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Muma S, Naidoo KS, Hansraj R. Situation analysis on the integration of refractive error services provided by optometrists into the national health services in Kenya. BMC Public Health 2024; 24:1442. [PMID: 38811959 PMCID: PMC11138047 DOI: 10.1186/s12889-024-18960-6] [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: 02/01/2024] [Accepted: 05/27/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Even though the burden of uncorrected refractive error could potentially be addressed through innovative and cost-effective approaches, integration of the services into the National Health Services (NHS) is desirable. However, minimal information exists on the current situation warranting the need for evidence about the integration of refractive error service provided by optometrists into the national health services in Kenya. METHODS A situation analysis of the Kenyan refractive error services provided by optometrists within the NHS was undertaken based on access to service delivery, service coverage, and human resource. A strengths, weaknesses, opportunities, and threats analysis was undertaken based on the existent evidence to identify the core factors that could potentially facilitate or hinder the integration of refractive error services provided by optometrists within the National Health Services. The proportion of optometrists to be integrated in the NHS was estimated based on the minimum ratios recommended by the World Health Organization. RESULTS A section of tertiary and secondary healthcare facilities in Kenya have specific services to address refractive errors within the NHS with most facilities lacking such services. Treatment of refractive error occurs at the level of eye care general services. There are 11,547 health facilities offering primary care services in Kenya. However, none of them offers refractive error services and only a section of facilities offering county health referral services provides eye care services which is limited to refraction without provision of spectacles. The existing workforce comprises of ophthalmologists, optometrists and ophthalmic clinical officers, together with nurses and other general paramedical assistants. Optometrists, ophthalmologists and ophthalmic clinical officers are allowed to undertake refraction. However, optometrists majorly practices in the private sector. Centralization of eye care services in urban areas, weak referral systems, and a shortage in the workforce per population was observed. CONCLUSIONS The Kenyan NHS should advocate for primary care and reorient the current hospital-based delivery approach for refractive error services. This is attributed to the fact that provision of refractive error services at primary care remains effective and efficient and could translate to early detection of other ocular conditions. The existing human resources in the eye health ecosystem in Kenya should maximize their efforts towards addressing uncorrected refractive error and optometrists should be integrated into the NHS.
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Affiliation(s)
- Shadrack Muma
- College of Health Sciences, Department of Optometry, University of KwaZulu-Natal, Durban, South Africa.
- , PO Box 811, Kisumu, Kenya.
| | - Kovin Shunmugam Naidoo
- College of Health Sciences, Department of Optometry, University of KwaZulu-Natal, Durban, South Africa
- ONESIGHT EssilorLuxottica Foundation, Paris, France
| | - Rekha Hansraj
- College of Health Sciences, Department of Optometry, University of KwaZulu-Natal, Durban, South Africa
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Sengo DB, Marraca NA, Muaprato AM, Moragues R, López-Izquierdo I, Caballero P. Visual impairment and associated factors in adults from three suburban communities in Nampula, Mozambique. Clin Exp Optom 2024:1-6. [PMID: 38763525 DOI: 10.1080/08164622.2024.2352501] [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: 10/26/2022] [Accepted: 05/02/2024] [Indexed: 05/21/2024] Open
Abstract
CLINICAL RELEVANCE Scientific evidence on the burden of visual impairment, its causes, and associated factors are essential to monitor progress in eye health, identify priorities and develop strategies and policies that meet the needs of the population, towards the eradication of preventable blindness. BACKGROUND The aim of this study was to determine the prevalence of visual impairment, its causes and associated factors in adults living in suburban communities in Nampula. METHODS This is a cross-sectional study conducted from November 2019 to February 2020. Eye examinations were performed on adults aged ≥18 years covered by the Lúrio University program, 'one student, one family'. The odds ratio (OR) and adjusted odds ratio (aOR) were calculated to study the association between the dependent variable (presenting visual impairment) and independent variables (gender, age, school level, residence, family income and systemic diseases), with a 95% confidence interval. RESULTS Distance and near presenting visual impairment had a prevalence of 16.3% and 21.1%, respectively, and were statistically associated with the age groups between 45-65 (OR:4.9) and >65 years (OR: 29.1), illiterate (OR:13.8), primary (OR:4.8) and secondary (aOR:37.5) school level, farmer (OR:32.8) and retired (OR:14.3) occupation, and presence of systemic diseases (OR :3.3). The main causes of presenting visual impairment were uncorrected refractive error and cataract. CONCLUSION The prevalence of presenting visual impairment is relatively high, given the enormous effort undertaken within the framework of VISION 2020: The Right to Sight global initiative. There is a need to develop intervention plans targeted at the highest risk groups, with a view to achieving the 'one student, one family' program goals with respect to eye health.
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Affiliation(s)
- Dulnério B Sengo
- Faculdade Ciências de Saúde, Bairro de Marrere, Universidade Lúrio, Nampula, Mozambique
- Department of Community Nursing Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Neves A Marraca
- Faculdade Ciências de Saúde, Bairro de Marrere, Universidade Lúrio, Nampula, Mozambique
| | - Alcino M Muaprato
- Faculdade Ciências de Saúde, Bairro de Marrere, Universidade Lúrio, Nampula, Mozambique
| | - Raúl Moragues
- Departamento Estadística, Matemáticas e Informática, Universitas Miguel Hernandez, Elx, Spain
| | | | - Pablo Caballero
- Department of Community Nursing Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
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Muma S, Naidoo KS, Hansraj R. SWOT analysis of the models used by social enterprises in scaling effective refractive error coverage to achieve the 2030 in SIGHT in Kenya. Sci Rep 2024; 14:3750. [PMID: 38355981 PMCID: PMC10866913 DOI: 10.1038/s41598-024-54493-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: 10/24/2023] [Accepted: 02/13/2024] [Indexed: 02/16/2024] Open
Abstract
Uncorrected refractive error has predominantly been delivered through commercial entrepreneurship in Kenya. However, to achieve the 2030 IN SIGHT, integration of other forms of entrepreneurship such as the social entrepreneurship is desirable to supplement the efforts of the dominant commercial entrepreneurship. Therefore, this study intended to undertake a SWOT analysis of the current models used by social enterprises in scaling effective refractive error coverage to achieve the 2030 IN SIGHT in Kenya. A review of the seven national strategic plans for eye health in Kenya was undertaken to get a glimpse on the efforts directed towards uncorrected refractive error in achieving the 2030 IN SIGHT. The review was inclined towards assessing the efforts directed by the strategic plans towards scaling human resource, spectacle provision and refraction points. A SWOT analysis was undertaken based on the financial, impact and the approach report for each model. A key informant interview was conducted with a representative and three to five members of the social enterprise about the model. Thereafter, the modified SWOT analysis based on the review and the interview was presented to the representatives of the social enterprises. Purposive sampling was used to identify seven models used by social enterprises in the delivery of refractive error services in Kenya. Finally, the recommendations were presented to key opinion leaders for an input through a Delphi technique. Out of the seven national strategic plans for eye health reviewed, only the strategic plan 2020-2025 intends to establish optical units within 15 different counties in Kenya. Of the seven models currently utilized by social enterprises, only the Kenya Society for the Blind has integrated the telemedicine concept. On application of mHealth, all of the social enterprises models tend to embrace the approach for screening activities. None of the models has a strengthened referral pathway utilizing telereferral and telemedicine. Out of all the models, only Operation Eyesight Universal, Fred Hollow Foundation and Peek Acuity do not depend on sales of subsidized spectacles for sustainability. Every model has the capacity to propel the delivery of refractive error services depending on its comprehensiveness. However, for the 2030 IN SIGHT to be achieved, models prioritizing human resource through telemedicine integration, service provision across all sectors, awareness creation and enhancing cost efficiency are desirable.
