Gwalior district in 2012, the magnitude of willingness to donate was found to
be 40.34 % (9). Another cross-sectional descriptive survey was conducted among
ophthalmic patients in Eastern India in 2017, and the result showed that 56.6% of the
patients who attended a tertiary health care center in Odisha volunteered to donate
their eyes after they die (10). According to a population-based cross-sectional study
which is conducted among stakeholders in Srikakulam district in South India, 82% of
the subjects were willing to donate their eyes (11). A similar study was conducted at
Manipal Academy of Higher Education India among the working literate population
and the proportion of participants willing to donate cornea was found to be only 25%
(12).

A hospital-based comparative cohort study was conducted at the University of Jordan

Hospital, Jordan in 2020, and 71% of the participants were willing to donate their
cornea to the eye bank (13). Another observational cross-sectional study was done on
adults in Saudi Arabia in 2017, and the finding revealed that 40.2% of the respondents
stated that they would be more willing to donate their corneas if they were provided
with more information (14).Another cross-sectional study was conducted in Nigeria's
delta state among medical doctors in 2013, and the result showed that only 33.3%
were willing to donate their eyes for transplant (15).

10
A cross-sectional descriptive study was conducted among adults who attended in Eye
Clinic of the Korle Bu Teaching Hospital Ghana in 2014 and 59.90% of respondents
were willing to donate their eyes (16).

A Cross-sectional hospital-based study with a quantitative and qualitative approach

was done among ophthalmic adult patients in Muhimbili National Hospital Tanzania
in 2017 and the result revealed that 47.9% were willing to donate their eyes (18).
Another cross-sectional study with qualitative and quantitative approaches was done
among adults in Kiambu slum in Nairobi and Kenyatta National Hospital in 2019, and
the result showed that the magnitude of willingness to donate cornea among
participants was 37.7% (17).

In Ethiopia, a community-based cross-sectional study was conducted among adults in

Gondar town in 2018, and the result revealed that The proportion of willing to donate
eyes was 37.6 % (18).

1.2.3 Factors Associated with willingness to donate cornea

1.2.3.1 Socio-demographic factors

According to cross-sectional studies conducted in India and Singapore, old age was
positively associated with willingness to donate cornea compared with younger age
(9, 19). Another comparative cross-sectional study was conducted among non-health
professionals and health professionals in Greece, and the result revealed those non-
health sciences professionals/ students responded more often than health professionals
that they would like to become a cornea donor (26.6% vs. 7.9%) (20). In an
institutional base cross-sectional study done among medical doctors in Delta State
Nigeria, females were more likely to donate cornea than males (15). In the cross-
sectional study done in Kenya ethnicity was significantly associated with willingness
to donate cornea (17). In the study done in Gondar Ethiopia, being Christian was more
likely to be positively associated with eye donation compared with being Islam. Based
on this research, those who had formal education like High School, and
College/university were 2.90 and 2.23 times more likely to be willing to donate their
eyes than those who had no formal education (18).

11
1.2.3.2 Family-related factors
According to a cross-sectional study conducted at the University of Jordan Hospital,
Patients with relatives waiting for corneal transplantation were more likely to state
that they will donate corneas (79.3% vs. 67.0%, p = 0.025) (13).

1.2.3.3 Knowledge-related factors

In the cross-sectional study done in China, the result showed that the sum of
knowledge items had the strongest positive association with the willingness to eye
donation (21). Another comparative cross-sectional study was conducted in Eastern
India, and the result showed that knowledge was negatively associated with the
willingness to practice eye donation (10). On the contrary, a population-based, cross-
sectional study was carried out in several cities of the Eastern province of Saudi
Arabia, knowledge was positively associated with willingness to donate (p = 0.003)
(14).

According to a population-based cross-sectional study conducted in Singapore,

Greater knowledge was also associated with increased willingness to donate corneas
(19).

In an observational cross-sectional study which was done in Saudi Arabia, the result
found that those who reported lacking knowledge about corneal donation were
significantly less inclined to donate their corneas than those who reported prior
knowledge of corneal donation (p = 0.002) (15). Another hospital-based cross-
sectional study was conducted in Northwest Ethiopia, those participants who had
good knowledge about corneal donation were 5.48 times (AOR = 5.48 (95% CI:
2.69–11.17) more likely to donate cornea as compared to those who had poor
knowledge about corneal donation (22).

