Socio-Structural Determinants of Glaucoma Blindness in West Africa: A Multi-Country Comparative Analysis

Glaucoma blindness in West Africa is driven not solely by biological disease processes but by deeply embedded socio-structural determinants including poverty, health system fragmentation, and structural inequalities that are inadequately theorised in existing ophthalmology literature. This study investigates the socio-structural determinants of glaucoma blindness through a multi-country comparative analysis of Nigeria, Ghana, and Senegal. A comparative health systems and social epidemiology design will be employed. National-level glaucoma blindness data from population-based surveys and tertiary hospital registries in each country will be compiled and harmonised. Structural determinants including national health expenditure on eye care, ophthalmologist workforce density, universal health coverage index, poverty rate, and glaucoma medication inclusion in essential medicines lists will be mapped for each country using publicly available datasets from WHO, World Bank, and IAPB. Qualitative case studies in two high-burden districts per country will explore how structural factors operate at community and facility levels through 90 in-depth interviews with patients, families, providers, and policymakers. Multi-level regression analysis will model the contribution of structural determinants to district-level glaucoma blindness rates. This study applies social epidemiology and critical health systems theory to glaucoma blindness in a West African context, generating an original analytical framework that transcends clinical risk factor paradigms. Findings will contribute to global evidence on the structural drivers of non-communicable eye disease and inform advocacy at the Economic Community of West African States level. Recommendations will target shared ophthalmology workforce policies and cross-border glaucoma medication access. Keywords: glaucoma blindness, socio-structural determinants, West Africa, health systems, comparative analysis