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Hussain AHME, Islam L, Mashreky SR, Rahman AKMF, Viitasara E, Dalal K. Barriers to the uptake of eye health services of the children in rural Bangladesh: A community-based cross-sectional survey. PLoS One 2023; 18:e0295341. [PMID: 38060515 PMCID: PMC10703229 DOI: 10.1371/journal.pone.0295341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Globally, ocular morbidity and disability among children are major public health concerns. This study was designed to explore the health-seeking behaviours of parents in Bangladesh whose children have ocular problems. A cross-sectional mixed method was followed for this study. The method was designed to measure the eye health care-seeking practices of caregivers/parents with children with ocular morbidity in three unions (the lowest administrative geographical area comprising 30,000-50,000 population) of the Raiganj Upazila under the Sirajganj District of Bangladesh. The study period was from January to April 2017. Face-to-face interviews using a semi-structured quantitative questionnaire with the caregivers and KI were conducted among the health service providers during the study period. This was the first community-based study conducted in Bangladesh to find out caregivers' health-seeking behaviour with identified ocular morbidity. Among 198 confirmed cases of childhood ocular problems, only 87 (43.9%) parents sought health care for their children's ocular morbidities. Better health-seeking behavior was found among the wealthier families. Proportions were 55.3% and 36% among wealthy and low-income families, respectively. Affluent families sought care from qualified service providers. Educated household heads chose qualified service providers for their children at a higher rate than illiterate household heads. Lack of knowledge, lack of awareness and financial constraints are significant barriers to seeking proper health care. More than half of the caregivers did not seek any eye care services for their children. Socio-demographic factors, and financial constraints play an essential role in the health-seeking behaviour of the parents.
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Affiliation(s)
- A. H. M. Enayet Hussain
- Department of Health Sciences, Division of Public Health Science, Mid Sweden University, Sundsvall, Sweden
| | - Labida Islam
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
- Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Saidur Rahman Mashreky
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
- Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - A. K. M. Fazlur Rahman
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
- Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Eija Viitasara
- Department of Health Sciences, Division of Public Health Science, Mid Sweden University, Sundsvall, Sweden
| | - Koustuv Dalal
- Department of Health Sciences, Division of Public Health Science, Mid Sweden University, Sundsvall, Sweden
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Hussain SZM, Jeeva I, Siddiqui MAR. Relationship of Gender With Laser Retinopexy for Retinal Breaks. Cureus 2023; 15:e39714. [PMID: 37398741 PMCID: PMC10309653 DOI: 10.7759/cureus.39714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 07/04/2023] Open
Abstract
PURPOSE To explore the relationship of gender with laser retinopexy for retinal breaks in the Pakistani population. MATERIALS AND METHODS This was a 10-year retrospective observational study conducted at Aga Khan University Hospital, Karachi, Pakistan. All consecutive patients who underwent laser retinopexy between January 2009 and December 2018 for a retinal tear or high-risk retinal degeneration (such as lattice degeneration) were included in this study. Data were collected from patients' files. Index eyes with a history of or treatment for retinal detachment were excluded. A structured pro forma was used to collect information. Descriptive statistics were used to explore the relationship between gender and laser retinopexy. RESULTS We identified 12,457 patients through the coding system of our hospital who underwent various laser procedures from January 2009 to December 2018. Yttrium aluminium garnet (YAG) laser, laser peripheral iridotomy (PI), and laser trabeculoplasty procedures were all excluded. A total of 3,472 patients' files were reviewed for this study, out of which 958 patients met the inclusion criteria. Males accounted for a higher number (n=515, 53.87%). The mean age was 43.99±15.37 years. For exploratory analysis, participants were divided into five age groups: <30 years (24.16%); 31-40 years (16.59%); 41-50 years (19.45%); 51-60 years (26.40%); and >60 years (13.49%). Bilateral laser retinopexy was performed in 48.12% of patients; 24.79% and 27.13% of patients underwent unilateral laser retinopexy for the right and left eyes, respectively. CONCLUSION In our cohort study, laser retinopexy was more commonly performed in men than in women. The ratio was not significantly different from the prevalence of retinal tears and retinal detachment in the general population, which has a slightly higher male preponderance. We did not find evidence of significant gender bias among patients who underwent laser retinopexy in our study.
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Affiliation(s)
| | - Irfan Jeeva
- Ophthalmology, Aga Khan University Hospital, Karachi, PAK
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Sneha S, Singh A, Singh A, Bhadauria M, Burgess C, Mugula L. Teleophthalmology. INTERNATIONAL JOURNAL OF E-ADOPTION 2023. [DOI: 10.4018/ijea.316538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As a result of COVID-19, a new approach for delivering eye care services to rural underprivileged areas were needed to improve eye disease outcomes. Sitapur Eye Hospital used a door-to-door model of medical delivery to alleviate the inability of rural residents from not receiving appropriate eye care during the COVID-19 pandemic. Sitapur Eye Hospital utilizes a healthcare delivery model that involves visiting patients door-to-door. The total number of patients that Sitapur Eye Hospital examined went from screening no patients in the months of April and May to screening 31,017 patients via the door-to-door service that was implemented in June 2020. Sitapur Eye Hospital managed to keep the prevalence of people who had severe eye impairment at pre-pandemic levels by offering a door-to-door service to patients who were unable to access appropriate medical care. The door-to-door healthcare model shows that leveraging telehealth and ride-hailing services alleviate certain barriers that make it difficult for people in rural areas to access eye care.
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Komal S, Radhakrishnan N, Vardhan S A, Prajna NV. Effectiveness of a Tele-Ophthalmology Vision Center in Treating Corneal Disorders and Its Associated Economic Benefits. Cornea 2022; 41:688-691. [PMID: 34116538 DOI: 10.1097/ico.0000000000002784] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to study the clinical and economic impact of a teleophthalmology-based vision center (VC) in the management of corneal diseases in rural south India. METHODS Data of patients with corneal disorders who visited the VC in the year 2019 were analyzed for the total number of outpatient visits, the proportion of corneal cases that were treated at the VC, those referred to the base hospital (BH), and the costs of treatment. RESULTS In 2019, 1131 (10%) of 10,850 patients who visited the VC were diagnosed with corneal disorders. Of these, 950 (84%) patients were treated at the VC itself and did not require to be referred. The remaining 181 (16%) were referred to the BH. Of these 1131 patients, 836 (74%) patients presented with a painful acute corneal disorder. The most common painful acute corneal disorders included corneal foreign body (376, 33%), epithelial abrasions (205, 18%), and infectious keratitis (124, 11%). A patient can save approximately a minimum of INR 1200 (USD 16) by attending the VC rather than the BH. In 2019, by treating 950 patients, the VC saved approximately INR 114,0000 (USD 15,200) for the community. A similar calculation extrapolated to a 10-year period (2009-2019) revealed that by providing care for these corneal disorders at the community level, the VC saved approximately INR 705,8400 (USD 94,112) for the community. CONCLUSIONS VC reduces the barriers to care by increasing the accessibility and affordability of treatment for patients with corneal disorders, resulting in a significant cost saving to the community.
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Affiliation(s)
- Sangoi Komal
- Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India
| | - Naveen Radhakrishnan
- Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India
| | - Ashok Vardhan S
- Department of Cataract, S.V. Aravind Eye Hospital, Aravind Eye Care System, Tirupati, India
| | - N Venkatesh Prajna
- Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India
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Shetti S, Pradeep TG, Devappa N. Barriers for the uptake of cataract surgery: A rural community-based study. AFRICAN VISION AND EYE HEALTH 2022. [DOI: 10.4102/aveh.v81i1.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hoffman JJ, Yadav R, Das Sanyam S, Chaudhary P, Roshan A, Singh SK, Mishra SK, Arunga S, Hu VH, Macleod D, Leck A, Burton MJ. Delay in accessing definitive care for patients with microbial keratitis in Nepal. Front Med (Lausanne) 2022; 9:915293. [PMID: 35935768 PMCID: PMC9354956 DOI: 10.3389/fmed.2022.915293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to describe the health-seeking journey for patients with microbial keratitis (MK) in Nepal and identify factors associated with delay. Methods Prospective cohort study where MK patients attending a large, tertiary-referral eye hospital in south-eastern Nepal between June 2019 and November 2020 were recruited. We collected demographic details, clinical history, and examination findings. Care-seeking journey details were captured including places attended, number of journeys, time from symptom onset, and costs. We compared "direct" with "indirect" presenters, analyzing for predictors of delay. Results We enrolled 643 patients with MK. The majority (96%) self-referred. "Direct" attenders accounted for only 23.6% (152/643) of patients, the majority of "indirect" patients initially presented to a pharmacy (255/491). Over half (328/643) of all cases presented after at least 7 days. The total cost of care increased with increasing numbers of facilities visited (p < 0.001). Those living furthest away were least likely to present directly (p < 0.001). Factors independently associated with delayed presentation included distance >50 km from the eye hospital [aOR 5.760 (95% CI 1.829-18.14, p = 0.003)], previous antifungal use [aOR 4.706 (95% CI 3.139-5.360)], and two or more previous journeys [aOR 1.442 (95% CI 1.111-3.255)]. Conclusions Most patients visited at least one facility prior to our institution, with time to presentation and costs increasing with the number of prior journeys. Distance to the eye hospital is a significant barrier to prompt, direct presentation. Based on these findings, improving access to eye care services, strengthening referral networks and encouraging early appropriate treatment are recommended to reduce delay, ultimately improving clinical outcomes.