1.2.3.4 Information-related factors

According to an observational cross-sectional study which was done in Saudi Arabia,
Those who believed that they had sufficient information about corneal donation were
significantly more likely to donate (p < 0.001) than those who believed they did not
have enough information (14). In another both qualitative and quantitative approach
cross-sectional study done in Kenya, lack of information concerning eye donation was
negatively associated with willingness towards corneal donation (17).

12
 In Ethiopia according cross-sectional study done in rural areas, awareness of corneal
donation is significantly associated with willingness to donate, with 73.7%ofthosewho
who were aware of eye donation being willing to donate eyes, as compared with
50.9% of those who were unaware (OR= 2.703, 95% CI: 1.778- 4.109) (23).

1.2.3 Conceptual framework

Socio demographic factors

Age
Sex
Occupation
Nature of profession
Religion
Ethnicity Information related factor
Awareness about corneal
donation

Family related factors Willingness to corneal donation

Having family or
relatives waiting for
transplantation

Knowledge

Figure 1. A conceptual framework for willingness to donate cornea and associated

factors at Addis Ababa, 2024.

13
1.3. Justification of study
Corneal diseases are a significant cause of blindness and visual impairment
worldwide especially in developing countries. The advanced disease of the cornea is
managed by corneal transplantation. In Ethiopia, despite having the presence of an
eye bank, the rate of corneal donation is very low and the current supply is unable to
match the demand (7). determining the magnitude of willingness to donate cornea
currently at the community level is a vital indicator to develop policies and strategies
that aim to create awareness among the public regarding the importance of eye
donation.

Knowing the magnitude and maximizing adults’ knowledge of corneal donation has
the potential to increase the rate of corneal donation reduce the burden of blindness
and visual impairments due to corneal disease and improve productivity. Moreover,
there is limited data regarding willingness to donate cornea and associated factors at
the community level in Ethiopia as well as in the study area where a lot of patients
with corneal disease are treated with corneal transplantation.

There are only two old studies in Ethiopia at the community level, and lack of all the
necessary variables. It will also give baseline information for further study.
Additionally, this study will offer valuable information for decision-makers,
healthcare planners and evaporators, and other concerned bodies to provide health
education.

14
2. OBJECTIVES
2.1. General Objective
To determine the magnitude of willingness to donate cornea among adults and related
factors in Addis Ababa city, central Ethiopia 2024

2.2. Specific Objectives

 To determine the magnitude of willingness to donate cornea among adults in
Addis Ababa city, central Ethiopia

 To determine factors related to willingness to donate cornea among adults in

Addis Ababa city, central Ethiopia.

15
3. METHODS AND MATERIALS
3.1. Study Design
A community-based cross-sectional study will be conducted.

3.2. Study Period and Study Area

The study will be conducted from May 1/2024 to June 1/2024 at Addis Ababa city,
which is the capital city of Ethiopia. It is also the largest city in the country by
population, with a total population of 3,384,569 according to the 2007 census.
Currently in 2024, according to the latest revision of the United Nations World
Urbanization Prospects, Addis Ababa's 2024 population is now estimated at 5,703,628
with an annual growth rate of 3.8 people and The total population between age
groups 15 and 64 years is 2,228,510. it has 10 administrative sub city and 116
woredas. There is total of 37 eye care center including public and private which
serves the community and one Eye bank available in the city currently.

3.3 Population

3.3.1 Source Population

All adults aged ≥ 18 years who live in Addis Ababa city

3.3.2 Study Population

All adults aged ≥ 18 years who live in Addis Ababa city town in the selected districts.

3.4. Inclusion and Exclusion Criteria

3.4.1. Inclusion Criteria

Adults aged ≥ 18 years who have lived in Addis Ababa for more than 6 months.

3.4.2. Exclusion criteria

Adults who is blind or visually impaired due to corneal disease and seriously ill
during data collection time.