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Affiliation(s)
- Shadrack Muma
- Department of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Kovin Shunmugam Naidoo
- Department of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- OneSight EssilorLuxottica Foundation, Paris, France
| | - Rekha Hansraj
- Department of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Muma S, Naidoo KS, Hansraj R. Proposed task shifting integrated with telemedicine to address uncorrected refractive error in Kenya: Delphi study. BMC Health Serv Res 2024; 24:115. [PMID: 38254104 PMCID: PMC10801974 DOI: 10.1186/s12913-024-10618-8] [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: 11/01/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Developing countries such as Kenya still experience challenges around human resource to deliver refractive error services. However, given the burden of uncorrected refractive error, adoption of innovative and cost effective approaches is desirable. Hence this study intended to develop a task shifting framework integrated with telemedicine to potentially scale refractive error services. METHODS This was an exploratory study conducted in four phases as follows: a scoping review of the scope of practice for ophthalmic workers in Kenya, an interview with key opinion leaders on the need for integration of public health approaches such as the vision corridors within the eye health ecosystem in Kenya and their knowledge on task shifting, and finally development and validation of a proposed task shifting framework through a Delphi technique. Purposive sampling was used to recruit key opinion leaders and data was collected via telephonic interviews. The qualitative data was analyzed thematically using NVivo Software, Version 11. RESULTS The scoping review showed that only optometrists, ophthalmologists and ophthalmic clinical officers are allowed to undertake refraction in Kenya. All of the key opinion leaders (100%) were aware of task shifting and agreed that it is suitable for adoption within the eye health ecosystem in Kenya. All of the key opinion leaders (100%) agreed that skills development for healthcare workers without prior training on eye health supervised by optometrists through telemedicine is desirable. Notwithstanding, all of the key opinion leaders (100%) agreed that integration of public health approaches such as the vision corridors across all levels of healthcare delivery channels and development of a self-assessment visual acuity tool is desirable. Finally all of the key opinion leaders (100%) agreed that task shifting is relevant for adoption within the eye health ecosystem in Kenya. The developed framework prioritized partnership, advocacy, skills development, establishment and equipping of refraction points. The proposed framework advocated for a telemedicine between professionals with conventional training and those with skills development. CONCLUSION Task shifting integrated with telemedicine could cost effectively scale refractive error service delivery. However, internal and external factors may hinder the success warranting the need for a multi-faceted interventions and a connection between planning and training to scale the uptake.
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Affiliation(s)
- Shadrack Muma
- College of Health Sciences, Department of Optometry, University of KwaZulu-Natal, Durban, South Africa.
| | | | - Rekha Hansraj
- College of Health Sciences, Department of Optometry, University of KwaZulu-Natal, Durban, South Africa
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Ntuli S. Challenges faced by nurses in managing patients with foot pathologies at primary healthcare clinics in Johannesburg-South Africa. Foot (Edinb) 2023; 57:101964. [PMID: 37865068 DOI: 10.1016/j.foot.2023.101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/30/2022] [Accepted: 01/22/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Foot health (podiatric) services remain inaccessible in many primary healthcare clinics across South Africa. As first-line contact practitioners at primary health care clinics, nurses manage all patients, including those presenting with foot pathologies. Anecdotal evidence suggests that nurses have challenges and are limited in their capability to assess the foot. In most cases, they do not assess the foot as part of the routine patient assessment. The primary aim of this study was to investigate the challenges nurses face in managing patients presenting with foot pathologies at primary healthcare clinics. METHODS The study used a qualitative design to explore nurses' challenges in managing patients presenting with foot complaints. A purposive sampling strategy was used to select participants from primary health care clinics in Johannesburg to participate in a focus group discussion. Data were analysed using Giorgi's qualitative thematic analysis to reveal themes based on similarities and relationships between the collected data. RESULTS Six PHC nurses participated in the focus group discussion. Participants confirmed challenges in managing patients presenting with foot pathologies. These include poor guidelines, limited training, consultation times, and a lack of defined referral pathways for patients with foot pathologies. Nurses indicated that due to challenges at the PHC level, foot assessment is not a mandatory part of patient assessment. All participants agreed on the need for structured foot health services. CONCLUSION Primary healthcare nurses have challenges in managing patients with foot pathologies. There is a need for structured foot health services and training for nurses to coordinate care for this patient group effectively. Further studies should establish the need and demand for podiatric services to distribute the limited podiatry resources equitably, such as placement of podiatrists at community healthcare centres which serve as the first referral point for primary healthcare clinics.
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Affiliation(s)
- Simiso Ntuli
- Department of Podiatry, Faculty of Health Sciences, University of Johannesburg, P O Box 524 Auckland Park 2006, Gauteng, South Africa.
