1
|
Kyei S, Asare FA, Assan JK, Zaabaar E, Assiamah F, Obeng EO, Asiedu K. Efficacy of intravitreal bevacizumab on diabetic macular oedema in an African population. Ir J Med Sci 2023; 192:2777-2783. [PMID: 36988835 DOI: 10.1007/s11845-023-03348-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE To evaluate the short-term effect of intravitreal bevacizumab (avastin) injection on visual outcomes of patients with diabetic macular oedema. METHODS A retrospective cross-sectional study was conducted to evaluate 39 eyes of thirty-nine patients (mean age ± SD: 61.4 ± 15.0 years) that received intravitreal bevacizumab injection (1.25 mg in 0.05 ml) as treatment for diabetic macular oedema between January 2014 and July 2019 in Ghana. Data on visual acuity and central macular thickness before treatment and 6 weeks post-treatment were collected and analysed using paired t-test. Ordinary least squares linear regression analysis was also conducted to determine the relationship between improvement in visual acuity and central macular thickness after treatment and other predictor variables. RESULTS The mean ± SD visual acuity (LogMAR-equivalent of Snellen) of patients with diabetic macular oedema significantly improved from 0.84 ± 0.58 LogMAR before treatment to 0.69 ± 0.58 LogMAR at 6 weeks post-treatment (mean difference: 0.15 ± 0.32 LogMAR; 95% CI: 0.04 to 0.25; p = 0.01). Mean macular thickness ± SD on the other hand, reduced significantly (p < 0.001) from 316.54 ± 75.35 μm before treatment to 275.54 ± 57.43 μm after treatment. While age and worse pre-treatment visual acuity predicted improvement in visual acuity after treatment, a higher central macular thickness before treatment predicted an improvement in central macular thickness after intravitreal bevacizumab injection. CONCLUSION Treatment with intravitreal bevacizumab injection produces short-term improvement in vision and reduction in central macular thickness in African patients with diabetic macular oedema.
Collapse
Affiliation(s)
- Samuel Kyei
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Frederick Afum Asare
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - John Kwesi Assan
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Zaabaar
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Frank Assiamah
- Cell Biology and Human Anatomy Department, University of California, Davis, USA
| | - Eric Obour Obeng
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Kofi Asiedu
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Fatehi F, Jahedi F, Tay-Kearney ML, Kanagasingam Y. Teleophthalmology for the elderly population: A review of the literature. Int J Med Inform 2020; 136:104089. [DOI: 10.1016/j.ijmedinf.2020.104089] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 12/13/2019] [Accepted: 01/27/2020] [Indexed: 11/30/2022]
|
3
|
Bilong Y, Katte JC, Koki G, Kagmeni G, Obama OPN, Fofe HRN, Mvilongo C, Nkengfack O, Bimbai AM, Sobngwi E, Mbacham W, Mbanya JC, Bella LA, Sharma A. Validation of Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening. Ophthalmic Surg Lasers Imaging Retina 2019; 50:S18-S22. [DOI: 10.3928/23258160-20190108-05] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/05/2019] [Indexed: 01/08/2023]
|
4
|
Okwen M, Signe J, Macpella SM, Mbibeh L, Cockburn L. Professional collaboration for vision and healthcare in Cameroon. AFRICAN VISION AND EYE HEALTH 2018. [DOI: 10.4102/aveh.v77i1.434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
5
|
Caffery LJ, Taylor M, Gole G, Smith AC. Models of care in tele-ophthalmology: A scoping review. J Telemed Telecare 2017; 25:106-122. [DOI: 10.1177/1357633x17742182] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The objective of this review was to identify and describe telehealth models of care for ophthalmic services. We conducted a scoping review of the literature to identify how ophthalmic care can be delivered by telehealth. We searched the PubMed database to identify relevant articles which were screened based on pre-defined inclusion criteria. For included articles, data were extracted, categorised and analysed. Synthesis of findings was performed narratively. The scoping review included 78 articles describing 62 discrete tele-ophthalmic models of care. Tele-ophthalmic models of care can be used for consultative service, screening, triage and remote supervision. The majority of services were for general eye care and triage ( n = 17; 26%) or emergency services ( n = 8; 12%). The most common conditions for disease-specific models of care were diabetic retinopathy ( n = 14; 21%), and glaucoma ( n = 8; 12%). Most models of care involved local clinicians capturing images and transmitting them to an ophthalmologist for assessment. This scoping review demonstrated tele-ophthalmology to be feasible for consultation, screening, triage and remote supervision applications across a broad range of ophthalmic conditions. A large number of models of care have been identified and described in this review. Considerable collaboration between patient-end clinicians and substantial infrastructure is typically required for tele-ophthalmology.