16
3.5. Sample Size and Sampling Procedure

3.5.1. Sample Size Determination

A. The sample size for willingness to donate cornea

Sample size will be determined by using the single population proportion

formula.Consider the proportion of people who are willing to donate cornea 37.6%
[95% CI: 34.3%–41.3%] in the study done at Gondar, Ethiopia (20), with a 5%
margin of error, a 95% CI of = 0.05, and a 10% non-response rate. Based on this
assumption, the actual sample size for this study will be determined by using the
single proportion formula as follows:

( Z α /2 )2 P ( 1 − P )
n=
d2

Where:

α (level of significance) = 5%

Z = the z statistic's 95% confidence level value = 1.96

W = allowable maximum error = 5%

P (proportion of people willing to donate eye = 37.6)

q = 1–p = 62.4 %.

n = sample size

The calculated sample size is 360.5

B. The sample size for associated factors to wards willingness to donate cornea

Educational status, religion, nature of profession,age,sex,awareness and knowledge

towards eye donation are consistent factors for willingness to donate cornea in the
study done in China, India Singapore, and Ethiopia (18, 19, 21). By using
Epidemiological Information version 7 computer software 95% CI, and 80% power
will be used to determine the sample size for the secondary objective.

17
Table 1. Sample size calculation for associated factors of willingness to donate eyes

Assumption Variable Exposure AOR 95% Sample Reference

CI size
Z(α/2)=1.96

α = 0.05 Educational status Yes 3.0 (1.82, 161 (18)

(being high school 5.04)
d = 5%
or not)
No 1

Religion( Christian Yes 1.73 (1.178, 392 (18)

or not) 2.90)
No 1

The sample size for objective two is selected because it will be sufficient to meet both

objectives. From objective two, religion (n = 392) is selected. Considering a design

effect of 3 for multistage sampling and a 10% non-response rate, the final sample size

will be 1296 adults.

18
3.5.2. Sampling Technique and Procedure
There are ten administrative sub-city in Addis Ababa. To obtain the necessary sample
a three-step multistage sampling technique will be used. The study included all 10
sub-cities and Initially, One district (‘woreda’) will be randomly picked from each
sub-city using computer-generated random numbers after a census of all woreda in
each sub-city. Then 1 village (’ketena’ -the smallest geographical unit of the district)
will be selected from each district randomly, and 10 villages will represent the
overall.

Based on the size of the population in each selected woreda, the sample size will be
proportionally allocated. Then a systematic random sampling method will be
employed to select the households by using an interval of constant (k =6); K will be
calculated as the total households in the selected ketenas [7500] divided by the sample
size [1296]. Then, we will select a number between 1 and 6 randomly to select the
first household to be included in the sample, and every 6th household will be
included. Finally, if more than one eligible adult, aged 18 years, is found in the
selected household, a lottery method will be used to recruit the study participants. The
household will be re-visited twice if the eligible individual cannot be located during
data collection. An immediate next household will be included in the interview when
there is no illegible person who fulfills the inclusion criteria at the selected household.

19
 Addis Abeba city
With ten administrative sub-cities
655118 households (2007 census)

Nifas silk Lideta Kolfe Gulele Bole(7 Yek

Akaki Nifas Kirkos Addis Arada
keranyo a
kaliti silk 46,206( 61,923( (54,398 ketema(52 (49,564 9,020
(90
97,287(hou
47,021 77,441(h
househo sehold)
househo househo ,063 househ househ ,1
(houshold ld) ld) ld) household) old)
ousehold old) 95

Systematic random sampling

Wore Woreda Woreda Word Wor Wor

Woreda Wored Wor
da woreda 59 eda eda
91 28 a 34 63 a 77 eda
105 88 40 1

Systematic random sampling

Ketena Ketena 14 Ketena 1 Ketena Keten Ket

Ketena Ketena Ketena a 10 ena
5 25 Ket
17
Prmpling 9
16 21 ena
13
proportional allocation with systematic random sampling

93 153 91(househo Kolfe 192 126(hous 108(hous 103(house 98(house 156(ho 178
hold) (ho
household househol ld hold) household ehold) ehold) hold) usehol
ush
d)
d old)

1296 Adults

Figure 2 Schematic presentation of sampling technique and procedure for willingness to

donate eyes and associated factors among adults in Addis Ababa city, central Ethiopia, 2024

20
3.6 Variables of the Study

3.6.1 Dependent Variable

Willingness to donate cornea

3.6.2 Independent Variables

Socio-demographic; age, sex, educational status, nature of profession, ethnicity,
religion.