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Ankomah SE, Fusheini A, Derrett S. Implementing patient-public engagement for improved health: Lessons from three Ghanaian community-based programmes. Health Expect 2023; 26:2684-2694. [PMID: 37694501 PMCID: PMC10632621 DOI: 10.1111/hex.13866] [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: 03/22/2023] [Revised: 06/28/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Community-based health interventions have been implemented as a key strategy for achieving improved health outcomes in Ghana. Effectiveness, however, largely depends on the successful implementation of patient-public engagement (PPE). Although several PPE studies have been conducted in Ghana, little research has been done to understand the specific role of PPE in the context of implementing community-based health programmes. This paper, therefore, examines the extent of PPE implementation in three selected community-based health programmes (Community-based Health Planning and Service [CHPS], Community-based Maternal and Child Health and Buruli Ulcer) to understand their specific effects on health outcomes. METHODS Three focus groups, involving 26 participants, were held in three districts of the Ashanti region of Ghana. Participants were mainly health service users involving community health committee members/volunteers, residents and health professionals. They were invited to participate based on their roles in the design and implementation of the programmes. Participants focused on each of Rifkin's spider-gram components. Data were transcribed and analysed descriptively using NVIVO 12 Plus. RESULTS PPE implementation was found to be extensive across the three programmes in specific areas such as organisation and resource mobilisation. PPE was more restricted in relation to community needs assessment, leadership and management, particularly for the CHPS and Buruli Ulcer programmes. CONCLUSION Findings suggest that benefits from community-based health interventions are likely to be greater if PPE can be widely implemented across all dimensions of the spider-gram framework.
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Affiliation(s)
- Samuel E. Ankomah
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
- Ngāi Tahu Māori Health Research Unit, Division of Health SciencesUniversity of OtagoDunedinNew Zealand
| | - Adam Fusheini
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Sarah Derrett
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
- Ngāi Tahu Māori Health Research Unit, Division of Health SciencesUniversity of OtagoDunedinNew Zealand
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Sherief ST, Tesfaye S, Eshetu Z, Ali A, Dimaras H. Child eye health in Ethiopia: a mixed methods analysis of policy and commitment to action. BMJ Open 2023; 13:e075622. [PMID: 37940160 PMCID: PMC10632828 DOI: 10.1136/bmjopen-2023-075622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Child eye health is a serious public health issue in Ethiopia, where children under the age of 15 account for over half of the population. Our aim was to review Ethiopian health policy and practice to reveal approaches and commitment to promotion and delivery of child eye health services. METHODS We conducted a mixed-methods situational analysis employing documentary analysis and key informant interview methods. Government publications touching on any element of child eye health were included. Key informants were eligible if they were leaders, authorities, researchers or clinicians involved in child health. Data was combined and analysed by narrative synthesis, using an adaptation of the Eye Care Situation Analysis Tool as a framework. FINDINGS Eleven documents developed by the Ministries of Health and Education were included and interviews with 14 key informants were conducted. A focus on child eye health was lacking in key health policy documents, demonstrated by limited allocation of funds, a shortage of human resources, and a subpar referral system across all levels of child eye care. CONCLUSION The study identified several gaps and limitations in child eye health in Ethiopia. There is a need for health policies that strengthen ownership, finance and partnerships for improved coordination, and collaboration with line ministries and other stakeholders to improve child eye health services in Ethiopia.
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Affiliation(s)
- Sadik Taju Sherief
- Ophthalmology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
- Ophthalmology and Visual Science, SickKids Research Institute, Toronto, Ontario, Canada
| | | | - Zelalem Eshetu
- Biruh Vision Speciality Eye Center, Addis Ababa, Ethiopia
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- SickKids Research Institute, Toronto, Ontario, Canada
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Tan TF, Thirunavukarasu AJ, Jin L, Lim J, Poh S, Teo ZL, Ang M, Chan RVP, Ong J, Turner A, Karlström J, Wong TY, Stern J, Ting DSW. Artificial intelligence and digital health in global eye health: opportunities and challenges. Lancet Glob Health 2023; 11:e1432-e1443. [PMID: 37591589 DOI: 10.1016/s2214-109x(23)00323-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
Global eye health is defined as the degree to which vision, ocular health, and function are maximised worldwide, thereby optimising overall wellbeing and quality of life. Improving eye health is a global priority as a key to unlocking human potential by reducing the morbidity burden of disease, increasing productivity, and supporting access to education. Although extraordinary progress fuelled by global eye health initiatives has been made over the last decade, there remain substantial challenges impeding further progress. The accelerated development of digital health and artificial intelligence (AI) applications provides an opportunity to transform eye health, from facilitating and increasing access to eye care to supporting clinical decision making with an objective, data-driven approach. Here, we explore the opportunities and challenges presented by digital health and AI in global eye health and describe how these technologies could be leveraged to improve global eye health. AI, telehealth, and emerging technologies have great potential, but require specific work to overcome barriers to implementation. We suggest that a global digital eye health task force could facilitate coordination of funding, infrastructural development, and democratisation of AI and digital health to drive progress forwards in this domain.
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Affiliation(s)
- Ting Fang Tan
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Arun J Thirunavukarasu
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Corpus Christi College, University of Cambridge, Cambridge, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Liyuan Jin
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Joshua Lim
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Stanley Poh
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Zhen Ling Teo
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - R V Paul Chan
- Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Urbana-Champaign, IL, USA
| | - Jasmine Ong
- Pharmacy Department, Singapore General Hospital, Singapore
| | - Angus Turner
- Lions Eye Institute, University of Western Australia, Nedlands, WA, Australia
| | - Jonas Karlström
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore General Hospital, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Jude Stern
- The International Agency for the Prevention of Blindness, London, UK
| | - Daniel Shu-Wei Ting
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
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Jiang D, Chen H, Zhang M, Zhang S, Xu J, Chen Y, Shi Y. Practice of the training program for ophthalmic specialist nurses in Zhejiang Province of China. BMC Nurs 2023; 22:120. [PMID: 37055828 PMCID: PMC10099926 DOI: 10.1186/s12912-023-01271-3] [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: 08/24/2022] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
AIMS To explore the effects of training programs for ophthalmic specialist nurses in Zhejiang Province of China. METHODS The training program included one month of theoretical training and three months of practical clinical training. The Two-Tutor system was used in training. The training contents were mainly set up around four modules: specialty knowledge and clinical skills, management, clinical teaching, and nursing research. We used theoretical examination, clinical practice assessment and trainee evaluation to assess the effectiveness of the training program. Before and after the training, the trainees' core competence was assessed by a homemade questionnaire. RESULTS In total, 48 trainees from 7 provinces (municipalities) in China participated in the training program. All trainees passed theoretical and clinical practice examinations and trainee evaluations. Their core competencies were significantly improved after training (p < 0.05). CONCLUSION This training program for ophthalmic specialist nurses is scientific and effective in improving nurses' ability to provide ophthalmic specialist nursing care.