Collapse
Affiliation(s)
- Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
| | - Monica Taylor
- Centre for Online Health, The University of Queensland, Australia
| | - Glen Gole
- Children’s Health Queensland, Queensland Children’s Hospital, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
| |
Collapse
|
6
|
Adeloye D, Adigun T, Misra S, Omoregbe N. Assessing the Coverage of E-Health Services in Sub-Saharan Africa. A Systematic Review and Analysis. Methods Inf Med 2017; 56:189-199. [PMID: 28244548 DOI: 10.3414/me16-05-0012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/07/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND E-Health has attracted growing interests globally. The relative lack of facilities, skills, funds and information on existing e-Health initiatives has affected progress on e-Health in Africa. OBJECTIVES To review publicly available literature on e-Health in sub-Saharan Africa (sSA) towards providing information on existing and ongoing e-Health initiatives in the region. METHODS Searches of relevant literature were conducted on Medline, EMBASE and Global Health, with search dates set from 1990 to 2016. We included studies on e-Health initiatives (prototypes, designs, or completed projects) targeting population groups in sSA. RESULTS Our search returned 2322 hits, with 26 studies retained. Included studies were conducted in 14 countries across the four sub-regions in sSA (Central, East, South and West) and spreading over a 12-year period, 2002-2014. Six types of e-Health interventions were reported, with 17 studies (65 %) based on telemedicine, followed by mHealth with 5 studies (19 %). Other e-Health types include expert system, electronic medical records, e-mails, and online health module. Specific medical specialties covered include dermatology (19 %), pathology (12 %) and radiology (8 %). Successes were 'widely reported' (representing 50 % overall acceptance or positive feedbacks in a study) in 10 studies (38 %). The prominent challenges reported were technical problems, poor internet and connectivity, participants' selection biases, contextual issues, and lack of funds. CONCLUSION E-Health is evolving in sSA, but with poorly published evidence. While we call for more quality research in the region, it is also important that population-wide policies and on-going e-Health initiatives are contextually feasible, acceptable, and sustainable.
Collapse
Affiliation(s)
- Davies Adeloye
- Dr. Davies Adeloye, Demography and Social Statistics, and the e-Health Research Cluster, Covenant University, Ota, Nigeria, E-mail:
| | | | | | | |
Collapse
|
7
|
Pareja-Ríos A, Bonaque-González S, Serrano-García M, Cabrera-López F, Abreu-Reyes P, Marrero-Saavedra MD. Tele-ophthalmology for diabetic retinopathy screening: 8 years of experience. ACTA ACUST UNITED AC 2016; 92:63-70. [PMID: 27756515 DOI: 10.1016/j.oftal.2016.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/10/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the results of a diabetic retinopathy screening program implemented in a primary care area. METHODS A retrospective study was conducted using data automatically collected since the program began on 1 January 2007 until 31 December 2015. RESULTS The number of screened diabetic patients has progressively increased, from 7,173 patients in 2007 to 42,339 diabetic patients in 2015. Furthermore, the ability of family doctors to correctly interpret retinographies has improved, with the proportion of retinal images classified as normal having increased from 55% in 2007 to 68% at the end of the study period. The proportion of non-evaluable retinographies decreased to 7% in 2015, having peaked at 15% during the program. This was partly due to a change in the screening program policy that allowed the use of tropicamide. The number of severe cases detected has declined, from 14% with severe non-proliferative and proliferativediabetic retinopathy in the initial phase of the program to 3% in 2015. CONCLUSIONS Diabetic eye disease screening by tele-ophthalmology has shown to be a valuable method in a growing population of diabetics. It leads to a regular medical examination of patients, helps ease the workload of specialised care services and favours the early detection of treatable cases. However, the results of implementing a program of this type are not immediate, achieving only modest results in the early years of the project that have improved over subsequent years.