Family-related factor; having family or relatives waiting for corneal transplantation.

Information-related factor; having awareness of the issue

Knowledge about the issue

21
3.7. Operational definitions
Knowledge; There will be yes-or-no questions that require a total of ten correct
responses. Each correct response will be given a score of 1, and a wrong response or
‘do not know’ will be given a score of 0. The total points to be scored will be 10, and
the minimum will be 0.

Good knowledge: Individuals who responded above the mean on the total knowledge
questions had good knowledge about corneal donation in adults (18).

Poor knowledge: Individuals who responded below the mean of the total knowledge

questions had poor knowledge of corneal donation in adults (18).

Awareness; respondents who ever heard about corneal donation in any source of
information are aware of it.

Willingness to donate cornea; will be categorized as willing if a subject had the

interest to pledge to donate his/her eyes and unwilling if a subject was involuntary to
pledge to donate his/her eyes or not decided.

22
3.8. Data Collection Tool, Procedure, and Quality Assurance
3.8.1. Data Collection Tool and Procedure
The data will be collected using a pre-tested and structured interviewer-administered
questionnaire that will be adapted from previous research done on similar topics (10,
11, 17, 18). It will be translated into the Amharic version (local language) from the
English version for ease of interview and then back to English for consistency. The
questionnaires will comprise questions to assess socio-demographic factors (age, sex,
marital status, educational status, religion, ethnicity, and occupation), information-
related factors, family-related factors, knowledge towards willingness to donate
cornea, and The data will be collected by four optometrists, and there will be one
optometrist for supervision. Both the data collectors and supervisor will be trained for
one day before data collection time. Data collectors will be responsible for
interviewing adults, consistently recording the results, and finally submitting the
results to the supervisor as scheduled.

3.8.2 Data quality assurance

A pretest will be done at Kebele 16 in Gondar town to validate the questionnaire by
taking 5% of the sample size. After the pre-test, necessary modifications will be made
before actual data collection. Training will be given to data collectors and supervisors
one day before data collection time on how to collect the data. On the field, the
supervisor will closely follow the day-to-day data collection process and ensure the
internal consistency of the collected data. Finally, collected samples will be checked
for completeness by the principal investigator each day.

3.9 Data Processing and Analysis

The data will be entered, cleaned, and coded in Epi data version 4.6, and will be
exported to SPSS version 25.0 for analysis. Descriptive statistics like frequency and
percentage will be used to summarize the variables and inferential statistics like odds
ratio, binary logistic regression, and multiple logistic regressions will be used to
determine whether there is an association between the dependent variable and
independent factors. Variables with a p-value of <0.2 in the bi-variable analysis will
be entered for multi-variable analysis then a P-value of less than 0.05 at multi-
variable.

23
logistic regression analysis will be considered statistically significant at 95% CI. The
model's fitness will be checked using the Homer-Lemeshow goodness-of-fit test. The
multicollinearity of the variables will be checked by the variance inflation factors
(VIF)/ tolerance test.

3.10 Ethical Consideration

Ethical approval will be obtained from the University of Gondar, College of Medicine
and Health Sciences and Comprehensive Specialized Hospital, School of Medicine
Ethical Review Committee. A letter of support will be provided by the Addis Ababa
city administrative office. Verbal informed consent will be obtained from all
participants. All participants will be informed about their right to withdraw from the
study at any time during the interview. For the selected study participants, no reward
will be provided, and no risk will be taken. Confidentiality will be maintained by
avoiding any personal identifiers in the data collection tools and by using password-
protected data on a computer.

3.11 Dissemination and Utilization of Results

The result of this study will be submitted to the Department of Optometry, the
College of Medicine and Health Sciences, and the School of Medicine at the
University of Gondar. The study results will also be submitted to the Addis Ababa
City Administration Health Bureau An effort will be made to present the findings at
conferences and meetings held locally or internationally. The result of this study will
be published in national or international peer-reviewed medical journals.