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Affiliation(s)
- Dandan Jiang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China
| | - Huarong Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China
| | - Mengyue Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Saijin Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China
| | - Jingjing Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China
| | - Yanyan Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Yinghui Shi
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
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Sengo DB, Salamo ZMA, dos Santos IIDB, Mate LM, Chivinde SM, Moragues R, Pérez PC, López-Izquierdo I. Assessment of the distribution of human and material resources for eye health in the public sector in Nampula, Mozambique. HUMAN RESOURCES FOR HEALTH 2023; 21:27. [PMID: 37004070 PMCID: PMC10067286 DOI: 10.1186/s12960-023-00812-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The unavailability of human and material resources can affect access to eye health services, constituting an obstacle in the fight against avoidable visual impairment. This study aimed to assess the availability and distribution of human and material resources for eye health in the public sector in Nampula province. METHODS A mixed method approach was used, which included document reviews (to extract information regarding the number of professionals and inhabitants in each district) and application of a questionnaire to heads of the ophthalmology department in each health facility (to obtain the list of available equipment). The ratios of eye health professionals per population in Nampula province and each of its districts were calculated and evaluated taking into account the recommendations of the World Health Organization (WHO). Based on the level of care of each health facility, the availability of equipment was evaluated. RESULTS Nampula Province has not reached the recommended ratio of eye health professionals per population in the different categories (ophthalmic technicians with 0.8 per 100 thousand inhabitants; optometrists and ophthalmologists with 0.4 and 0.2 per 250 thousand inhabitants, respectively). Most districts of Nampula did not reach the recommended ratio in the three categories of professionals, except Nampula City (provincial capital). However, there was a greater concentration of professionals and facilities with eye health services in the provincial capital. Primary and secondary level health facilities lacked some equipment to provide eye health services within their scope. CONCLUSIONS There is an unequal distribution of the workforce in Nampula and the centralization of surgical services at the Central Hospital of Nampula level. Therefore, there is a need to review resource distribution strategies and decentralization policy of eye health services in Nampula.
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Affiliation(s)
- Dulnério Barbosa Sengo
- Faculdade Ciências de Saúde, Universidade Lúrio, Bairro de Marrere, R. nr. 4250, Km 2,3, Nampula, Mozambique
| | - Zubair Momade Abudo Salamo
- Faculdade Ciências de Saúde, Universidade Lúrio, Bairro de Marrere, R. nr. 4250, Km 2,3, Nampula, Mozambique
| | | | - Laura Mavota Mate
- Ministério dos Combatentes, Av Mártires Machava 307, Cidade de Maputo, Moçambique
| | - Sancho Manuel Chivinde
- Hospital Central de Nampula, Av Samora Machel, Bairro Central, Cidade de Nampula, Moçambique
| | - Raul Moragues
- Departamento Estadística, Matemáticas e Informática, Universitas Miguel Hernandez, Av de la Universidad s/n, 03202 Elx, Spain
| | - Pablo Caballero Pérez
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universitat d’Alacant, Carretera Sant Vicent del Raspeig s/n, 03690, Sant Vicent del Raspeig, Alacant, Spain
| | - Inmaculada López-Izquierdo
- Departamento de Física de la Materia Condensada, Universidad de Sevilla, Av. Reina Mercedes s/n, 41012 Sevilla, Spain
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Ogundo CLA, Bascaran C, Habtamu E, Buchan J, Mwangi N. Eye Health Integration in Southern and Eastern Africa: A Scoping Review. Middle East Afr J Ophthalmol 2023; 30:44-50. [PMID: 38435102 PMCID: PMC10903717 DOI: 10.4103/meajo.meajo_320_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 03/05/2024] Open
Abstract
Integrated health systems are deemed necessary for the attainment of universal health coverage, and the East, Central, and Southern Africa Health Community (ECSA-HC) recently passed a resolution to endorse the integration of eye health into the wider health system. This review presents the current state of integration of eye health systems in the region. Eight hundred and twelve articles between 1946 and 2020 were identified from four electronic databases that were searched. Article selection and data charting were done by two reviewers independently. Thirty articles met the eligibility criteria and were included in the narrative synthesis. Majority were observational studies (60%) and from Tanzania (43%). No explicit definition of integration was found. Eye health was prioritized at national level in some countries but failed to cascade to the lower levels. Eye health system integration was commonly viewed in terms of service delivery and was targeted at the primary level. Eye care data documentation was inadequate. Workforce integration efforts were focused on training general health-care cadres and communities to create a multidisciplinary team but with some concerns on quality of services. Government funding for eye care was limited. The findings show eye health system integration in the ECSA-HC region has been in progress for about four decades and is focused on the inclusion of eye health services into other health-care programs. Integration of comprehensive eye care into all the health system building blocks, particularly financial integration, needs to be given greater emphasis in the ECSA-HC.
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Affiliation(s)
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Eyu-Ethiopia: Eye Health Research, Training and Service Centre, Bahir Dar, Ethiopia
- Department of Ophthalmology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - John Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nyawira Mwangi
- Department of Ophthalmology, Kenya Medical Training College, Nairobi, Kenya
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Olawoye O, Salami KK, Azeez A, Adebola P, Sarimiye T, Imaledo J, Realini T, Hauser MA, Ashaye A. The social construction of genomics and genetic analysis in ocular diseases in Ibadan, South-western Nigeria. PLoS One 2022; 17:e0278286. [PMID: 36454870 PMCID: PMC9714877 DOI: 10.1371/journal.pone.0278286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
Genomics, an emerging field to improve public health practice, has potential benefits to understanding ocular diseases. This study explored the social construction of genomics in ocular diseases in the blind community in Ibadan, Nigeria, through two focus group discussions and twelve in-depth interview sessions conducted among people living with ocular disorders. The data were thematic and content-analysed. Although the participants had limited knowledge about ocular diseases, genomics, and their nexus, they maintained a positive attitude toward its potential benefits. This informed their willingness to participate in genomics testing for ocular diseases. The participants preferred saliva-based sample collection over blood-based, and expressed concern for the procedure and accrued benefits of genomics studies. Thus, public sensitisation about ocular diseases and client-centred genomics testing procedures should be engendered.