Collapse
Affiliation(s)
- A Pareja-Ríos
- Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - S Bonaque-González
- Departamento de Física, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, España; Grupo de Ciencias de la Visión, Universidad de Murcia., Murcia, España
| | - M Serrano-García
- Hospital Universitario de Canarias, La Laguna, Tenerife, España.
| | - F Cabrera-López
- Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España
| | - P Abreu-Reyes
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - M D Marrero-Saavedra
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| |
Collapse
|
8
|
Park DW, Mansberger SL. Eye Disease in Patients with Diabetes Screened with Telemedicine. Telemed J E Health 2016; 23:113-118. [PMID: 27328169 DOI: 10.1089/tmj.2016.0034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Telemedicine with nonmydriatic cameras can detect not only diabetic retinopathy but also other eye disease. OBJECTIVE To determine the prevalence of eye diseases detected by telemedicine in a population with a high prevalence of minority and American Indian/Alaskan Native (AI/AN) ethnicities. SUBJECTS AND METHODS We recruited diabetic patients 18 years and older and used telemedicine with nonmydriatic cameras to detect eye disease. Two trained readers graded the images for diabetic retinopathy, age-related macular degeneration (ARMD), glaucomatous features, macular edema, and other eye disease using a standard protocol. We included both eyes for analysis and excluded images that were too poor to grade. RESULTS We included 820 eyes from 424 patients with 72.3% nonwhite ethnicity and 50.3% AI/AN heritage. While 283/424 (66.7%) patients had normal eye images, 120/424 (28.3%) had one disease identified; 15/424 (3.5%) had two diseases; and 6/424 (1.4%) had three diseases in one or both eyes. After diabetic retinopathy (104/424, 24.5%), the most common eye diseases were glaucomatous features (44/424, 10.4%) and dry ARMD (24/424, 5.7%). Seventeen percent (72/424, 17.0%) showed eye disease other than diabetic retinopathy. CONCLUSIONS Telemedicine with nonmydriatic cameras detected diabetic retinopathy, as well as other visually significant eye disease. This suggests that a diabetic retinopathy screening program needs to detect and report other eye disease, including glaucoma and macular disease.
Collapse
Affiliation(s)
- Dong-Wouk Park
- 1 Legacy Devers Eye Institute , Legacy Health, Portland, Oregon.,2 Casey Eye Institute, Oregon Health and Science University , Portland, Oregon
| | - Steven L Mansberger
- 1 Legacy Devers Eye Institute , Legacy Health, Portland, Oregon.,2 Casey Eye Institute, Oregon Health and Science University , Portland, Oregon.,3 Department of Public Health and Preventive Medicine, Oregon Health and Science University , Portland, Oregon
| |
Collapse
|
9
|
Brinkel J, Krämer A, Krumkamp R, May J, Fobil J. Mobile phone-based mHealth approaches for public health surveillance in sub-Saharan Africa: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11559-82. [PMID: 25396767 PMCID: PMC4245630 DOI: 10.3390/ijerph111111559] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/24/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022]
Abstract
Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. We conducted electronic search in MEDLINE, EMBASE, IEE Xplore, African Index Medicus (AIM), BioMed Central, PubMed Central (PMC), the Public Library of Science (PLoS) and IRIS for publications used in the review. In all, a total of nine studies were included which focused on infectious disease surveillance of malaria (n = 3), tuberculosis (n = 1) and influenza-like illnesses (n = 1) as well as on non-infectious disease surveillance of child malnutrition (n = 2), maternal health (n = 1) and routine surveillance of various diseases and symptoms (n = 1). Our review revealed that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented. We conclude by advocating for a strong drive for more research in the applied field as well as a better reporting of lessons learned in order to create an epistemic community to help build a more evidence-based field of practice in mHealth surveillance in the region.
Collapse
Affiliation(s)
- Johanna Brinkel
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100131, D-33501 Bielefeld, Germany.
| | - Alexander Krämer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100131, D-33501 Bielefeld, Germany.
| | - Ralf Krumkamp
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht-Str. 74, D-20359 Hamburg, Germany.
| | - Jürgen May
- Infectious Disease Epidemiology Unit, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht-Str. 74, D-20359 Hamburg, Germany.
| | - Julius Fobil
- Department of Biological, Environmental, Occupational Health Sciences, School of Public Health, University of Ghana, P.O. Box LG13, Legon, Ghana.
| |
Collapse
|
10
|
Pérez GM, Swart W, Munyenyembe JK, Saranchuk P. Barriers to pilot mobile teleophthalmology in a rural hospital in Southern Malawi. Pan Afr Med J 2014; 19:136. [PMID: 25767656 PMCID: PMC4345219 DOI: 10.11604/pamj.2014.19.136.5196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/26/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Malawi has one of the highest HIV prevalences in Sub-Saharan Africa. The rate of eligible HIV-infected people being initiated on antiretroviral therapy (ART) and retained in HIV-care is currently far from adequate. Consequently, many people continue present with advanced immunosuppression at public health facilities, often with undiagnosed opportunistic infections (OIs). METHODS In this context, mHealth was the innovation chosen to assist Eye Clinical Officers in early diagnosis of HIV-related diseases having eye manifestations in a rural hospital in Thyolo, Southern Malawi. RESULTS The mTeleophthalmology program began in October 2013, but was stopped prematurely due to organizational and technological barriers that compromised its feasibility. CONCLUSION Sharing these barriers might be useful to inform the design of similar innovations in other resource-limited settings with a high HIV prevalence and a dearth of eye specialists with capacity to diagnose HIV-related retinopathies.