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Affiliation(s)
- Jeremy J Hoffman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
| | - Reena Yadav
- Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
| | | | | | | | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Victor H Hu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Macleod
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Astrid Leck
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Umar F, Odugbo OP, Mpyet CD. Utilization of orthodox eye care services among visually impaired adults in jos north local government area of Plateau State. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_75_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Situational analysis of diabetic retinopathy treatment Services in Ghana. BMC Health Serv Res 2021; 21:584. [PMID: 34140000 PMCID: PMC8212523 DOI: 10.1186/s12913-021-06608-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background Although the equitable distribution of diabetic retinopathy (DR) services across Ghana remains paramount, there is currently a poor understanding of nationwide DR treatment services. This study aims to conduct a situation analysis of DR treatment services in Ghana and provide evidence on the breadth, coverage, workload, and gaps in service delivery for DR treatment. Methods A cross-sectional study was designed to identify health facilities which treat DR in Ghana from June 2018 to August 2018. Data were obtained from the facilities using a semi-structured questionnaire which included questions identifying human resources involved in DR treatment, location of health facilities with laser, vitreoretinal surgery and Anti–vascular endothelial growth factor therapy (Anti-VEGF) for DR treatment, service utilisation and workload at these facilities, and the average price of DR treatment in these facilities. Results Fourteen facilities offer DR treatment in Ghana; four in the public sector, seven in the private sector and three in the Christian Health Association of Ghana (CHAG) centres. There was a huge disparity in the distribution of facilities offering DR services, the eye care cadre, workload, and DR treatment service (retinal laser, Anti-VEGF, and vitreoretinal surgery). The retinal laser treatment price was independent of all variables (facility type, settings, regions, and National Health Insurance Scheme coverage). However, settings (p = 0.028) and geographical regions (p = 0.010) were significantly associated with anti-VEGF treatment price per eye. Conclusion Our results suggest a disproportionate distribution of DR services in Ghana. Hence, there should be a strategic development and implementation of an eye care plan to ensure the widespread provision of DR services to the disadvantaged population as we aim towards a disadvantaged population as we aim towards a universal health coverage. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06608-9.
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Toit RD, Ramke J, Palagyi A, Brian G. Spectacles in Fiji: need, acquisition, use and willingness to pay. Clin Exp Optom 2021; 91:538-44. [DOI: 10.1111/j.1444-0938.2008.00286.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rènée Du Toit
- The Fred Hollows Foundation (New Zealand), Auckland, New Zealand
- The International Centre for Eyecare Education, Sydney, Australia,
- § The Vision Cooperative Research Centre, Sydney, Australia
E‐mail:
| | - Jacqueline Ramke
- The Fred Hollows Foundation (New Zealand), Auckland, New Zealand
- The International Centre for Eyecare Education, Sydney, Australia,
- § The Vision Cooperative Research Centre, Sydney, Australia
E‐mail:
| | - Anna Palagyi
- The Fred Hollows Foundation (New Zealand), Auckland, New Zealand
- The International Centre for Eyecare Education, Sydney, Australia,
- § The Vision Cooperative Research Centre, Sydney, Australia
E‐mail:
| | - Garry Brian
- The Fred Hollows Foundation (New Zealand), Auckland, New Zealand
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Qutishat Y, Shublaq S, Masoud M, Alnuman N. Low Vision Profile in Jordan: A Vision Rehabilitation Center-Based Study. Healthcare (Basel) 2020; 9:healthcare9010020. [PMID: 33375257 PMCID: PMC7823940 DOI: 10.3390/healthcare9010020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 01/04/2023] Open
Abstract
The aim of this paper is to study the profile of persons with low vision in Jordan based on the clinical records of service users who attended the Vision Rehabilitation Center (VRC) at the German Jordanian University (GJU). A retrospective study was conducted by reviewing the archived data for persons with low vision attending the VRC over the period September 2012 to December 2017. The information collected included age, gender, referral, geographical distribution, chief functional visual problems, and ocular pathology. The records of 725 (28.9 ± 20.3 years old) persons out of 858 persons were analyzed. Almost half (50.6%) of the sample was less than 18 years old. The main cause of the low vision was retinal diseases (53.4%), followed by albinism. Gender and age showed no significant influence on ocular pathology distribution. For the referrals, ophthalmologists (37.8%) were the largest source of referral, followed by institutions for people with disabilities (14.9%). Near tasks were reported as the main functional problems for patients with low vision (74.9%), followed by distance tasks (8.3%). This study sets a precedent for determining the characteristics of persons with low vision in Jordan. Developing an efficient referral system between eye health care professionals and other health caregivers is important to ensure the best multidisciplinary services for low vision.
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Odayappan A, Kavitha S, Ramulu ST, Upadhyaya S, Venkatesh R. Assessment of Reasons for Presentation in New Primary Glaucoma Patients and Identification of Risk Factors for Late Presentation. Ophthalmol Glaucoma 2020; 4:382-389. [PMID: 33279673 DOI: 10.1016/j.ogla.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the reasons for seeking care among South Indian primary glaucoma patients and to determine the relationship of various patient characteristics to glaucoma severity at presentation. DESIGN Cross-sectional study. PARTICIPANTS One hundred sixty-one new primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) patients seeking treatment at a tertiary eye hospital. METHODS After confirmation of diagnosis, participants' clinical information and their reported reasons for presentation were assessed. Data collected include age, gender, education, occupation, rural or urban residence, distance traveled to the hospital, method of transportation, need for an accompanying person, place of screening before referral or whether they came by themselves for testing. Advanced glaucoma was defined by a cup-to-disc ratio of 0.85 or higher in either eye. MAIN OUTCOME MEASURES The primary outcomes were the various reasons for presentation. The secondary outcome was to determine whether a relationship existed between the patient characteristics mentioned above and presentation with advanced glaucoma. RESULTS The mean age of the participants was 60.8 years. The primary reason for presentation was defective vision (55.2%) followed by routine ophthalmic evaluation (13%). Sixty-four patients (39.8%) showed advanced glaucoma in at least 1 eye at presentation. Unilateral blindness was noted in 18 patients (11.2%). The mean vertical cup-to-disc ratio was 0.66 (standard deviation [SD], ±0.16) in the better-seeing eye and 0.76 (SD, ±0.12) in the worse-seeing eye. The mean presenting intraocular pressure was 22.9 mmHg in POAG and 25.5 mmHg in PACG patients. Multivariate logistic regression analyses showed that people who are currently unemployed (P < 0.001; odds ratio [OR], 4.19; 95% confidence interval [CI], 1.95-8.99) and rural residence (P = 0.04; OR, 0.46; 95% CI, 0.21-0.99) had greater odds of demonstrating advanced glaucoma at presentation. Presentation with defective vision, older age, and education less than college graduation were associated with greater odds of showing advanced glaucoma in univariate analysis, but not in multivariate analyses. CONCLUSIONS In a South Indian population, absence of work and rural residence was associated with advanced glaucoma at presentation. The population in whom these risk factors are common should be targeted for screening and outreach.
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Mitchell W, Hassall M, Henderson T. Updating the model of eye care for Aboriginal populations in remote Central Australia. Clin Exp Ophthalmol 2020; 48:1299-1306. [PMID: 32748478 DOI: 10.1111/ceo.13838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/17/2023]
Abstract
Eye disease is the third-highest contributor towards health inequality for Aboriginal Australians. Understanding how the Central Australian ophthalmology service addresses complexities of remote eye care is crucial in understanding how expansion can meet current and future needs. The present study analyses findings from the MEDLINE database and Governmental reports, and descriptive information from stakeholders in Central Australia and the Australian Department of Health. We describe the current Central Australian ophthalmology model at three levels; (a) the healthcare service level (specialized primary care, local/outreach optometry and ophthalmology services, and intensive extended surgical weeks), (b) the community level (local community staff, clinics and initiatives, and eye "champions" and mutual support), and (c) the healthcare system level (federal and state government, and private funding). We conclude that building full-time specialist availability, and system-wide approaches to increase patient utilisation, will facilitate overcoming barriers of remoteness, and create enduring improvements in Central Australian eye care and health-inequality.
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Affiliation(s)
- William Mitchell
- Harvard TH Chan School of Public Health, Boston MA, USA.,Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston MA, USA
| | - Mark Hassall
- Flinders Medical Centre, Department of Ophthalmology, Bedford Park, SA, Australia
| | - Tim Henderson
- Alice Springs Hospital, Department of Ophthalmology, Alice Springs, NT, Australia
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Factors associated with the uptake of cataract surgery and interventions to improve uptake in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0235699. [PMID: 32645065 PMCID: PMC7347115 DOI: 10.1371/journal.pone.0235699] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/21/2020] [Indexed: 11/19/2022] Open
Abstract
Despite significant evidence around barriers hindering timely access to cataract surgery in low- and middle-income countries (LMICs), little is known about the strategies necessary to overcome them and the factors associated with improved access. Despite significant evidence that certain groups, women for example, experience disproportionate difficulties in access, little is known about how to improve the situation for them. Two reviews were conducted recently: Ramke et al., 2018 reported experimental and quasi-experimental evaluations of interventions to improve access of cataract surgical services, and Mercer et al., 2019 investigated interventions to improve gender equity. The aim of this systematic review was to collate, appraise and synthesise evidence from studies on factors associated with uptake of cataract surgery and strategies to improve the uptake in LMICs. We performed a literature search of five electronic databases, google scholar and a detailed reference review. The review identified several strategies that have been suggested to improve uptake of cataract surgery including surgical awareness campaigns; use of successfully operated persons as champions; removal of patient direct and indirect costs; regular community outreach; and ensuring high quality surgeries. Our findings provide the basis for the development of a targeted combination of interventions to improve access and ensure interventions which address barriers are included in planning cataract surgical services. Future research should seek to examine the effectiveness of these strategies and identify other relevant factors associated with intervention effects.
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Li Y, McKay GN, Durr NJ, Tian L. Diffuser-based computational imaging funduscope. OPTICS EXPRESS 2020; 28:19641-19654. [PMID: 32672237 PMCID: PMC7340384 DOI: 10.1364/oe.395112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 05/28/2023]
Abstract
Poor access to eye care is a major global challenge that could be ameliorated by low-cost, portable, and easy-to-use diagnostic technologies. Diffuser-based imaging has the potential to enable inexpensive, compact optical systems that can reconstruct a focused image of an object over a range of defocus errors. Here, we present a diffuser-based computational funduscope that reconstructs important clinical features of a model eye. Compared to existing diffuser-imager architectures, our system features an infinite-conjugate design by relaying the ocular lens onto the diffuser. This offers shift-invariance across a wide field-of-view (FOV) and an invariant magnification across an extended depth range. Experimentally, we demonstrate fundus image reconstruction over a 33° FOV and robustness to ±4D refractive error using a constant point-spread-function. Combined with diffuser-based wavefront sensing, this technology could enable combined ocular aberrometry and funduscopic screening through a single diffuser sensor.