24
4. WORK PLAN
Table 2. A GANNT chart showing a work plan to determine the magnitude of
willingness to donate cornea and associated factors among adults in Addis Ababa
city, central Ethiopia, 2024.

Activitie Responsible body April May June weeks July

s weeks weeks weeks

W W W W W w W W W W W W W W
1 2 3 4 1 2 3 4 1 2 3 4 1 2

Title PI
defence

Research PI
proposal
developm
ent

Proposal PI
defence

Securing University of
ethical
Gondar ethical
clearance
and review committee
budget
permissio
n
Pretesting PI
questionnair
es
Data Data collectors
collection
Data PI
coding,
entry,
and

25
cleaning
Thesis PI
writing

First draft PI
report

Second PI
draft
report

Final PI
report

Thesis PI
defense

26
5. BUDGET BREAKDOWN
Table 3. Budget breakdown for willingness to donate cornea and associated factors

1. Personnel

No Title No of Duration in Incentive Total

persons days per days
1. Data 4 10 300 12000
collector

2. Supervisor 1 10 300 3000

2. Materials and equipment

No Items Unit Quantity Unit price Total price

in birr
in birr

1 Pen Pieces 5 25 125

2 Photocopy Pieces 3888 2 7776

Total 7901

3. Transport

1 Transport 2 2000 4000

4. Budget Summary

No Items Amount in
birr
1 Personal 10000
allowance
2 Materials 7901
and
equipment

3 Transport 2 4000

4 Contingency 10%

Grand total 29593.10

27
References
1. Oliva M, Schottman T, Gulati M. Turning the tide of corneal blindness. Indian
J Ophthalmol. 2012;60(5):423.
2. Berhane Y, Worku A, Bejiga A, Adamu L, Alemayehu W, Bedri A, et al.
Prevalence and causes of blindness and Low Vision in Ethiopia. Ethiopian Journal of
Health Development. 2008;21(3):204-10.
3. Duman F, Kosker M, Suri K, Reddy J, Ma J, Hammersmith K, et al.
Indications and Outcomes of Corneal Transplantation in Geriatric Patients. American
journal of ophthalmology. 2013;156.
4. Vanathi M, Tandon R, Panda A, Vengayil S, Kai S. Challenges of eye banking
in a developing world. Expert Review of Ophthalmology. 2007;2(6):923-30.
5. Gain P, Jullienne R, He Z, Aldossary M, Acquart S, Cognasse F, et al. Global
Survey of Corneal Transplantation and Eye Banking. JAMA ophthalmology.
2016;134(2):167.
6. Gupta N, Vashist P, Ganger A, Tandon R, Gupta S. Eye donation and eye
banking in India. Natl Med J India. 2018;31(5):283.
7. Bauen M, Rouiller N. Swiss banking: an introduction for bank customers and
their advisors. Zurich: Schulthess; 2013 2013. 617 p.
8. Fentie D, Solomon Y, Menberu T. The burden of visual impairment among
Ethiopian adult population: Systematic review and meta-analysis. PLOS ONE.
2023;18(7):e0288707.
9. Tiwari R, Diwakar A, Marskole P, Bhargo L, Anwar D. A study to assess
awareness on eye donation and willingness to pledge eyes for donation in adult
population in Gwalior district (M.P.), India. Int J Res Med Sci. 2014;2(2):662.
10. Panigrahi S, Rath B, Sahu RK, Rath S, Sethi SK, Mahapatra K. Knowledge,
Attitude and Willingness for Eye Donation in General Population of Odisha inEastern
India. IOSR JDMS. 2017;16(07):01-6.
11. Ronanki VR, Sheeladevi S, Ramachandran BP, Jalbert I. Awareness regarding
eye donation among stakeholders in Srikakulam district in South India. BMC
ophthalmology. 2014;14(1):25.
12. Egnasious J, Srinivasan K, S Ve R, Noushad B. Knowledge, awareness,
perception, and willingness towards eye donation among the literate working
population. Asian JO. 2018;16(1):7-18.
13. AlRyalat SA, Aburumman R, Taweel L, Al-Rawi H, Dababseh S, Al Bdour
M. The impact of having a relative in a need for cornea: the Knowledge, Attitude, and
Willingness for Corneal Donation (KAWCD) questionnaire. Cell Tissue Bank.
2022;23(4):899-908.
14. Alanazi LF, Aldossari SH, Gogandy MA, Althubaiti GA, Alanazi BF,
Alfawaz AM. Attitude, beliefs and awareness towards corneal donation in Saudi
Arabia. Saudi Journal of Ophthalmology. 2019;33(2):121-9.
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18. Hussen MS, Gebreselassie KL, Woredekal AT, Adimassu NF. Willingness to
donate eyes and its associated factors among adults in Gondar town, North West
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7. NNEXES
Annex I: information sheet, the English version