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Affiliation(s)
- Olusola Olawoye
- Department of Ophthalmology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Ophthalmology, University College Hospital Ibadan, Ibadan, Nigeria
| | - Kabiru K. Salami
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Abolaji Azeez
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Precious Adebola
- Department of Ophthalmology, University College Hospital Ibadan, Ibadan, Nigeria
| | - Tarela Sarimiye
- Department of Ophthalmology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Ophthalmology, University College Hospital Ibadan, Ibadan, Nigeria
| | - John Imaledo
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tony Realini
- Department of Ophthalmology and Visual Sciences, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Michael A. Hauser
- Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
- Department of Ophthalmology, Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Adeyinka Ashaye
- Department of Ophthalmology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Ophthalmology, University College Hospital Ibadan, Ibadan, Nigeria
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13
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Zulu NL, van Staden D. Experiences and perceptions of undergraduate optometry students towards public eye care services in South Africa. AFRICAN VISION AND EYE HEALTH 2022. [DOI: 10.4102/aveh.v81i1.726] [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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Daba KT, Gessesse GW, Molla JM, Alemu TA. Assessment of Risk Factors for Advanced Open Angle Glaucoma Presentation among Patients Visiting Jimma University Medical Center, Jimma, Ethiopia. Ethiop J Health Sci 2022; 32:929-936. [PMID: 36262710 PMCID: PMC9554772 DOI: 10.4314/ejhs.v32i5.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Glaucoma is the predominant cause of irreversible blindness, particularly the late presentation. The purpose of this study is to identify the risk factors associated with late presentation in Jimma University Medical Center. METHODS A case-control study was done among patients newly diagnosed to have open angle glaucoma (of any type) at Jimma University Medical Center from July 2014 - January 2019. Cases were patients/eyes diagnosed to have any type of open angle glaucoma with advanced glaucomatous disc features, whereas controls were patients diagnosed with early and moderate stages of glaucoma. RESULTS There were 205 (116 cases and 89 controls) participants. The mean age of the participants at the time of diagnosis was 58.3±13.4yrs. Family history of blindness, presenting IOP, type of glaucoma and age were independently associated with late presentation. Patients with family history of blindness had late advanced glaucoma five times higher than those with no family history of blindness. The presence of late glaucoma among patients with presenting intra ocular pressure < 30mmHg is lower than those having ≥30mmHg (Adjusted Odds Ratio= 0.136). Primary open-angle glaucoma patients were less likely to present with advanced glaucoma than pseudoexfoliative glaucoma patients (Adjusted Odds Ratio=0.39). The chance of presenting with late glaucoma was increased by 3.4% for every one year increment of age. CONCLUSIONS Presence of family history of blindness, high presenting intraocular pressure, pseudoexfoliative glaucoma and old age are risk factors for late presentation of glaucoma.
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Yasmin S, Schmidt E. Primary eye care: opportunities for health system strengthening and improved access to services. Int Health 2022; 14:i37-i40. [PMID: 35385864 PMCID: PMC8986357 DOI: 10.1093/inthealth/ihab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022] Open
Abstract
Primary eye care (PEC) is a vital component of primary healthcare (PHC) and is the cornerstone for the progress towards universal eye health coverage. While the concept of PEC is not new, with the increased focus of the global eye-health agenda on equity and people-centred care, it is critical to review experiences of delivering PEC in low- and middle-income countries and to identify common lessons learnt. This commentary builds on the available evidence and focuses specifically on three recently published evaluations of PEC in Sightsavers-supported programmes in Tanzania, Sierra Leone and Pakistan. It argues that systems thinking is critical in the delivery of PEC interventions, as only this approach can ensure that the integration of PEC into PHC is delivered in a comprehensive, coherent and sustainable way.
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Affiliation(s)
- Sumrana Yasmin
- Sightsavers, 3-A, Street 7, Sector G-10/2, Islamabad, 44000, Pakistan
| | - Elena Schmidt
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BW, UK
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Ramke J, Evans JR, Habtamu E, Mwangi N, Silva JC, Swenor BK, Congdon N, Faal HB, Foster A, Friedman DS, Gichuhi S, Jonas JB, Khaw PT, Kyari F, Murthy GVS, Wang N, Wong TY, Wormald R, Yusufu M, Taylor H, Resnikoff S, West SK, Burton MJ. Grand Challenges in global eye health: a global prioritisation process using Delphi method. THE LANCET. HEALTHY LONGEVITY 2022; 3:e31-e41. [PMID: 35028632 PMCID: PMC8732284 DOI: 10.1016/s2666-7568(21)00302-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. METHODS Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. FINDINGS Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. INTERPRETATION This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. FUNDING The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. TRANSLATIONS For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Eyu-Ethiopia: Eye Health Research, Training and Service Centre, Bahirdar, Ethiopia
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Kenya Medical Training College, Nairobi, Kenya
| | | | - Bonnielin K Swenor
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Orbis International, New York, NY, USA
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria
- Africa Vision Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Peng T Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Indian Institute of Public Health, Hyderabad, India
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Hugh Taylor
- Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute and School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Aghaji A, Burchett HED, Oguego N, Hameed S, Gilbert C. Primary health care facility readiness to implement primary eye care in Nigeria: equipment, infrastructure, service delivery and health management information systems. BMC Health Serv Res 2021; 21:1360. [PMID: 34930271 PMCID: PMC8690487 DOI: 10.1186/s12913-021-07359-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Over two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for primary eye care. However, there are limited data on the capacities needed for delivery, to guide policymakers and implementers on the feasibility of integration. The overall purpose of this study was to assess the technical capacity of the health system at primary level to deliver the WHO primary eye care package. Findings with respect to service delivery, equipment and health management information systems (HMIS) are presented in this paper. Methods This was a mixed-methods, cross sectional feasibility study in Anambra State, Nigeria. Methods included a desk review of relevant Nigerian policies; a survey of 48 primary health facilities in six districts randomly selected using two stage sampling, and semi-structured interviews with six supervisors and nine purposively selected facility heads. Quantitative study tools included observational checklists and questionnaires. Survey data were analysed descriptively using STATA V.15.1 (Statcorp, Texas). Differences between health centres and health posts were analysed using the z-test statistic. Interview data were analysed using thematic analysis assisted by Open Code Software V.4.02. Results There are enabling national health policies for eye care, but no policy specifically for primary eye care. 85% of facilities had no medication for eye conditions and one in eight had no vitamin A in stock. Eyecare was available in < 10% of the facilities. The services delivered focussed on maternal and child health, with low attendance by adults aged over 50 years with over 50% of facilities reporting ≤10 attendances per year per 1000 catchment population. No facility reported data on patients with eye conditions in their patient registers. Conclusion A policy for primary eye care is needed which aligns with existing eye health policies. There are currently substantial capacity gaps in service delivery, equipment and data management which will need to be addressed if eye care is to be successfully integrated into primary care in Nigeria. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07359-3.