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Sen P, Gupta N, Mohan A, Shah C, Sen A, Jain E. Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care center in central rural India. Indian J Ophthalmol 2020; 68:603-607. [PMID: 32174578 PMCID: PMC7210835 DOI: 10.4103/ijo.ijo_872_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/28/2019] [Accepted: 10/22/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To find out the sociodemographic, sociocultural, and socioeconomic factors leading to delay in pediatric cataract surgery and its impact on final visual outcome. Methods A prospective interview-based analytical cohort study was conducted on 156 children aged 0-16 years with either unilateral or bilateral congenital/developmental cataracts. Caregivers were interviewed using a pretested validated questionnaire. Time intervals between recognition by a caregiver to consultation were denoted as Delay-1 and between consultations to surgical intervention as Delay-2. Spearman's rank correlation was used to determine the presence of correlation between causes of delay and visual outcome. Results The mean age of presentation was 7.78 ± 4.34 years. Mothers were the first informant of the problem (n = 110, 70.5%). Out of 156 children, only 8 (5.1%) children presented to the hospital within 1 month by caregivers and 26 (16.7%) children underwent surgery within 2 months of advice. About 22 (14.1%) children had total cumulative delay of 1-6 months, 11 (7%) had delay of 6-12 months, and 115 (73.71%) had delay of >12 months. The most common cause identified for Delay-1 was unawareness in 41 cases (26.28%), however, for Delay-2 major factor responsible was cost (n = 38, 24.35%). The median preoperative visual acuity was 1.31 logMAR and median postoperative visual acuity at 4 weeks was 0.61 logMAR. (P < 0.001) Less age at surgery, upper socioeconomic status, less time delay, and better preoperative vision were positively correlated to better visual outcomes. Conclusion Delay in presentation for childhood cataract surgery remains a significant problem in central rural India. Delay in surgery is multifactorial which includes unawareness, cost, misdiagnosis, self-treatment, distance from the hospital, lack of family support, and poor socioeconomic status.
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Affiliation(s)
- Pradhnya Sen
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Namrata Gupta
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Amit Mohan
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Chintan Shah
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Alok Sen
- Vitreoretina and Uvea, Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Elesh Jain
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
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Namperumalsamy P. Maintaining quality in community eye care - The Aravind model. Indian J Ophthalmol 2020; 68:285-287. [PMID: 31957708 PMCID: PMC7003607 DOI: 10.4103/ijo.ijo_41_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- P Namperumalsamy
- Chairman-Emeritus, Aravind Eye Care System; Director-Research, Aravind Eye Hospital, 1, Anna Nagar, Madurai - 625 020, India
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Prasad N, Ormsby GM, Finger RP. Validating a tool to assess eye health knowledge, attitude and practice in Cambodia and Vietnam. Int J Ophthalmol 2019; 12:1767-1774. [PMID: 31741867 DOI: 10.18240/ijo.2019.11.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To develop an eye health knowledge, attitude and practice (EH-KAP) field-based assessment tool for use in implementing effective eye health care services. METHODS An instrument development and validation study. A Vietnam EH-KAP dataset were used to identify and eliminate redundant questions to develop a standardized tool. Face validity was assessed by the KAP survey team. Internal validity (congruency/criterion) was assessed by comparing descriptive analysis of two datasets (n=531; n=38) collected from the same sampling frame at different time points. Weighted scores were calculated for each construct. Kappa values for test-retest and inter-observer agreement were calculated to check the reliability of responses. The modified version was assessed by analysing the raw and ungrouped data. Responses were weighted and agreement was tested by comparing construct scores. RESULTS Totally 38 respondents were included in this validation process (mean age 58.5y). Mean scores for knowledge were 9.15 (old questionnaire n=531) and 5.05 (modified version). For attitude, the scores were 2.23 and 2.42, and for practice the scores were 3.33 and 2.21. Test-retest agreement was between 62% to 93% (Kappa 0.24 to 0.86) for the ungrouped raw data, and 55% to 72% (Kappa 0.42 to 0.65) for KAP domain. Inter-observer Kappa value for ungrouped data was 0.37 and 0.45 for the weighted scores. CONCLUSION This standardized tool applied at critical time points can assess trends in KAP within the same population and for comparison across groups. If used alongside a Rapid Assessment of Avoidable Blindness (RAAB), this tool provides a comprehensive perspective on eye-health of a population.
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Affiliation(s)
- Noela Prasad
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3011, Australia.,VACCHO, Collingwood, VIC 3066, Australia
| | - Gail M Ormsby
- Professional Studies, Faculty of Business, Education, Law and Arts, University of Southern Queensland, West Street, Toowoomba, QLD 4350, Australia.,Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, NSW 2265, Australia
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Regina-Pacis-Weg 3, Bonn 53113, Germany
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Nigam I, Keshari R, Vatsa M, Singh R, Bowyer K. Phacoemulsification Cataract Surgery Affects the Discriminative Capacity of Iris Pattern Recognition. Sci Rep 2019; 9:11139. [PMID: 31366988 PMCID: PMC6668423 DOI: 10.1038/s41598-019-47222-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/02/2019] [Indexed: 01/10/2023] Open
Abstract
Cataract is a common ophthalmic disorder and the leading cause of blindness worldwide. While cataract is cured via surgical procedures, its impact on iris based biometric recognition has not been effectively studied. The key objective of this research is to assess the effect of cataract surgery on the iris texture pattern as a means of personal authentication. We prepare and release the IIITD Cataract Surgery Database (CaSD) captured from 132 cataract patients using three commercial iris sensors. A non-comparative non-randomized cohort study is performed on the iris texture patterns in CaSD and authentication performance is studied using three biometric recognition systems. Performance is lower when matching pre-operative images to post-operative images (74.69 ± 9.77%) as compared to matching pre-operative images to pre-operative images (93.42 ± 1.76%). 100% recognition performance is observed on a control-group of healthy irises from 68 subjects. Authentication performance improves if cataract affected subjects are re-enrolled in the system, though re-enrollment does not ensure performance at par with pre-operative scenarios (86.67 ± 5.64%). The results indicate that cataract surgery affects the discriminative nature of the iris texture pattern. This finding raises concerns about the reliability of iris-based biometric recognition systems in the context of subjects undergoing cataract surgery.
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Prasad M, Malhotra S, Kalaivani M, Vashist P, Gupta SK. Gender differences in blindness, cataract blindness and cataract surgical coverage in India: a systematic review and meta-analysis. Br J Ophthalmol 2019; 104:220-224. [PMID: 31221669 DOI: 10.1136/bjophthalmol-2018-313562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/12/2019] [Accepted: 04/02/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The magnitude of blindness is unevenly distributed worldwide. This systematic review aimed to study gender differences in the prevalence of blindness, cataract blindness and cataract surgical coverage in India among persons aged 50 years and above. METHODS Literature search was carried out in the Medline, Web of Science, Google Scholar, EMBASE and Trip databases. Data were abstracted and risk of bias was assessed for the selected full-text articles. Pooled prevalence, ORs and risk differences were synthesised by meta-analyses. RESULTS 22 studies were included in the systematic review. The pooled prevalence of blindness obtained for men was 4.17% and that for women was 5.68%. Women had 35% higher odds of being blind (OR 1.35, 95% CI 1.08 to 1.62) and 69% higher odds of being cataract blind (OR 1.69, 95% CI 1.44 to 1.95). Women had a 27% lower odds of getting cataract surgery (OR 0.73, 95% CI 0.45 to 1.01). In women, around 35% of the prevalence of blindness and 33% of the prevalence of cataract blindness are attributable to their gender. CONCLUSION Marked gender differences in blindness, cataract blindness and cataract surgical coverage were seen in India, with the odds being unfavourable for women. Interventions implemented for reduction of blindness, including cataract blindness, need to consider these gender differentials in the Indian context. Further research is needed to ascertain the reasons for these differences and devise interventions to reduce these differences in order to tackle the magnitude of avoidable blindness in India.
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Affiliation(s)
- Manya Prasad
- Community Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Sumit Malhotra
- Community Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Mani Kalaivani
- Biostatistics, All India Institute of Medical Sciences, Delhi, India
| | - Praveen Vashist
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Sanjeev K Gupta
- Community Medicine, All India Institute of Medical Sciences, Delhi, India
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Zuurmond M, Mactaggart I, Kannuri N, Murthy G, Oye JE, Polack S. Barriers and Facilitators to Accessing Health Services: A Qualitative Study Amongst People with Disabilities in Cameroon and India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071126. [PMID: 30934813 PMCID: PMC6480147 DOI: 10.3390/ijerph16071126] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 11/22/2022]
Abstract
Background: Article 25 of the UNCRPD stipulates the right of people with disabilities to the highest attainable standard of health, and the timely uptake of appropriate health and rehabilitation services. This study seeks to explore the factors which influence access to health care among adults with disabilities in Cameroon and India. Methods: A total of 61 semi-structured interviews were conducted with a purposive sample of adults with vision, hearing or musculoskeletal impairments, using data from an earlier cross-sectional disability survey. In addition, 30 key informants were interviewed to provide contextual information about the local services and context. Results: Key themes included individual-level factors, understanding and beliefs about an impairment, and the nature of the impairment and interaction with environmental factors. At the community and household level, key themes were family dynamics and attitudes, economic factors, social inclusion and community participation. Intersectionality with gender and age were cross-cutting themes. Trust and acceptability of health service providers in India and poor understanding of referral processes in both countries were key service-level themes. Conclusions: The interaction of environmental and personal factors with the impairment and their levels of participation and inclusion in community structures, all contributed to the take up of services. This study illustrated the need for a multi-faceted response to improve access to health services for people with disabilities.