29
The title of the research: willingness to Donate Cornea and associated factors among
Adults in Addis Ababa City, central Ethiopia, 2024

Name of principal investigator: Wubalem Addis

Name of organization: University of Gondar, College of Medicine and Health

Sciences, Comprehensive and Specialized Hospital, School of Medicine, Department
of Optometry.

Introduction: This information sheet and consent form will be prepared with the aim
of studying willingness to donate cornea and associated factors among adults in Addis
Ababa City, central Ethiopia, 2024. The research group will include the principal
investigator, four trained data collectors, one supervisor, and two advisors from the
University of Gondar.

Objective: to determine willingness to donate cornea and associated factors among

adults in Addis Ababa city, central Ethiopia, 2024

Procedures: The study involves an adult population and will be conducted from May
1 to June 1 1, 2024. You will be selected randomly to be one of the study participants,
and we kindly invite you to take part in our project. If you are willing to participate,
we are very happy, and we need you to clearly understand the aim of this study and
show your agreement. Finally, you are kindly requested to give your genuine response
in the interview.

Confidentiality: To establish secure safeguards for the confidentiality of research

data, the data collector will use codes during the data collection period instead of
using names. The original data will be locked in cabinets until the data analysis is
carried out, and no one shall have access to it except the principal investigator and the
supervisor for data checking and cleaning purposes. The use of information for any
purpose other than that to which participants consent is unethical, and it will not be
performed in this way. The information you provide is not disclosed in a way that
may identify your characteristics or violate your privacy. After the research defense
and final work are approved by the university senate, the original data questionnaire
will be incinerated securely.

Benefits: There are no financial gains associated with this research. However, by
taking part in this research, you will learn more about what corneal donation is and its

30
importance. I would like to ask you a few questions. Your truthful answers to the
questions will help the study reach its goal. All the information that you provide will
be kept confidential and private. The information will only be accessible to the
interviewer and the primary investigator. You are kindly asked to respond voluntarily.
You can also decide not to participate in this study at all, and you are free to leave at
any moment if you find the study to be uncomfortable. At any time that you have

Questions.

Potential Risks: There is no foreseen risk to being in this study.

Freedom to withdraw: You have the full right to withdraw from the study at any
time you wish without any penalty. Nobody will ask or force you to explain the
reason for your withdrawal. Non-participation in this research project will not harm
the study participant in any way.

Person to contact: Before and during the research, the participant has the right to
inquire about any details that are unclear regarding the context and content of the
study. You can contact the principal investigator, the data collector, and the
supervisor. In addition, this research project has undergone ethical review and
approval by the University of Gondar College of Medicine and Health Sciences
postgraduate ethical review approval committee. If you want more information about
this research project, you can contact the following people:

1. University of Gondar, Office Phone: 0581110004

2. Principal investigator: Wubalem Addis

Address: Cell Phone: +251996654633

E-mail: wubalemaddis2017@gmail.com

3. Advisors: Mr. Merkineh Markos

Cell phone: +251984942180 Ms. Hirut G/Meskel; +251918295846

Annex II: Informed consent form, the English version

31
Title of the thesis project: willingness to Donate Cornea and associated factors
among Adults in Addis Ababa City, central Ethiopia, 2024

I am aware that this research undertaking is a postgraduate MSc degree research

project that is fully coordinated by the University of Gondar, and the designated
principal investigator is Wubalem Addis.