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Affiliation(s)
- Ada Aghaji
- Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu, Nigeria. .,International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Helen E D Burchett
- Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine , London, UK
| | - Ngozi Oguego
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Shaffa Hameed
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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18
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Aghaji A, Burchett HED, Oguego N, Hameed S, Gilbert C. Human resource and governance challenges in the delivery of primary eye care: a mixed methods feasibility study in Nigeria. BMC Health Serv Res 2021; 21:1321. [PMID: 34893081 PMCID: PMC8662916 DOI: 10.1186/s12913-021-07362-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 11/23/2021] [Indexed: 11/11/2022] Open
Abstract
Background To increase access to eye care, the World Health Organization’s Africa Region recently launched a primary eye care (PEC) package for sub-Saharan Africa. To determine the technical feasibility of implementing this package, the capacity of health systems at primary level needs to be assessed, to identify capacity gaps that would need to be addressed to deliver effective and sustainable PEC. This study reports on the human resource and governance challenges for delivering PEC in Anambra State, Nigeria. Methods Design: This was a mixed methods feasibility study. A desk review of relevant Nigerian national health policy documents on both eye health and primary health care was conducted, and 48 primary health care facilities in Anambra state were surveyed. Data on human resource and governance in primary health facilities were collected using structured questionnaires and through observation with checklists. In-depth interviews were conducted with district supervisors and selected heads of facilities to explore the opportunities and challenges for the delivery of PEC in their facilities/districts. Data were analysed using the World Health Organization’s health system framework. Results A clear policy for PEC is lacking. Supervision was conducted at least quarterly in 54% of facilities and 56% of facilities did not use the standard clinical management guidelines. There were critical shortages of health workers with 82% of facilities working with less than 20% of the number recommended. Many facilities used volunteers and/or ad hoc workers to mitigate staff shortages. Conclusion Our study highlights the policy, governance and health workforce gaps that will need to be addressed to deliver PEC in Nigeria. Developing and implementing a specific policy for PEC is recommended. Implementation of existing national health policies may help address health workforce shortages at the primary health care level. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07362-8.
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Affiliation(s)
- Ada Aghaji
- Department of Ophthalmology, College of Medicine, Enugu, Nigeria. .,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
| | - Helen E D Burchett
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ngozi Oguego
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Shaffa Hameed
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, GB, UK
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Sengo DB, Dos Santos IIDB, Faquihe MF, Tomo HBJF, Muaprato AM, Puchar S, Lôbo GMRJ, López-Izquierdo I, Caballero P. The Prevalence of Visual Impairment and Refractive Errors among a Youth Population in Mozambique: Evidence of the Need for Intervention. CHILDREN (BASEL, SWITZERLAND) 2021; 8:892. [PMID: 34682157 PMCID: PMC8534347 DOI: 10.3390/children8100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022]
Abstract
Visual impairment (VI) can significantly interfere in the child's daily activities and quality of life, having a negative effect on their development and learning. The aim of the study was to determine the prevalence of VI and associated demographic factors in students examined during the program "Moçambique te vejo melhor". This study was cross-sectional and retrospective, based on the 2018/19 edition of the program. Eye examinations were performed in secondary school students, aged between 12 and 20 years, of five districts in Nampula province. The examination included visual acuity, non-cycloplegic refraction and assessment of the anterior and posterior segment and ocular adnexa. The prevalence of uncorrected, presenting and best-corrected VI found was 18.3%, 10.8%, and 5.0%, respectively. Refractive error (RE) had a prevalence of 24.7%, and the age groups between 15-17 years and 18-20 years were significantly associated with myopia (with OR: 4.9 and OR: 8.8, respectively), as well as the 11th and 12th grade (OR: 8.1 and OR: 10.7, respectively), and Malema district had association with myopia (ORa: 0.4) and hyperopia (ORa: 0.4 and OR: 0.3) as a protective factor. The prevalence of RE and VI was relatively high, showing the need for greater intervention at the school level.
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Affiliation(s)
- Dulnério B. Sengo
- Faculty of Health Sciences, Lúrio University, Nampula City 3100, Mozambique; (D.B.S.); (I.I.D.B.D.S.); (M.F.F.); (H.B.J.F.T.); (A.M.M.); (S.P.); (G.M.R.J.L.)
| | - Isaura I. D. B. Dos Santos
- Faculty of Health Sciences, Lúrio University, Nampula City 3100, Mozambique; (D.B.S.); (I.I.D.B.D.S.); (M.F.F.); (H.B.J.F.T.); (A.M.M.); (S.P.); (G.M.R.J.L.)
| | - Momade F. Faquihe
- Faculty of Health Sciences, Lúrio University, Nampula City 3100, Mozambique; (D.B.S.); (I.I.D.B.D.S.); (M.F.F.); (H.B.J.F.T.); (A.M.M.); (S.P.); (G.M.R.J.L.)
| | - Hermenegildo B. J. F. Tomo
- Faculty of Health Sciences, Lúrio University, Nampula City 3100, Mozambique; (D.B.S.); (I.I.D.B.D.S.); (M.F.F.); (H.B.J.F.T.); (A.M.M.); (S.P.); (G.M.R.J.L.)
| | - Alcino M. Muaprato
- Faculty of Health Sciences, Lúrio University, Nampula City 3100, Mozambique; (D.B.S.); (I.I.D.B.D.S.); (M.F.F.); (H.B.J.F.T.); (A.M.M.); (S.P.); (G.M.R.J.L.)
| | - Sualé Puchar
- Faculty of Health Sciences, Lúrio University, Nampula City 3100, Mozambique; (D.B.S.); (I.I.D.B.D.S.); (M.F.F.); (H.B.J.F.T.); (A.M.M.); (S.P.); (G.M.R.J.L.)
| | - Guida M. R. J. Lôbo
- Faculty of Health Sciences, Lúrio University, Nampula City 3100, Mozambique; (D.B.S.); (I.I.D.B.D.S.); (M.F.F.); (H.B.J.F.T.); (A.M.M.); (S.P.); (G.M.R.J.L.)
| | - Inmaculada López-Izquierdo
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes St., 41012 Seville, Spain
| | - Pablo Caballero
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain;
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Maseko SN, van Staden D, Mhlongo EM. The Rising Burden of Diabetes-Related Blindness: A Case for Integration of Primary Eye Care into Primary Health Care in Eswatini. Healthcare (Basel) 2021; 9:835. [PMID: 34356213 PMCID: PMC8307827 DOI: 10.3390/healthcare9070835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
There is a rampant increase in diabetes prevalence globally. Sub-Saharan Africa (SSA) is projected to carry the largest burden of diabetes (34.2 million) by 2030. This will inevitably cause a parallel increase in diabetes-associated complications; with the predominant complications being blindness due to diabetic retinopathy and diabetic cataracts. Eye programs in developing countries remain inadequate, existing as stand-alone programs, focused on the provision of acute symptomatic care at secondary and tertiary health levels. Over 60% of people with undiagnosed diabetes report to eye care facilities with already advanced retinopathy. While vision loss due to cataracts is reversible, loss of vision from diabetic retinopathy is irreversible. Developing countries have in the last two decades been significantly impacted by infectious pandemics; with SSA countries committing over 80% of their health budgets towards infectious diseases. Consequently, non-communicable diseases and eye health have been neglected. This paper aimed to highlight the importance of strengthening primary health care services to prevent diabetes-related blindness. In SSA, where economies are strained by infectious disease, the projected rise in diabetes prevalence calls for an urgent need to reorganize health systems to focus on life-long preventative and integrated measures. However, research is critical in determining how best to integrate these without further weakening health systems.