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Affiliation(s)
- Maria Zuurmond
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Islay Mactaggart
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Nanda Kannuri
- Indian Institute of Public Health, Hyderabad 122002, India.
| | - Gudlavalleti Murthy
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- Indian Institute of Public Health, Hyderabad 122002, India.
| | | | - Sarah Polack
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
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Norris AJ, Norris CE. Factors influencing non-attendance to scheduled eye surgery in rural Swaziland. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
PURPOSE Severe corneal disease contributes significantly to the global burden of blindness. Corneal allograft surgery remains the most commonly used treatment, but does not succeed long term in every patient, and the odds of success fall with each repeated graft. The Boston keratoprosthesis type I has emerged as an alternative to repeat corneal allograft. However, cost limits its use in resource-poor settings, where most corneal blind individuals reside. METHODS All aspects of the Boston keratoprosthesis design process were examined to determine areas of potential modification and simplification, with dual goals to reduce cost and improve the cosmetic appearance of the device in situ. RESULTS Minor modifications in component design simplified keratoprosthesis manufacturing. Proportional machinist time could be further reduced by adopting a single axial length for aphakic eyes, and a single back plate diameter. The cosmetic appearance was improved by changing the shape of the back plate holes from round to radial, with a petaloid appearance, and by anodization of back plate titanium to impute a more natural color. CONCLUSIONS We have developed a modified Boston keratoprosthesis type I, which we call the "Lucia." The Lucia retains the 2 piece design and ease of assembly of the predicate device, but would allow for manufacturing at a reduced cost. Its appearance should prove more acceptable to implanted patients. Successful keratoprosthesis outcomes require daily medications for the life of the patient and rigorous, frequent, postoperative care. Effective implementation of the device in resource-poor settings will require further innovations in eye care delivery.
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Bhondve A, Pathak B, Manapurath RM. Mixed-Method Analysis of Community Health Camps: A Novel Approach Beckoning. Indian J Community Med 2019; 44:233-237. [PMID: 31602110 PMCID: PMC6776955 DOI: 10.4103/ijcm.ijcm_349_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: In India, 60% of the population lack basic medical facilities, so health camps which provide short-term medical interventions for target communities may be beneficial. This study epidemiologically analyzes a health camp event in a rural area of Maharashtra to provide practical insights for organizing, planning, and implementation of health camps. Objectives: 1. Assess the sociodemographic profile and spectrum of morbidity of camp beneficiaries. 2. Assess expectations and satisfaction perceived by community and organizers from health camps. 3. Gain practical insights from the camp event to advocate participation-friendly policies in the community. Materials and Methods: This is a cross-sectional mixed design study. Using qualitative method, a total of four focus group discussions (FGDs) were held with beneficiaries attending the camp and three in-depth interviews (IDIs) were held with camp organizers. A semi-structured questionnaire was used to interview 358 beneficiaries to be studied quantitatively. Results: The camp comprised 52.7% of males and 36.7% of females as beneficiaries. Observed were cases of acute disease (41.6% [n = 149]) and chronic disease (58.7% [n = 209]) with maximum beneficiaries visiting ophthalmology department (25.4%) followed by general medicine (16.70%). FGDs and IDIs revealed two major themes – expectation and satisfaction and several subthemes. Conclusion: The beneficiaries appreciated the event and expressed the requirement of organizing such camps in future again. The camp was need based as revealed by the organizers and beneficiaries. Few strategies in future can result in more participation-friendly health camps.
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Affiliation(s)
- Amit Bhondve
- Department of Community Medicine, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
| | - Barsha Pathak
- Department of Community Medicine, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
| | - Rukman M Manapurath
- Department of Community Medicine, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
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Kizor-Akaraiwe NN. Follow-up and adherence to glaucoma care by newly diagnosed glaucoma patients in enugu, nigeria. Ophthalmic Epidemiol 2018; 26:140-146. [DOI: 10.1080/09286586.2018.1555263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nkiru N. Kizor-Akaraiwe
- College of Medicine, Enugu State University of Technology(ESUT), Enugu State University of Science and Technology (ESUT) Teaching Hospital Parklane, The Eye Specialists Hospital (TESH), Enugu, Nigeria
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A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102165. [PMID: 30279358 PMCID: PMC6210163 DOI: 10.3390/ijerph15102165] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 02/05/2023]
Abstract
Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services—diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to services for any disability. A diverse range of measures of disability and access were used across studies making comparability difficult. However, there was some evidence that access to rehabilitation is low among people with disabilities. No clear patterns were seen in access by equity measures such as age, locality, socioeconomic status, or country income group due to the limited number of studies measuring these indicators, and the range of measures used. Access to rehabilitation services was highly variable and poorly measured within the studies in the review, but generally shown to be low. Far better metrics are needed, including through clinical assessment, before we have a true appreciation of the population level need for and coverage of these services.
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Amritanand A, Jasper S, Paul P, Kuriakose T. Facilitating factors in overcoming barriers to cataract surgical services among the bilaterally cataract blind in Southern India: A cross-sectional study. Indian J Ophthalmol 2018; 66:963-968. [PMID: 29941740 PMCID: PMC6032741 DOI: 10.4103/ijo.ijo_216_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To effectively address cataract blindness, increasing sight-restoring surgeries among the bilaterally blind are essential. To improve uptake of surgical services among this group, evidence regarding the problems of access is vital. Barriers in accessing eye care services have previously been reported but not specific to bilaterally cataract blind patients. Further, there is a gap in knowledge regarding factors facilitating access to eye care. Our aims were to (1) report proportion of bilaterally cataract blind patients undergoing surgery and sight restoration rate (SRR) and (2) analyze barriers and factors enabling access to eye care services among bilaterally cataract blind patients. Methods Retrospective analysis of interview and clinical data of bilaterally cataract blind patients undergoing surgery through outreach services at the base hospital, from June 2015 to May 2016, was performed. Demographic data, vision, postoperative visual outcomes, barriers, and facilitating factors in accessing cataract surgical services were obtained. Results Bilateral cataract blindness was present in 196/3178 (6.2%, 95% confidence interval 5.4-7.06) patients. SRR was 6.5%. Fear of surgery (24.2%) and lack of family support/escort (22.9%) were the most common barriers. Neighbors and acquaintances (28.6%), general health workers (20.2%), and persons who had undergone cataract surgery (19.6%) were the most common facilitating factors. Conclusion Proportion of bilaterally cataract blind people undergoing surgery and consequently SRR were low. The most common barriers were at the individual level while facilitating factors at the community level were instrumental in promoting uptake of services. Interventions involving community-based support for the blind may be useful in overcoming barriers to eye care.
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Affiliation(s)
- Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Padma Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Kuriakose
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
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Kumar SGP, Mondal A, Vishwakarma P, Kundu S, Lalrindiki R, Kurian E. Factors limiting the Northeast Indian elderly population from seeking cataract surgical treatment: Evidence from Kolasib district, Mizoram, India. Indian J Ophthalmol 2018; 66:969-974. [PMID: 29941741 PMCID: PMC6032733 DOI: 10.4103/ijo.ijo_1184_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Reliable data on the barriers to the uptake of cataract surgical services in the Northeast Indian states are scanty. The purpose of this study was to assess the barriers to uptake of cataract surgical services among elderly patients and suggest appropriate strategies to reduce these. Methods: A cross-sectional study was conducted among patients who failed to avail cataract surgical services, 6–12 months’ postinitial diagnosis at a community eye health camp. Validated questionnaire was used to collect information through face-to-face interviews at the residence of the participants. Descriptive statistics and Chi-square tests were conducted to assess the association between the barriers quoted and sociodemographic variables. Results: A total of 140 (89.2%) individuals participated in the study, of whom 56 (40%) were aged between 71 and 80 years. The median age for men and women was 73.5 and 72.5 years, respectively. About 57% of participants were female patients. A total of 66 (47.1%) participants had borderline visual acuity followed by those with poor vision (41.4%, n = 58). “Bad roads/difficult terrain” (P = 0.009), “witnessed bad surgical outcomes in others” and “did not feel important” (P < 0.024), “poor overall health status” (P < 0.001), “lack of information” (P = 0.025) and “no escort” (P = 0.025) were significant barriers reported by this population. Conclusion: Most of the barriers reported in this study seem to be endogenous in nature and appear to be within the purview of the local eye care service provider to remedy. Counseling and targeted awareness and information, education, and communication strategies could nullify many of the barriers reported in this study.
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Affiliation(s)
| | - Amit Mondal
- Mission for Vision, Mumbai, Maharashtra, India
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Gan S, Zhou X, Yan J, Liu X, Yi J, Zhou X, Liu D, Xie Q, Geng J, Lu Y. The prevalence and risk factors of visual impairment among rural residents aged 50 years and above in Yugan county, China. Ophthalmic Epidemiol 2018; 25:331-337. [PMID: 29842804 DOI: 10.1080/09286586.2018.1476557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE The purpose of the study is to assess the prevalence of visual impairment (PVI) among rural residents aged 50 years and above in Yugan county, China. Researchers analyzed risk factors and obtained scientific baseline information for blindness prevention and control. METHODS Stratified cluster random sampling was used in randomly selecting 5540 rural residents aged ≥50 in Yugan county. Eligible residents were invited to receive visual acuity measurement via ophthalmic examinations. Multivariable logistic regression was performed to analyze any risk factors. RESULTS A total of 5119 rural residents participated the ophthalmic examination and investigation. The PVI was 19.2%. The prevalence of moderate and severe visual impairment (≥20/400 and <20/60) was 16.9%, and blindness (<20/400) was 2.27%. Multivariable logistic regression showed that age, gender, education, occupation, marital status, drinking attitude, dietary habits, amount of sleep, and daily fruit intake were the main factors that were most predictive of the PVI. CONCLUSION The PVI among rural residents aged 50 years and above in Yugan county was higher than many other districts. Preventive work in Yuan and other local regions should be focused on older, separated/divorced, or widowed individuals, and those with a lower level of education. Strengthening public awareness consists of educating the public about visual health promotion and blindness intervention, including healthy diet and healthy habits, which will help to reduce visual impairment of the population.