have also been fully informed in the language I understood and about the research
project objective to assess the magnitude of willingness towards eye donation and
associated factors among adults in Addis Ababa, Ethiopia. I have been informed that
all the information I will provide will be kept confidential. I understood that the
research carries no risk and offers no compensation. I also know that I have the right
to withhold information, skip answering questions, or withdraw from the study at any
time. I have been informed that nobody will impose on me to explain the reason for
my withdrawal. It is also clear that there will be no effect at all on my health benefits
or other administrative benefits that I get from the district. I have been assured of the
right to ask for information that is not clear about the research before and/or during
the research work by contacting:

1. The University of Gondar, Office Phone: 0581110004

2. Principal investigator: Mr. Wubalem Addis phone; 0996654633

3. Supervisor name and address: ______________

I have read this form, or it has been read to me in the language I comprehend, and I

understand the condition stated above; therefore, I am willing to confirm my

participation

by signing this consent form.

Participant’s signature ____________________

Name of the data collector: _____________

Signature __________________ Date ____________________

Annex III: Questionnaire, English Version

32
 Good morning/afternoon, my name is -------------------------------- I am collecting data
for studying willingness towards eye donation and associated factors towards
spectacle use among adults in Addis Ababa by asking questions. Your appropriate
answers to all of our questions are important to know regarding knowledge,
Awareness, willingness, and other factors toward eye donation. Your answers will be
confidential and kept secret. If you decide that you do not want to participate in the
study now or at any time in the future, it is your right not to participate in the study.
But we appreciate it if you participated, and it will take us 20 minutes to complete the
questionnaire. Thank you. Next, I will read a consent, which assures your interest in
participating.

Data collector

Name ----------------------- signature ------------------------ date -------------------

Checked by supervisor

Name --------------------- signature ----------------- date -------------------

Code ______________ Kettena______

Data collection date:____________________Name of data collector______________

Part one: Questions related to socio-demographic characteristics

33
Questions Responses

Age ---------

Sex 1. Male 2. Female

What is your current marital status? 1. Single 2. Married 3. Divorced 4.

Widowed
What is your ethnicity? 1. Amhara 2. Oromo 3. Tigriyan 4. Somalia 5.
Wolayta 6. Others------

What is your current educational level? 1. Have not received formal education 2.
Primary school 3. Secondary School 4.
College/university 5. certificate and above

What is your occupation? 1. Merchant 2. Healthcare professionals 3. non-

health care professionals 4. Unemployed

What is your religion? 1. Christian 2. Muslim 3. Others----

What is your monthly income? 1. <=1000 2. 1000-2000 3. 2000-3000 4. >3000

2 Part two Information related questions

1. Have you ever heard about eye donation? 1. Yes 2. No

2. What is your source of information? 1. Mass media 2. Colleagues 3.

Family 4. Reading materials 5. More than
one source 6. Others specify
3. Do you have a history of training in eye 1. Yes 2. No
health?

3. Part Three knowledge-related questions

Questions Answers

34
1. which part of the eye can be donated? 1. the whole eye 2. the white part 3. the
cornea 4. I don’t know
2. Is donation possible from a living person 1. Yes 2. No 3. I don’t know
3.Can a living person pledge to donate 1. Yes 2. No 3. I don’t know
his/her eyes?
3. Is it mandatory to get the permission of 1. Yes 2. No 3.I don’t know
the donor family?
4. What is the optimal time to retrieve the 1. <24hr 2. <6hr 3. I don’t know
eye after death?
5. Can a human eye be allowed to be sold or 1. Yes 2. No 3. I don’t know
bought?
6. Can a person with HIV can donate an 1. Yes 2. No 3. I don’t know
eye?
7. Which patients should be considered for 1. Any willing patient 2. any patient who
donation? has died in hospital 3. I don’t know
8. Can a donor choose his/her recipient and 1. Yes 2. No. 3. I don’t know
vice/versa
9. Do you know where to contact to donate 1. Yes 2.No 3. I don’t know
eyes?
10. Is there any eye bank in Ethiopia? State 1. Yes, where--------
where is it?
2. No 3. I don’t know
Part four Questions for willingness
1. Are you willing to pledge your eye? 1. Yes 2. No
2. Are you willing to donate your close 1. Yes 2. No
relatives?
3. If yes what is your perceived reason? 1. It is pleased to help blind people
2. It is noble work
3. May the eye be useless after death
4. Other reason------
4. If no what is your perceived reason? 1. Not acceptable work
2. If I agree I may be killed before my time
3. It is against my religion
4. I don’t have any information about it.
Annex IV ፡ የተሳታፊዎች መረጃ የመጠየቂያ ቅጽ-በአማርኛ