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Affiliation(s)
- Sharon Nobuntu Maseko
- Department of Optometry, School of Health Sciences, University of Kwa-Zulu Natal, Durban 4001, South Africa;
| | - Diane van Staden
- Department of Optometry, School of Health Sciences, University of Kwa-Zulu Natal, Durban 4001, South Africa;
| | - Euphemia Mbali Mhlongo
- Department of Nursing, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban 4001, South Africa;
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Seelam B, Liu H, Borah RR, Sheeladevi S, Keay L. A realist evaluation of the implementation of a large-scale school eye health programme in India: a qualitative study. Ophthalmic Physiol Opt 2021; 41:565-581. [PMID: 33860968 DOI: 10.1111/opo.12815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study investigates how and in what circumstances a school-based eye health programme, the Refractive Errors Among CHildren (REACH) programme, achieved its desired outcomes: accessibility, standards of refractive care, fidelity and availability of comprehensive services, for over 2 million school children in six districts across India. METHODS We conducted a realist evaluation to identify programme aspects and their causal relationships with outcomes. Deductive and inductive thematic analysis of qualitative data included three phases: 1. theory gleaning, 2. eliciting programme theory, 3. revisiting programme theory. The Initial Programme Theories (IPTs) were developed and revised through review of the literature, programme documents and field notes. We reviewed informal and formal discussions from the participatory advisory workshops and conducted semi-structured interviews with key stakeholders for the development and refinement of the IPTs. We based our analysis on the programme designers' perspective; used contexts, mechanisms and outcomes configuration for the analysis and presentation of the findings and reported the revised IPTs for the REACH programme. RESULTS We identified four major programme aspects of the REACH programme for evaluation: programme governing unit, human resource, innovation and technology and funding. Based on the intended outcomes of the programme, themes and contexts were sorted and IPTs were defined. We revised the IPTs based on the analysis of the interviews (n = 19). The contexts and mechanisms that were reported to have potential influence on the attainment of favourable programme outcomes were identified. The revisions to the IPTs included: co-designing a collaborative model and involving local government officials to reinforce trust, community partnerships; local well-trained staff to encourage participation; use of the web-based data capturing system with built-in quality control measures and continued technical support; pre-determined costs and targets for the outputs promoted transparency and adherence with costs. CONCLUSION This process provided a comprehensive understanding of the opportunities and possibilities for a large-scale school eye health programme in diverse local contexts in India. This illustrated the importance of embracing principles of system thinking and considering contextual factors for School Eye Health programmes in low and middle-income countries.
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Affiliation(s)
- Bharani Seelam
- The University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, New Delhi, India
| | - Hueiming Liu
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | - Lisa Keay
- The University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
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Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021; 9:e489-e551. [PMID: 33607016 PMCID: PMC7966694 DOI: 10.1016/s2214-109x(20)30488-5] [Citation(s) in RCA: 478] [Impact Index Per Article: 159.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Damodar Bachani
- John Snow India, New Delhi, India; Ministry of Health and Family Welfare, New Delhi, India
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Tasanee Braithwaite
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; The Medical Eye Unit, St Thomas' Hospital, London, UK
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chimgee Chuluunkhuu
- Orbis International, Ulaanbaatar, Mongolia; Mongolian Ophthalmology Society, Ulaanbaatar, Mongolia
| | | | | | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alastair K Denniston
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Emerson
- International Trachoma Initiative and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - João M Furtado
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Eyu-Ethiopia Eye Health Research, Training, and Service Centre, Bahirdar, Ethiopia
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Peng Tee Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Van C Lansingh
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico; Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico; Help Me See, New York, NY, USA
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Milka M Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lizette Mowatt
- University Hospital of the West Indies, Kingston, Jamaica
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Indian Institute of Public Health, Hyderabad, India
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kenya Medical Training College, Nairobi, Kenya
| | - Daksha B Patel
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Solange R Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Bernadetha R Shilio
- Department of Curative Services, Ministry of Health Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nation, New York, NY, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Vision Institute, University of New South of Wales, Sydney, Australia
| | | | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria; Africa Vision Research Institute, Durban, South Africa
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Aghaji A, Burchett HED, Mathenge W, Faal HB, Umeh R, Ezepue F, Isiyaku S, Kyari F, Wiafe B, Foster A, Gilbert CE. Technical capacities needed to implement the WHO's primary eye care package for Africa: results of a Delphi process. BMJ Open 2021; 11:e042979. [PMID: 33741664 PMCID: PMC7986885 DOI: 10.1136/bmjopen-2020-042979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The aim of the study was to establish the technical capacities needed to deliver the WHO African Region's primary eye care package in primary healthcare facilities. DESIGN A two-round Delphi exercise was used to obtain expert consensus on the technical complexity of each component of the package and the technical capacities needed to deliver them using Gericke's framework of technical feasibility. The panel comprised nine eyecare experts in primary eyecare in sub-Saharan Africa. In each round panel members used a 4-point Likert scale to indicate their level of agreement. Consensus was predefined as ≥70% agreement on each statement. For round 1, statements on technical complexity were identified through a literature search of primary eyecare in sub-Saharan Africa from January 1980 to April 2018. Statements for which consensus was achieved were included in round 2, and the technical capacities were agreed. RESULTS Technical complexity statements were classified into four broad categories: intervention characteristics, delivery characteristics, government capacity requirements and usage characteristics. 34 of the 38 (89%) statements on health promotion and 40 of the 43 (93%) statements on facility case management were considered necessary technical capacities for implementation. CONCLUSION This study establishes the technical capacities needed to implement the WHO Africa Office primary eye care package, which may be generalisable to countries in sub-Saharan Africa.