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Affiliation(s)
- Shaohui Gan
- a School of Public Health and Jiangxi Province Key Laboratory of Preventive Medicine , Nanchang University , Nanchang , Jiangxi , China
| | - Xiaojun Zhou
- a School of Public Health and Jiangxi Province Key Laboratory of Preventive Medicine , Nanchang University , Nanchang , Jiangxi , China
| | - Jingzhen Yan
- a School of Public Health and Jiangxi Province Key Laboratory of Preventive Medicine , Nanchang University , Nanchang , Jiangxi , China
| | - Xiaojun Liu
- a School of Public Health and Jiangxi Province Key Laboratory of Preventive Medicine , Nanchang University , Nanchang , Jiangxi , China
| | - Jinglin Yi
- b Affiliated eye hospital , Nanchang University , Nanchang , Jiangxi , China
| | - Xueqing Zhou
- c School of Foreign Languages , South China University of Technology , Guangzhou , Guangdong , China
| | - Denglai Liu
- a School of Public Health and Jiangxi Province Key Laboratory of Preventive Medicine , Nanchang University , Nanchang , Jiangxi , China
| | - Qinghong Xie
- d Department of Public Health Sciences , University of Hawaii at Mānoa , Honolulu , Hawaii , USA
| | - Jiacheng Geng
- d Department of Public Health Sciences , University of Hawaii at Mānoa , Honolulu , Hawaii , USA
| | - Yuanan Lu
- a School of Public Health and Jiangxi Province Key Laboratory of Preventive Medicine , Nanchang University , Nanchang , Jiangxi , China.,d Department of Public Health Sciences , University of Hawaii at Mānoa , Honolulu , Hawaii , USA
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Efficacy of Facilitated Capacity Building in Providing Cleft Lip and Palate Care in Low- and Middle-Income Countries. J Craniofac Surg 2018; 28:1737-1741. [PMID: 28872505 DOI: 10.1097/scs.0000000000003884] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Providing surgical repair for congenital anomalies such as cleft lip and palate (CLP) can be challenging in low- and middle-income countries. One nonprofit organization seeks to address this need through a partnership model. This model provides long-term aid on multiple levels: surgeon and healthcare provider education, community outreach, and funding. The authors examined the effectiveness of this partnership model in providing CLP care and increasing cleft care capacity over time. This organization maintains data on each partner and procedure and collected data on hospital and patient characteristics through voluntary partner surveys from 2010 to 2014. Effectiveness of care provision outcomes included number of surgeries/partner hospital and patient demographics. Cleft surgical system strengthening was measured by the complexity of repair, waitlist length, and patient follow-up. From 2001 to 2014, the number of procedures/hospital/year grew from 15 to 109, and frequency of alveolar bone grafts increased from 1% to 3.4%. In addition, 97.9% of partners reported that half to most patients come from rural areas. Waitlists decreased, with 9.2% of partners reporting a waitlist of ≥50 in 2011 versus 2.7% in 2014 (P < 0.001). Patient follow-up also improved: 35% of partners in 2011 estimated a follow-up rate of ≥75%, compared with 51% of partners in 2014 (P < 0.001). The increased number of procedures/hospital/year supports the partnership model's effectiveness in providing CLP care. In addition, data supports cleft surgical system strengthening-more repairs use alveolar bone grafts, waitlists decreased, and follow-up improved. These findings demonstrate that the partnership model may be effective in providing cleft care and increasing cleft surgical capacity.
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Chidambaram JD, Venkatesh Prajna N, Srikanthi P, Lanjewar S, Shah M, Elakkiya S, Lalitha P, Burton MJ. Epidemiology, risk factors, and clinical outcomes in severe microbial keratitis in South India. Ophthalmic Epidemiol 2018; 25:297-305. [PMID: 29580152 PMCID: PMC5985925 DOI: 10.1080/09286586.2018.1454964] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Here, we report risk factors associated with outcome in severe bacterial keratitis (BK), fungal keratitis (FK), and Acanthamoeba keratitis (AK) in India. METHODS Prospective observational cohort study conducted in Aravind Eye Hospital, India. Adults presenting with severe microbial keratitis (MK) were enrolled (size ≥3 mm) and followed to 21 days post-enrolment. Ulcer clinical features were recorded at presentation. Outcomes by final visit were classified as good (completely healed or reduced infiltrate size) or poor (enlarged infiltrate size, perforated, or surgery performed). RESULTS Of 252 participants with severe MK, 191 had FK, 18 had AK, 19 had BK, 4 had mixed BK/FK, and 20 were microbiologically negative. Median age was 50 years (interquartile range [IQR]: 37-60 years), 64% were male, 63% were agriculturalists, and 45% had no formal education. Corneal trauma occurred in 72%, and median symptom duration before presentation was 7 days (IQR: 5-15 days). Clinical features associated with FK were feathery margins (p < 0.001), raised profile (p = 0.039), or dry surface (p = 0.007). Hypopyon was more likely in BK (p = 0.001) and ring infiltrate in AK (p < 0.001). Ulcers with poor outcome (n = 106/214) were more likely to be larger (odds ratio [OR]: 1.63, 95% confidence interval [CI]: 1.30-2.05, p < 0.001), involve the posterior cornea at presentation (OR: 2.31, 95% CI: 1.16-4.59, p = 0.017), involve Aspergillus sp. (OR: 3.23, 95% CI: 1.26-8.25, p = 0.014), or occur in females (OR: 2.04, 95% CI: 1.03-4.04, p = 0.04). Even after treatment, 34% (n = 76/221) had severe visual impairment by the final visit. CONCLUSIONS Severe MK occurred predominantly in agriculturalists post-corneal trauma and often had poor outcomes. Provision of community-based eyecare may allow earlier treatment and improve outcomes.
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Affiliation(s)
- Jaya Devi Chidambaram
- a International Centre for Eye Health & Clinical Research Department , London School of Hygiene and Tropical Medicine , London , UK
| | - Namperumalsamy Venkatesh Prajna
- b Cornea Department , Aravind Eye Hospital , Madurai , Tamil Nadu , India.,c Microbiology Department , Aravind Medical Research Foundation , Madurai , Tamil Nadu , India
| | - Palepu Srikanthi
- b Cornea Department , Aravind Eye Hospital , Madurai , Tamil Nadu , India
| | - Shruti Lanjewar
- b Cornea Department , Aravind Eye Hospital , Madurai , Tamil Nadu , India
| | - Manisha Shah
- b Cornea Department , Aravind Eye Hospital , Madurai , Tamil Nadu , India.,c Microbiology Department , Aravind Medical Research Foundation , Madurai , Tamil Nadu , India
| | - Shanmugam Elakkiya
- b Cornea Department , Aravind Eye Hospital , Madurai , Tamil Nadu , India.,c Microbiology Department , Aravind Medical Research Foundation , Madurai , Tamil Nadu , India
| | - Prajna Lalitha
- b Cornea Department , Aravind Eye Hospital , Madurai , Tamil Nadu , India.,c Microbiology Department , Aravind Medical Research Foundation , Madurai , Tamil Nadu , India
| | - Matthew J Burton
- a International Centre for Eye Health & Clinical Research Department , London School of Hygiene and Tropical Medicine , London , UK.,d Cornea Department , Moorfields Eye Hospital , London , UK
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Abstract
Globally, 32.4 million individuals are blind and 191 million have moderate or severe visual impairment (MSVI); 80% of cases of blindness and MSVI are avoidable. However, great efforts are needed to tackle blindness and MSVI, as eye care in most places is delivered in isolation from and without significant integration with general health sectors. Success stories, including control of vitamin A deficiency, onchocerciasis, and trachoma, showed that global partnerships, multisectoral collaboration, public-private partnerships, corporate philanthropy, support from nongovernmental organizations-both local and international-and governments are responsible for the success of these programs. Hence, the World Health Organization's universal eye health global action plan for 2014-2019 has a goal of reducing the public health problem of blindness and ensuring access to comprehensive eye care; the plan aims to integrate eye health into health systems, thus providing universal eye health coverage (UEHC). This article discusses the challenges faced by low- and middle-income countries in strengthening the six building blocks of the health system. It discusses how the health systems in these countries need to be geared toward tackling the issues of emerging noncommunicable eye diseases, existing infectious diseases, and the common causes of blindness and visual impairment, such as cataract and refractive error. It also discusses how some of the comprehensive eye care models in the developing world have addressed these challenges. Moving ahead, if we are to achieve UEHC, we need to develop robust, sustainable, good-quality, comprehensive eye care programs throughout the world, focusing on the areas of greatest need. We also need to develop public health approaches for more complex problems such as diabetic retinopathy, glaucoma, childhood blindness, corneal blindness, and low vision. There is also a great need to train high-level human resources of all cadres in adequate numbers and quality. In addition to this, we need to exploit the benefits of modern technological innovations in information, communications, biomedical technology, and other domains to enhance quality of, access to, and equity in eye care.
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Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India.,Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Gullapalli N Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India
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Kemmanu V, Giliyar SK, Shetty BK, Singh AK, Kumaramanickavel G, McCarty CA. Parental inability to detect eye diseases in children: barriers to access of childhood eye-care services in south India. Eye (Lond) 2018; 32:467-468. [DOI: 10.1038/eye.2017.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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A Study on the Awareness of Cataract Disease and Treatment Options in Patients who Need Surgery in a Rural Area of Eastern China. Eur J Ophthalmol 2018; 18:544-50. [DOI: 10.1177/112067210801800407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vishnuprasad R, Bazroy J, Madhanraj K, Prashanth HR, Singh Z, Samuel AK, Muthukumar T. Visual impairment among 10-14-year school children in Puducherry: A cross-sectional study. J Family Med Prim Care 2017; 6:58-62. [PMID: 29026750 PMCID: PMC5629901 DOI: 10.4103/2249-4863.214983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: According to the 2010 estimates by the World Health Organization, nearly 285 million (4.24% of total population) people of all ages worldwide are visually impaired. Almost 18.9 million children under 15 years of age are visually impaired globally. In developing countries, 7%–31% of childhood blindness and visual impairment is avoidable. Materials and Methods: The study was conducted as a cross-sectional study among 1884 school students in Puducherry, in the age group of 10–14 years. A child with presenting maximum vision ≤6/12 Snellen equivalent in the better eye is considered visually impaired. Data were entered in Microsoft Excel 2013 and analyzed using the statistical software SPSS version 21.0. Chi-square test was applied for testing difference in proportion and a P < 0.05 was considered statistically significant. Results: The overall prevalence of visual impairment (vision ≤6/12) among the study participants was 6.37% (95% confidence interval = 5.27–7.47). The prevalence of visual impairment increased with age and it was found to be high among male students (6.6%) when compared to female students (6%). Presenting vision of 6/6 was observed in 79.8% of the children while with pinhole correction, the proportion increased to 94.6%. Conclusion: The prevalence of visual impairment in our study population was found to be 6.37% and the prevalence was even higher among children who belonged to schools of urban region or private schools. Children with a positive family history of spectacle use were more likely to have visual impairment.