Collapse
Affiliation(s)
| | - Wayne Swart
- Department of Mechanics and Mechatronics, University of Stellenbosch, South Africa
| | | | - Peter Saranchuk
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, Southern Africa
| |
Collapse
|
11
|
|
12
|
Hautala N, Aikkila R, Korpelainen J, Keskitalo A, Kurikka A, Falck A, Bloigu R, Alanko H. Marked reductions in visual impairment due to diabetic retinopathy achieved by efficient screening and timely treatment. Acta Ophthalmol 2014; 92:582-7. [PMID: 24131738 DOI: 10.1111/aos.12278] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Diabetic retinopathy (DR) is the most common complication of diabetes and needs to be diagnosed early to prevent severe sight-threatening retinopathy. Digital photography with telemedicine connections is a novel way to deliver cost-effective, accessible screening to remote areas. Screening for DR in a mobile eye examination unit (EyeMo) is compared to traditional service models (i.e. local municipal services or a commercial service provider). The quality of images, delays from screening to treatment, the stage of DR, coverage of screening and the rate of visual impairment due to DR are evaluated. METHODS EyeMo utilizes telemedicine technology. The electronic databases of the hospital and information from the Finnish Register of Visual Impairment were used to determine delays and the rate of visual impairment. RESULTS Fourteen thousand eight hundred and sixty-six fundus photographs were taken in EyeMo in 2007-2011. Coverage reached 78% of potential clients. No DR was detected in 43%, mild background retinopathy in 23%, moderate or severe background retinopathy in 31% and proliferative retinopathy in 3% of the evaluations. The quality of images was higher (p < 0.01) and delays shorter (p < 0.01) in EyeMo as compared to traditional service models. The rate of visual impairment due to DR decreased by 86% in the area covered by EyeMo, and the change compared favourably to the situation in the entire Finland (p < 0.0005). CONCLUSION EyeMo is a feasible model of telemedicine application for screening of DR. Effective screening and timely access to care may indeed have influenced the reduced rate of visual damage.
Collapse
Affiliation(s)
- Nina Hautala
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | | | | | - Antti Keskitalo
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Anne Kurikka
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Aura Falck
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Risto Bloigu
- Medical Informatics Group; University of Oulu; Oulu Finland
| | - Hannu Alanko
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| |
Collapse
|
13
|
Kurji K, Kiage D, Rudnisky CJ, Damji KF. Improving diabetic retinopathy screening in Africa: patient satisfaction with teleophthalmology versus ophthalmologist-based screening. Middle East Afr J Ophthalmol 2014; 20:56-60. [PMID: 23580853 PMCID: PMC3617530 DOI: 10.4103/0974-9233.106388] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose: To assess patient preference for diabetic retinopathy (DR) screening with teleophthalmology or face-to-face ophthalmologist evaluation in Nairobi, Kenya. Materials and Methods: Fifty seven diabetic patients from a one-stop multidisciplinary diabetic clinic (consisting of a diabetologist, nurse educator, foot specialist, nutritionist, ophthalmologist, and neurologist) in Nairobi, Kenya were included if they had undergone both a teleophthalmology (stereoscopic digital retinal photographs graded by an ophthalmologist remotely) and a traditional clinical screening exam (face to face examination). A structured questionnaire with a 5-point Likert scale was developed in both English and Swahili. The questionnaire was administered over the telephone. Ten questions were used to compare patient experience and preferences between teleophthalmology and a traditional clinical examination for DR. A mean score >3.25 on the Likert scale was considered favourable. Results: Successfully telephone contact was possible for 26 (58% male, 42% females) of the 57 patients. The mean ages of the male and female patients were 52.4 and 46.5 years respectively. Patients were satisfied with their teleophthalmology examination (mean 4.15 ± 0.97). Patients preferred the teleophthalmology option for future screenings (mean 3.42 ± 1.52). This preference was driven primarily by convenience, reduced examination time, and being able to visualize their own retina. Conclusion: In this study, diabetic patients preferred a teleophthalmology based screening over a traditional ophthalmologist-based screening. The use of teleophthalmology in Africa warrants further study and has the potential to become the screening model of choice. Cost effectiveness in comparison to an ophthalmologist-based screening also requires evaluation.