35
የጥናቱ ርዕስ ፡ በአዲስ አበባ ከተማ፣ ማዕከላዊ ኢትዮጵያ ውስጥ ከሚገኙ አዋቂዎች መካከል አይን
የመስጠት ፍቃደኝነት እና ተያያዥ ምክንያቶች፣ 2024

የዋና አጥኚ ስም:- ዉባለም አዲስ

የመስሪያ ቤቱ ስም:- የጎንደር ዩኒቨርሲቲ ፣ የህክምና እና ጤና ሳይንስ ኮሌጅ ኮምፕረሄንሲቭ እና

ስፔሻላይዝድ ሆስፒታል ፣ የህክምና ትምህርት ቤት እና ኦፕቶሜትሪ ትምህርት ክፍል፡፡

መግቢያ:- ይህ የመረጃ ወረቀትእና ስምምነት ፎርም የተዘጋጀው በማዕከላዊ ኢትዮጵያ፣ አዲስ

አበባ ከተማ፣ 2024 በአዋቂዎች መካከል አይን ለመለገስ ፈቃደኛ መሆንንእና ተያያዥ
ምክንያቶችን ለማጥናት ነው። የምርምር ቡድኑ ዋና መርማሪውንጨምሮ አራት የሰለጠኑ መረጃ
ሰብሳቢዎችን፣ አንድ ተቆጣጣሪን እና ከጎንደር ዩኒቨርሲቲ ሁለት አማካሪዎችን ያካተተ ይሆናል።

የጥናቱ ዓላማ:- በአዲስ አበባ ከተማ፣ ማዕከላዊ ኢትዮጵያ በአዋቂዎች መካከል አይን ለመለገስ
ፈቃደኛ መሆንን እና ተያያዥ ምክንያቶችን ለማዎቅ፣ 2024

የጥናቱ ሂደት እና ጊዜ፦ ጥናቱ አዋቂዎችን የሚመለከት ሲሆን ከግንቦት 1 እስከ ሰኔ 1 ቀን 2024
ዓ.ም. ድረስ ይካሄዳል። ከጥናቱ ተካፋዮች አንዱ እንድትሆኑ በአጋጣሚ ትመረጣላችሁ፤
እንዲሁም በፕሮጄክታችን እንድትካፈሉ በትህትና እንጋብዛችኋለን። በዚህ ተሳትፎ ለመካፈል
ፈቃደኛ ከሆንክ በጣም ደስተኞች ነን፤ እንዲሁም የዚህን ጥናት ዓላማ በግልጽ እንድትረዳና
ስምምነትህን እንድታሳይ እንፈልጋለን። በመጨረሻም ቃለ መጠይቁ ላይ እውነተኛ ምላሽ
እንድትሰጥ በትህትና እንጠይቃለን።

ምስጢር አጠባበቅ- ለምርምር መረጃዎች ምስጢራዊነት አስተማማኝ የሆኑ ጥበቃዎችን

ለማመቻቸት መረጃ ሰብሳቢው ስሞችን ከመጠቀም ይልቅ በመረጃ አሰባሰብ ወቅት ኮዶችን
ይጠቀማል። የመረጃ ትንታኔው እስኪካሄድ ድረስ የመጀመሪያው መረጃ በጽ/ቤት ውስጥ
ይቆለፋል። ከዋናው መርማሪና የመረጃ ፍተሻና የጽዳት ዓላማ ተቆጣጣሪ በስተቀር ማንም ሰው
መረጃውን ማግኘት አይችልም። ተሳታፊዎች ከተስማሙበት በስተቀር ለማንኛውም ዓላማ
መረጃመጠቀም ሥነ ምግባር የጎደለው፣ እና

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37