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Affiliation(s)
| | - Joy Bazroy
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
| | - K Madhanraj
- Department of Community Medicine, ACS Medical College, Chennai, Tamil Nadu, India
| | - Hannah Ranjee Prashanth
- Department of Ophthalmology, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
| | - Zile Singh
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
| | - Abel K Samuel
- Department of Community Medicine, Believers Church Medical College, Thiruvalla, Kerala, India
| | - T Muthukumar
- Department of Community Medicine, Sri Sathya Sai Medical College and Research institution, Kancheepuram, Tamil Nadu, India
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Rani PK, Kasoju R, Komara V, Kothapalli R, Choudary D, Korani J, Williams JD, Schor CM, Wilson N. Envisioning Eye Care From a Rural Perspective: A Photovoice Project From India. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2017; 37:161-171. [PMID: 28994646 DOI: 10.1177/0272684x17736153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background To understand barriers and promoters for accessing eye care by rural communities, we used a modified approach to Photovoice, a community-based participatory action research approach Methods Community members took photographs and wrote or spoke stories based upon a series of questions intended to facilitate deeper thinking. Fifteen rural paramedical team members who were affiliated with the rural network of L V Prasad Eye Institute, and 60 people from four villages reported barriers and promoters for eye care access for 20 villages Results Important barriers for accessing eye care included the following: no caretaker at home for grandchildren except for the grandparent(s), alcoholism, uncontrolled blood pressure, inadequate diabetes management, lack of escort for blind people and elders, affordability, and inadequate clinic staffing during summer season when farming villagers were available. Important promoters for seeking eye care included having a neighbor who had a good surgical outcome in one eye which resulted in the ability to resume work. The Photovoice project offered specific suggestions to hospital management for improving eye care access, including providing evening transportation, providing additional surgical staffing during busy summer season, and the creation of tool spectacle repair kits to be kept at the primary vision centers Conclusions This Photovoice project facilitated a deeper understanding of the important barriers and promoters for accessing eye care by villagers, and by the rural eye care team, offering specific suggestions to hospital management for improving eye care access and to communicate without any inhibiting factors like fear of hierarchy within the hospital administration.
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Affiliation(s)
- Padmaja Kumari Rani
- 1 Srimati Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Rajita Kasoju
- 2 Gullapalli Prathibha Rao International Center for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Venkatiah Komara
- 2 Gullapalli Prathibha Rao International Center for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Raju Kothapalli
- 2 Gullapalli Prathibha Rao International Center for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Devichandar Choudary
- 2 Gullapalli Prathibha Rao International Center for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Jyothi Korani
- 2 Gullapalli Prathibha Rao International Center for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Jachin D Williams
- 2 Gullapalli Prathibha Rao International Center for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Clifton M Schor
- 3 University of California at Berkeley School of Optometry, CA, USA
| | - Nance Wilson
- 4 Social Epidemiologist, Photovoice and Participatory Photography Project Consultant, Oakland, CA, USA
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Vengadesan N, Ahmad M, Sindal MD, Sengupta S. Delayed follow-up in patients with diabetic retinopathy in South India: Social factors and impact on disease progression. Indian J Ophthalmol 2017; 65:376-384. [PMID: 28573993 PMCID: PMC5565887 DOI: 10.4103/ijo.ijo_620_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: To identify social factors associated with delayed follow-up in South Indian patients with diabetic retinopathy (DR) and to study DR progression during the delayed follow-up period. Materials and Methods: In this cross-sectional study, 500 consecutive patients with DR returning after greater than twice the advised follow-up period were identified from a tertiary referral center in South India. A previously validated 19-item questionnaire was administered to study patients to assess causes for the follow-up delay. Patient demographics, DR status, and treatment plan were recorded at the study visit and the visit immediately before the delay. The eye with the most severe disease was included in the analysis. Results: Complete data were available for 491 (98.2%) patients. Among these, 248 (50.5%) cited “my eyes were okay at the time,” 201 (41.0%) cited “no attender to accompany me,” and 190 (38.6%) cited “financial cost” as causes of the follow-up delay. Those with vision-threatening DR (VTDR, n = 233) predominantly reported “financial cost” (47% vs. 32%, P = 0.001), whereas those with non-VTDR more frequently reported “my eyes were okay at the time” (58% vs. 42%, P = 0.001). Evidence of disease progression from non-VTDR to VTDR was seen in 67 (26%) patients. Almost 1/3rd (29%) of patients who were previously advised regular examination required additional intervention. Conclusion: Many patient-level factors affect poor compliance with follow-up in DR, and these factors vary by disease severity. Targeting these barriers to care through patient education and clinic procedures may promote timely follow-up and better outcomes in these patients.
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Affiliation(s)
| | - Meleha Ahmad
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Manavi D Sindal
- Department of VitreoRetina, Aravind Eye Hospital, Puducherry, India
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Abstract
PURPOSE Humanitarianism is by definition a moral of kindness, benevolence and sympathy extended to all human beings. In our view as surgeons working in underserved countries, humanitarianism means performing the best operation in the best possible circumstances with high income country (HIC) results and training in-country surgeons to do the same. Hernia Repair for the Underserved (HRFU), a not for profit organization, is developing a long term public health initiative for hernia surgery in Western Hemisphere countries. We report the progress of HRFUs methods to render humanitarian care. METHODS In a collaborative effort, Creighton University and the Institute for Latin American Concern developed an outpatient surgery site for hernia surgery in Santiago, Dominican Republic. Based on this experience, we developed a sustainable care model by recruiting American and European Hernia Society expert surgeons, staff members they recommended, building relationships with local and industry partners, and selecting local surgeons to be trained in mesh hernioplasty. HRFU then extended the care model to other Western Hemisphere countries. RESULTS Between 2004 and 2015, the HRFU elective hernia morbidity and mortality rates for 2052 hernia operations were 0.7 and 0%, respectively. This is consistent with outcomes from HICs and confirms the feasibility of a public health initiative based on the principles of the Preferential Option for the Poor. CONCLUSIONS HRFU has recorded HIC morbidity and mortality rates for hernia surgery in low and middle income countries and has initiated a new surgical training model for sustainability of effect.
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Gupta N, Vashist P, Tandon R, Gupta SK, Kalaivani M, Dwivedi SN. Use of traditional eye medicine and self-medication in rural India: A population-based study. PLoS One 2017; 12:e0183461. [PMID: 28829812 PMCID: PMC5567472 DOI: 10.1371/journal.pone.0183461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 08/04/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the type and nature of traditional eye medicine (TEM), their sources and use and practices related to self-medication for ophthalmic diseases in a rural Indian population. METHODS A population-based, cross-sectional study was conducted in 25 randomly selected clusters of Rural Gurgaon, Haryana, India as part of CORE (Cornea Opacity Rural Epidemiological) study. In addition to comprehensive ophthalmic examination, health-seeking behavior and use of self-medication and TEM was assessed in the adult population using a semi-structured questionnaire. Physical verification of available ophthalmic medications in the enumerated households was conducted by the study team. Descriptive statistics were computed along with multivariable logistic regression analysis to determine associated factors for use of self-medication and TEM. RESULTS Of the 2160 participants interviewed, 396 (18.2%) reported using ophthalmic medications without consulting an ophthalmologist, mainly for symptoms like watering (37.1%), redness (27.7%), itching (19.2%) and infection (13.6%). On physical verification of available eye drops that were being used without prescription, 26.4% participants were practicing self-medication. Steroid, expired/unlabeled and indigenous eye drops were being used by 151(26.5%), 120(21.1%) and 75 (13.2%) participants respectively. Additionally, 25.7% (529) participants resorted to home remedies like 'kajal'(61.4%), honey (31.4%), ghee (11.7%) and rose water (9.1%). CONCLUSION Use of TEM is prevalent in this population. The rampant use of steroid eye drops without prescription along with use of expired or unlabelled eye drops warrants greater emphasis on safe eye care practices in this population. Public awareness and regulatory legislations must be implemented to decrease harmful effects arising due to such practices.
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Affiliation(s)
- Noopur Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Vashist
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev K. Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - S. N. Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Radhakrishnan M, Venkatesh R, Valaguru V, Frick KD. Economic and social factors that influence households not willing to undergo cataract surgery. Indian J Ophthalmol 2016; 63:594-9. [PMID: 26458477 PMCID: PMC4652250 DOI: 10.4103/0301-4738.167116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Literature investigating barriers to cataract surgery is mostly done from the patient's point of view. However, many medical decisions are jointly taken by household members, especially in developing countries such as India. We investigated from the household head's (or representative's) perspective, households’ view on those not willing to undergo cataract surgery along with the economic and social factors associated with it. Materials and Methods: A cross-sectional survey of four randomly selected village clusters in rural areas of Theni district, Tamil Nadu, India, was conducted to elicit the willingness to pay for cataract surgery by presenting “scenarios” that included having or not having free surgery available. The presentation of scenarios allowed the identification of respondents who were unwilling to undergo surgery. Logistic regression was used to estimate relationships between economic and social factors and unwillingness to undergo cataract surgery. Results: Of the 1271 respondents, 49 (3.85%) were not willing to undergo surgery if they or their family members have cataract even if free surgery were available. In the regression results, those with good understanding of cataract and its treatment were less likely to be unwilling to undergo cataract surgery. Those not reporting household income were more likely to be unwilling to undergo cataract surgery. Conclusions: As a good understanding of cataract was an important predictor of willingness to undergo cataract surgery, health education on cataract and its intervention can improve uptake.