Collapse
Affiliation(s)
- Khaliq Kurji
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | | |
Collapse
|
14
|
Kingue S, Angandji P, Menanga AP, Ashuntantang G, Sobngwi E, Dossou-Yovo RA, Kaze FF, Kengne AP, Dzudie A, Ndobo P, Muna W. Efficiency of an intervention package for arterial hypertension comprising telemanagement in a Cameroonian rural setting: The TELEMED-CAM study. Pan Afr Med J 2013; 15:153. [PMID: 24396559 PMCID: PMC3880813 DOI: 10.11604/pamj.2013.15.153.2655] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/16/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction Sub-Saharan Africa has a disproportionate burden of disease and an extreme shortage of health workforce. Therefore, adequate care for emerging chronic diseases can be very challenging. We implemented and evaluated the effectiveness of an intervention package comprising telecare as a mean for improving the outcomes of care for hypertension in Rural Sub-Saharan Africa. Methods The study involved a telemedicine center based at the Yaounde General Hospital (5 cardiologists) in the Capital city of Cameroon, and 30 remote rural health centers within the vicinity of Yaoundé (20 centers (103 patients) in the usual care group, and 10 centers (165 patients) in the intervention groups). The total duration of the intervention was 24 weeks. Results Participants in the intervention group had higher baseline systolic (SBP) and diastolic (DBP) blood pressure, and included fewer individuals with diabetes than those in the usual care group (all p < 0.01). Otherwise, the baseline profile was mostly similar between the two groups. During follow-up, more participants in the intervention groups achieved optimal BP control, driven primarily by greater improvement of BP control among High risk participants (hypertension stage III) in the intervention group. Conclusion An intervention package comprising tele-support to general practitioners and nurses is effective in improving the management and outcome of care for hypertension in rural underserved populations. This can potentially help in addressing the shortage of trained health workforce for chronic disease management in some settings. However context-specific approaches and cost-effectiveness data are needed to improve the application of telemedicine for chronic disease management in resource-limited settings.
Collapse
Affiliation(s)
- Samuel Kingue
- Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon
| | - Prisca Angandji
- Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon
| | | | | | - Eugene Sobngwi
- Diabetes and Endocrine service, Yaounde Central Hospital, Yaounde, Cameroon
| | | | | | - André Pascal Kengne
- NCRP for Cardiovascular and Metabolic Disease, South African Medical Research Council & University of Cape Town, Cape Town, South Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Anastase Dzudie
- Service of Internal Medicine, General Hospital of Douala, Douala, & Buea faculty of Health Sciences, Buea, Cameroon, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Pierre Ndobo
- Diabetes and Endocrine service, Yaounde Central Hospital, Yaounde, Cameroon
| | - Walinjom Muna
- Service of Medicine A, General Hospital of Yaounde, Yaounde, Cameroon
| |
Collapse
|
15
|
Ruta LM, Magliano DJ, Lemesurier R, Taylor HR, Zimmet PZ, Shaw JE. Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries. Diabet Med 2013; 30:387-98. [PMID: 23331210 DOI: 10.1111/dme.12119] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND As the global prevalence of diabetes increases, so will the numbers of people with diabetic retinopathy. Our review aimed to provide a comprehensive picture of available studies of diabetic retinopathy and how prevalence varies around the developed and developing world. METHODS A detailed literature search using PubMed was undertaken. The following search term was used: 'diabetic retinopathy AND prevalence'. The titles and abstracts of all publications identified by the search were reviewed and 492 studies were retrieved. Inclusion and exclusion criteria were applied. RESULTS A total of 72 articles from 33 countries were included. There were only 26 population-based studies using fundus photography (12 in developing countries), of which only 16 (eight in developing countries) were published since 2000. Prevalence estimates varied from as low as 10% to as high as 61% in persons with known diabetes and from 1.5 to 31% in newly diagnosed diabetes. Across all the studies, the median (interquartile range) prevalence of any diabetic retinopathy in known diabetes was 27.9% (22-37%) and 10.5% (6-16%) in newly diagnosed diabetes. Prevalence of diabetic retinopathy was higher in developing countries. CONCLUSION Significant gaps exist in that reliable population-based data from developing nations and indigenous populations in particular are lacking. Major differences in study characteristics and methodologies make comparisons very difficult. More research is required and study methodologies must be better standardized. This will provide important information for prevention and treatment strategies.
Collapse
Affiliation(s)
- L M Ruta
- Baker IDI Heart and Diabetes Institute, The University of Melbourne, Melbourne, Vic., Australia
| | | | | | | | | | | |
Collapse
|