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Affiliation(s)
| | - Rengaraj Venkatesh
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Puducherry, India
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Ravilla TD, Gupta S, Ravindran RD, Vashist P, Krishnan T, Maraini G, Chakravarthy U, Fletcher AE. Use of Cooking Fuels and Cataract in a Population-Based Study: The India Eye Disease Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:1857-1862. [PMID: 27227523 PMCID: PMC5132636 DOI: 10.1289/ehp193] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/15/2015] [Accepted: 04/25/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Biomass cooking fuels are commonly used in Indian households, especially by the poorest socioeconomic groups. Cataract is highly prevalent in India and the major cause of vision loss. The evidence on biomass fuels and cataract is limited. OBJECTIVES To examine the association of biomass cooking fuels with cataract and type of cataract. METHODS We conducted a population-based study in north and south India using randomly sampled clusters to identify people ≥ 60 years old. Participants were interviewed and asked about cooking fuel use, socioeconomic and lifestyle factors and attended hospital for digital lens imaging (graded using the Lens Opacity Classification System III), anthropometry, and blood collection. Years of use of biomass fuels were estimated and transformed to a standardized normal distribution. RESULTS Of the 7,518 people sampled, 94% were interviewed and 83% of these attended the hospital. Sex modified the association between years of biomass fuel use and cataract; the adjusted odds ratio (OR) for a 1-SD increase in years of biomass fuel use and nuclear cataract was 1.04 (95% CI: 0.88, 1.23) for men and 1.28 (95% CI: 1.10, 1.48) for women, p interaction = 0.07. Kerosene use was low (10%). Among women, kerosene use was associated with nuclear (OR = 1.76, 95% CI: 1.04, 2.97) and posterior subcapsular cataract (OR = 1.71, 95% CI: 1.10, 2.64). There was no association among men. CONCLUSIONS Our results provide robust evidence for the association of biomass fuels with cataract for women but not for men. Our finding for kerosene and cataract among women is novel and requires confirmation in other studies. Citation: Ravilla TD, Gupta S, Ravindran RD, Vashist P, Krishnan T, Maraini G, Chakravarthy U, Fletcher AE. 2016. Use of cooking fuels and cataract in a population-based study: the India Eye Disease Study. Environ Health Perspect 124:1857-1862; http://dx.doi.org/10.1289/EHP193.
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Affiliation(s)
- Thulasiraj D. Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Sanjeev Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Praveen Vashist
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Giovanni Maraini
- Dipartimento di Scienze Otorino-Odonto-Oftalmologiche e Cervico Facciali, Universita` degli Studi di Parma, Parma, Italy
| | - Usha Chakravarthy
- Centre for Vision and Vascular Science, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Astrid E. Fletcher
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Ormsby GM, Grant-Skiba D, Naidoo K, Keeffe JE. Patient Perspectives on Acquiring Spectacles: A Cambodian Experience. Asia Pac J Ophthalmol (Phila) 2016; 5:339-43. [PMID: 27213766 DOI: 10.1097/apo.0000000000000176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To assess the perspectives of patients who acquired spectacles from an eye unit/vision center in Cambodia. DESIGN A sample (n = 62) of patients was selected across 4 provinces: Prey Veng, Siem Reap, Battambang, and Takeo. METHODS The Patient Spectacle Satisfaction Survey covering demographic and semistructured questions regarding patient satisfaction, style, and costs incurred was used to collect data. Information was transcribed and translated into English and analyzed by thematic coding using NVivo. RESULTS Although there were more women seeking eye health care treatment, there was no significant age difference. Patient satisfaction levels were high although the patients had to pay for transportation, registration, and the glasses themselves. A total of 60 patients (96.7%) stated they would recommend the refractive service center to others. Despite a high level of awareness of eye disease such as cataract, only 2 in 10 people could accurately identify cataract as a major cause of poor vision or blindness. Most of the people (52%) blamed bad vision or blindness on dust or other foreign objects getting into the eye, old age (31%), or poor hygiene (16%). CONCLUSIONS Most people will pay eye care costs once barriers to seeking treatment have been broken via education and encouragement. Satisfaction of wearing spectacles was associated with improved vision; style, color, and fit of the spectacles; and protection from sunlight and dust. The proximity of and easy access to health facilities influenced patient desire to seek treatment.
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Affiliation(s)
- Gail Melva Ormsby
- From the *Faculty of Education, Science and Business, and Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, NSW, Australia; †Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia; ‡Brien Holden Vision Institute, Durban, South Africa; §African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa; and ¶LV Prasad Eye Institute, Hyderabad, India
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Olusanya BA, Ashaye AO, Owoaje ET, Baiyeroju AM, Ajayi BG. Determinants of Utilization of Eye Care Services in a Rural Adult Population of a Developing Country. Middle East Afr J Ophthalmol 2016; 23:96-103. [PMID: 26957847 PMCID: PMC4759912 DOI: 10.4103/0974-9233.164621] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To describe the factors that determine the utilization of eye care services in a rural community in South-Western Nigeria. Methods: A descriptive cross-sectional survey using a multistage sampling technique was conducted. The main outcome measure was self-reported previous consultation of an orthodox medical facility for eye care. Results: The study sample included 643 participants. Only 122 (19%) respondents had previously visited orthodox facilities in search of eye care and 24% of those with presenting visual acuity <6/18 had sought eye care. Characteristics associated with previous utilization of eye care services were age of =70 years (odds ratio [OR] ≥ 1.7, P = 0.02); male gender (OR = 1.5, P = 0.04); literacy (OR = 1.7, P = 0.007); and residing close to an eye care facility (OR = 2.8, P < 0.001). Blind respondents were three times more likely to seek eye care (P < 0.001). Regression analysis revealed that factors associated with increased likelihood of utilization of eye care services included age ≥70 years; literacy; residence close to an eye facility; being diabetic or hypertensive; history of ocular symptoms, and blindness. Conclusions: These findings suggest that a significant proportion (75%) of adults in the study area are not utilizing eye care services and that blindness is an important determinant of utilization of eye care services. Health education and awareness campaigns about the importance and benefits of seeking eye care early, and the provision of community-based eye care programs are essential to boost the uptake of eye care services in this community as well as other rural areas of West Africa.
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Affiliation(s)
- Bolutife A Olusanya
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adeyinka O Ashaye
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Aderonke M Baiyeroju
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Benedictus G Ajayi
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Mtuya C, Cleland CR, Philippin H, Paulo K, Njau B, Makupa WU, Hall C, Hall A, Courtright P, Mushi D. Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study. BMC Ophthalmol 2016; 16:115. [PMID: 27435362 PMCID: PMC4950081 DOI: 10.1186/s12886-016-0288-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/05/2016] [Indexed: 11/25/2022] Open
Abstract
Background Diabetes is an emerging public health problem in sub-Saharan Africa. Diabetic retinopathy is the commonest microvascular complication of diabetes and is a leading cause of blindness, mainly in adults of working age. Follow-up is crucial to the effective management of diabetic retinopathy, however, follow-up rates are often poor in sub-Saharan Africa. The aim of this study was to assess the proportion of patients not presenting for follow-up and the reasons for poor follow-up of diabetic patients after screening for retinopathy in Kilimanjaro Region of Tanzania. Methods All diabetic patients referred to a tertiary ophthalmology hospital after screening for retinopathy in 2012 were eligible for inclusion in the study. A randomly selected group of patients from the community-based diabetic retinopathy screening register were identified; among this group, follow-up was assessed. Interviews were conducted within this group to inform on the reasons for poor follow-up. Results Among the 203 patients interviewed in the study 50 patients (24.6 %) attended the recommended referral appointment and 153 (75.4 %) did not. Financial reasons were self-reported by 35.3 % of those who did not attend the follow-up appointment as the reason for non-attendance. Multiple logistic regression analysis showed that the patient report of the clarity of the referral process (p = 0.014) and the patient report of whether a healthcare worker told the patient that diabetic retinopathy could be treated (p = 0.005) were independently associated with attendance at a follow-up appointment. Income per month was not associated with attendance at a follow-up appointment on multivariate analysis. Conclusions Financial factors are commonly cited as the reason for non-compliance with follow-up recommendations. However, the reasons for poor compliance are likely to be more complicated. This study highlights the importance of health system factors. Improving the clarity of the referral process and frequent reminders to patients that diabetic retinopathy can be treated are practical strategies that should be incorporated into screening programmes to increase attendance at subsequent follow-up appointments. The results from this study are applicable to other screening programmes as well as those for diabetic retinopathy. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0288-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina Mtuya
- Kilimanjaro Christian Medical University College, Faculty of Nursing, Moshi, Tanzania
| | - Charles R Cleland
- Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
| | - Heiko Philippin
- Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Kidayi Paulo
- Kilimanjaro Christian Medical University College, Faculty of Nursing, Moshi, Tanzania
| | - Bernard Njau
- Kilimanjaro Christian Medical University College, Faculty of Nursing, Moshi, Tanzania
| | - William U Makupa
- Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Claudette Hall
- Department of Work & Social Psychology, University Maastricht, Faculty of Psychology and Neuroscience, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Anthony Hall
- Newcastle Eye Hospital Research Foundation, 182 Christo Road, Waratah, NSW, 2289, Australia
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, Faculty of Nursing, Moshi, Tanzania
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Olatunji VA, Adepoju FG, Owoeye JFA. Perception and Attitude of a Rural Community Regarding Adult Blindness in North Central Nigeria. Middle East Afr J Ophthalmol 2016; 22:508-13. [PMID: 26692726 PMCID: PMC4660541 DOI: 10.4103/0974-9233.167826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To determine the perception and attitudes of a rural community regarding the etiology, prevention, and treatment of blindness in adults. METHODS A cross-sectional, descriptive study was performed in a rural community in Kwara State, Nigeria using semi-structured questionnaire. All adults aged 40 years or older who were residents for a minimum of 6 months in the community were included. Data were collected on patient demographics, knowledge, attitude, perception, and use of the eye care facility. RESULTS A total of 290 participants were interviewed. The male-to-female ratio was 1:2. Consumption of certain types of food was an important cause of blindness as perceived by 57.9% of the respondents, followed by supernatural forces (41.7%) and aging (19%). Sixty percent of respondents thought blindness could be prevented. Age (P = 0.04) and level of education (P =0.003) significantly affected the beliefs on the prevention of blindness. Most respondents (79.3%) preferred orthodox eye care, but only 65% would accept surgical intervention if required. The level of education significantly affected the acceptance of surgery (P = 0.04). Reasons for refusing surgery were, fear (64%), previous poor outcomes in acquaintances (31%), belief that surgery is not required (3%), and cost (2%). About 65% used one form of traditional eye medication or the other. Over half (56.6%) believed that spectacles could cure all causes of blindness. Of those who had ocular complaints, 57.1% used orthodox care without combining with either traditional or spiritual remedies. CONCLUSION This rural Nigerian community had some beliefs that were consistent with modern knowledge. However, the overall knowledge, attitude, and perceptions of this community need to be redirected to favor the eradication of avoidable blindness. Although an eye care facility was available, use by the community was suboptimal. Age and the level of education affected their overall perception and attitudes.
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Affiliation(s)
- Victoria A Olatunji
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin Kwara State, Nigeria
| | - Feyi G Adepoju
- Department of Ophthalmology, University of Ilorin Teaching Hospital and University of Ilorin, Ilorin Kwara State, Nigeria
| | - Joshua F A Owoeye
- Department of Ophthalmology, University of Ilorin Teaching Hospital and University of Ilorin, Ilorin Kwara State, Nigeria
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Johnson DM, Stratford S, Shyu AP, Sembhi H, Molineaux J, Reamer C, Spaeth GL, Myers JS, Hark LA, Katz LJ, Waisbourd M. The impact of educational workshops on individuals at risk for glaucoma in the Philadelphia Glaucoma Detection and Treatment Project. PATIENT EDUCATION AND COUNSELING 2016; 99:659-664. [PMID: 26686991 DOI: 10.1016/j.pec.2015.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/19/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the impact of educational workshops, led by community health educators, on the level of knowledge, perceived risk of glaucoma, and rate of attendance in a subsequent glaucoma detection examination. METHODS Participants attended an educational workshop about glaucoma and completed an 8-question pre- and post-test to assess knowledge. A paired samples t-test assessed mean differences in composite pre- and post-test scores, correct responses for each question, and perceived risk of glaucoma after the workshop. RESULTS Seven hundred and seven (707) pre- and post-test surveys were completed. There was a significant increase in the level of knowledge about glaucoma as reflected in the pre- and post-test composite scores (M=3.86, SD=1.95 vs. M=4.97, SD=1.82, P<0.001). In the 5 largest community sites, 44% (n=221/480) of the participants who attended an educational workshop scheduled a glaucoma detection examination appointment and 76% (n=160/211) of these participants completed this eye examination in the community setting. CONCLUSIONS Educational workshops increased knowledge and awareness about glaucoma and were helpful in recruiting patients for community-based glaucoma detection examinations. PRACTICE IMPLICATIONS We recommend including educational workshops when conducting community-based outreach programs.
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Affiliation(s)
- Deiana M Johnson
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Shayla Stratford
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Andrew P Shyu
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Harjeet Sembhi
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Jeanne Molineaux
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Courtney Reamer
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
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Ryan ME, Rajalakshmi R, Prathiba V, Anjana RM, Ranjani H, Narayan KMV, Olsen TW, Mohan V, Ward LA, Lynn MJ, Hendrick AM. Comparison Among Methods of Retinopathy Assessment (CAMRA) Study: Smartphone, Nonmydriatic, and Mydriatic Photography. Ophthalmology 2015; 122:2038-43. [PMID: 26189190 PMCID: PMC4581972 DOI: 10.1016/j.ophtha.2015.06.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We compared smartphone fundus photography, nonmydriatic fundus photography, and 7-field mydriatic fundus photography for their abilities to detect and grade diabetic retinopathy (DR). DESIGN This was a prospective, comparative study of 3 photography modalities. PARTICIPANTS Diabetic patients (n = 300) were recruited at the ophthalmology clinic of a tertiary diabetes care center in Chennai, India. METHODS Patients underwent photography by all 3 modalities, and photographs were evaluated by 2 retina specialists. MAIN OUTCOME MEASURES The sensitivity and specificity in the detection of DR for both smartphone and nonmydriatic photography were determined by comparison with the standard method, 7-field mydriatic fundus photography. RESULTS The sensitivity and specificity of smartphone fundus photography, compared with 7-field mydriatic fundus photography, for the detection of any DR were 50% (95% confidence interval [CI], 43-56) and 94% (95% CI, 92-97), respectively, and of nonmydriatic fundus photography were 81% (95% CI, 75-86) and 94% (95% CI, 92-96%), respectively. The sensitivity and specificity of smartphone fundus photography for the detection of vision-threatening DR were 59% (95% CI, 46-72) and 100% (95% CI, 99-100), respectively, and of nonmydriatic fundus photography were 54% (95% CI, 40-67) and 99% (95% CI, 98-100), respectively. CONCLUSIONS Smartphone and nonmydriatic fundus photography are each able to detect DR and sight-threatening disease. However, the nonmydriatic camera is more sensitive at detecting DR than the smartphone. At this time, the benefits of the smartphone (connectivity, portability, and reduced cost) are not offset by the lack of sufficient sensitivity for detection of DR in most clinical circumstances.
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Affiliation(s)
- Martha E Ryan
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Harish Ranjani
- Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Timothy W Olsen
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
| | | | - Laura A Ward
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michael J Lynn
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Andrew M Hendrick
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia.
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Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training. World J Surg 2015; 39:10-20. [PMID: 24682278 PMCID: PMC4179995 DOI: 10.1007/s00268-014-2516-0] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective This study was designed to propose a classification scheme for platforms of surgical delivery in low- and middle-income countries (LMICs) and to review the literature documenting their effectiveness, cost-effectiveness, sustainability, and role in training. Approximately 28 % of the global burden of disease is surgical. In LMICs, much of this burden is borne by a rapidly growing international charitable sector, in fragmented platforms ranging from short-term trips to specialized hospitals. Systematic reviews of these platforms, across regions and across disease conditions, have not been performed. Methods A systematic review of MEDLINE and EMBASE databases was performed from 1960 to 2013. Inclusion and exclusion criteria were defined a priori. Bibliographies of retrieved studies were searched by hand. Of the 8,854 publications retrieved, 104 were included. Results Surgery by international charitable organizations is delivered under two, specialized hospitals and temporary platforms. Among the latter, short-term surgical missions were the most common and appeared beneficial when no other option was available. Compared to other platforms, however, worse results and a lack of cost-effectiveness curtailed their role. Self-contained temporary platforms that did not rely on local infrastructure showed promise, based on very few studies. Specialized hospitals provided effective treatment and appeared sustainable; cost-effectiveness evidence was limited. Conclusions Because the charitable sector delivers surgery in vastly divergent ways, systematic review of these platforms has been difficult. This paper provides a framework from which to study these platforms for surgery in LMICs. Given the available evidence, self-contained temporary platforms and specialized surgical centers appear to provide more effective and cost-effective care than short-term surgical mission trips, except when no other delivery platform exists.
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The Barrie Jones Lecture-Eye care for the neglected population: challenges and solutions. Eye (Lond) 2015; 29:30-45. [PMID: 25567375 DOI: 10.1038/eye.2014.239] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/02/2014] [Indexed: 11/09/2022] Open
Abstract
Globally, pockets of 'neglected populations' do not have access to basic health-care services and carry a much greater risk of blindness and visual impairment. While large-scale public health approaches to control blindness due to vitamin A deficiency, onchocerciasis, and trachoma are successful, other causes of blindness still take a heavy toll in the population. High-quality comprehensive eye care that is equitable is the approach that needs wide-scale application to alleviate this inequity. L V Prasad Eye Institute of India developed a multi-tier pyramidal model of eye care delivery that encompasses all levels from primary to advanced tertiary (quaternary). This has demonstrated the feasibility of 'Universal Eye Health Coverage' covering promotive, preventive, corrective, and rehabilitative aspects of eye care. Using human resources with competency-based training, effective and cost-effective care could be provided to many disadvantaged people.
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Chande PK, Korani H, Shamanna BR. A novel strategy for management of uncorrected refractive errors in urban slums. Oman J Ophthalmol 2015; 8:107-10. [PMID: 26622138 PMCID: PMC4640034 DOI: 10.4103/0974-620x.159258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Blindness and Vision impairment remains a major public health issue not only in rural but also in urban areas. Concept of using peripheral health centers to render primary health care services to the community was a WHO proposed model. However, establishing them in urban slums is a challenge as most of the slums are illegal establishments. So, aim was to establish vision centers for providing primary eye care services in the urban slums of Mumbai, West India. METHODS Vision centers were established in various slum pockets of Mumbai from the year 2008 till 2009. Refraction and screening for ocular morbidity were carried out for those who attended this center and management for uncorrected refractive errors was done. RESULTS Data from 6 such vision centers located in various slum pockets of Mumbai city from April 9 to March 2011 were collected and analyzed. Of the 19,550 adults, 2270 (11.61%) had moderate vision impairment with presenting visual acuity of <0.5 LogMAR in both eyes. Severe Visual impairment was seen in (723) 3.70%. Blindness was seen in (357) 1.82%. Of the 2993, which were moderately and severely visually impaired, 1893 subjects that is, 63.24% of them improved to 0.2 LogMAR or better with spectacle correction. CONCLUSIONS About 63.24% of visual impairment was due to uncorrected refractive errors, these included both moderately and severely vision impaired. Totally, 357 (1.82%) were also identified as blind. This model of vision centers has a role in the identification and management of sight-threatening problems.
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Affiliation(s)
- Prema K. Chande
- Department of Optometry, Lotus College of Optometry, Mumbai, Maharashtra, India
| | - Hiral Korani
- Department of Optometry, Lotus College of Optometry, Mumbai, Maharashtra, India
| | - B. R. Shamanna
- Department of Research, Prashasa Health Consultants Private Limited, Hyderabad, Andhra Pradesh, India
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Durr NJ, Dave SR, Lage E, Marcos S, Thorn F, Lim D. From Unseen to Seen: Tackling the Global Burden of Uncorrected Refractive Errors. Annu Rev Biomed Eng 2014; 16:131-53. [DOI: 10.1146/annurev-bioeng-071813-105216] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicholas J. Durr
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
| | - Shivang R. Dave
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
| | - Eduardo Lage
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
| | - Susana Marcos
- Instituto de Óptica “Daza de Valdés,” Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
| | - Frank Thorn
- New England College of Optometry, Boston, Massachusetts 02115
| | - Daryl Lim
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
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