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Affiliation(s)
- Ada Aghaji
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Ophthalmology, University of Nigeria Faculty of Medical Sciences, Enugu, Nigeria
| | - Helen E D Burchett
- Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | | | - Hannah Bassey Faal
- African Vision Research Institute, Durban, South Africa
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria
| | - Rich Umeh
- Department of Ophthalmology, University of Nigeria Faculty of Medical Sciences, Enugu, Nigeria
| | - Felix Ezepue
- Department of Ophthalmology, University of Nigeria Faculty of Medical Sciences, Enugu, Nigeria
| | | | - Fatima Kyari
- Department of Ophthalmology, Baze University, Abuja, Nigeria
| | | | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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24
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Pente V, Bechange S, Jolley E, Tobi P, Roca A, Ruddock A, Smart N, Ogundimu K, Vandy M, Schmidt E. Task-shifting eye care to ophthalmic community health officers (OCHO) in Sierra Leone: A qualitative study. J Glob Health 2021; 11:07001. [PMID: 33763216 PMCID: PMC7956140 DOI: 10.7189/jogh.11.07001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Preventing visual impairment due to avoidable causes has been a long-standing global priority. Of all blindness in Sierra Leone, 91.5% is estimated to be avoidable and 58.2% treatable, however there are only 6 ophthalmologists for the whole country. Task-shifting has been suggested as a strategy to address this issue and a training intervention was developed to create a cadre of community-based staff known as Ophthalmic Community Health Officers (OCHOs). This qualitative study aimed to explore the experiences of OCHOs, their relationship with other eye health workers, and how they interact with the wider health system, in order to provide recommendations for the design and delivery of future task shifting strategies. Methods Between April and May 2018, we conducted semi-structured interviews with 42 participants including: OCHOs (n = 13), traditional ophthalmic staff (n = 17) and other stakeholders from the districts (n = 6), training institution staff (n = 4) and MOH headquarters (n = 2). We identified participants using purposive sampling. Interviews were audio-recorded, transcribed, and thematically analysed. We draw largely on in-depth interviews but complement the analysis with evidence from a document review. Results In Sierra Leone, the roll-out of the OCHO programme presented a mixed picture. OCHOs participating in the study expressed a strong commitment to their new role. However, policy changes proposed to clearly demarcate roles and responsibilities and institutionalise the cadre in the civil service were not implemented, resulting in the posting of some staff at an inappropriate level, dissatisfaction with the OCHO certification, and lack of opportunities for advancement and training. These challenges reflect structural weaknesses in the health system that undermine a cohesive implementation of eye health initiatives at the primary health care level in Sierra Leone. Conclusions Task-shifting has the potential to improve provision in under-resourced specialities such as eye health. However, the success of this approach will be contingent upon the development of a robust and supportive health policy environment.
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Affiliation(s)
| | | | | | - Patrick Tobi
- Sightsavers, Haywards Heath, UK.,Middlesex University, London, UK
| | | | | | - Nancy Smart
- Sightsavers, Freetown, Sierra Leone Country Office
| | | | - Matthew Vandy
- Ministry of Health and Sanitation, Freetown, Sierra Leone
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Kagoya HR, Mitonga H, Kibuule D, Rennie T. National standard treatment guidelines: their impact on medicine use indicators in a resource-limited setting. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Objectives
Standard treatment guidelines improve patient care outcomes. Few studies assess the impact of standard treatment guidelines on population-level medicine use indicators in resource limited settings in sub-Saharan Africa, where the burden of disease is greatest. The objective of this study was to determine the immediate and long-term impact of the national standard treatment guidelines on medicine use indicators at the population-level in Namibia.
Methods
An interrupted time-series modeling of the impact of national standard treatment guidelines implemented in Namibia in 2011, on population-level medicine use indicators. Antibiotic, generic and polypharmacy prescribing indicators were abstracted from the national Pharmaceutical Information System, over an eight-year period, 2007– 2015. This generated 15-quarterly time points. The impact was estimated by changes in trends of the indicators, immediately and after the intervention using R-software. The immediate impact was reflected by level change while long term impact was determined by trends/quarterly change after standard treatment guideline implementation.
Key findings
Data points from 522 Pharmaceutical Information System reports from 38 health facilities were included. The eight-year period estimates were, 2.9 ± 0.1 medicines prescribed per outpatient, 48.1 ± 2.5% of prescriptions had an antibiotic and 74.0 ± 4.2% of medicines were prescribed by generic name. Of the 13 regions, 61.3% and 53.8% had a decline in the average medicines per prescription and prescriptions with antibiotics respectively, as well as 53.8% of the regions had an increase in prescribing of generic medicines immediately after implementation of the standard treatment guidelines. Thereafter, quarterly trends in the three indicators did not significantly improve after the intervention at national and in all regions, except for generic prescribing in Oshikoto region, 4.5% (95% CI: 2.6 – 6.3%, P < 0.001).
Conclusion
Whilst national standard treatment guidelines immediately improved medicine use indicators, it is discouraging that the improvement over time was marginal across regions and was not sustained at the national level. Robust point of care interventions is needed for sustained and effective implementation of standard treatment guidelines.
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Affiliation(s)
- Harriet Rachel Kagoya
- School of Public Health, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Honoré Mitonga
- School of Public Health, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Timothy Rennie
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
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Cicinelli MV, Marmamula S, Khanna RC. Comprehensive eye care - Issues, challenges, and way forward. Indian J Ophthalmol 2020; 68:316-323. [PMID: 31957719 PMCID: PMC7003576 DOI: 10.4103/ijo.ijo_17_19] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
As we move from a disease-specific care model toward comprehensive eye care (CEC), there is a need for a more holistic and integrated approach involving the health system. It should encompass not only treatment, but also prevention, promotion, and rehabilitation of incurable blindness. Although a few models already exist, the majority of health systems still face the challenges in the implementation of CEC, mainly due to political, economic, and logistic barriers. Shortage of eye care human resources, lack of educational skills, paucity of funds, limited access to instrumentation and treatment modalities, poor outreach, lack of transportation, and fear of surgery represent the major barriers to its large-scale diffusion. In most low- and middle-income countries, primary eye care services are defective and are inadequately integrated into primary health care and national health systems. Social, economic, and demographic factors such as age, gender, place of residence, personal incomes, ethnicity, political status, and health status also reduce the potential of success of any intervention. This article highlights these issues and demonstrates the way forward to address them by strengthening the health system as well as leveraging technological innovations to facilitate further care.
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Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Srinivas Marmamula
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Senior Visiting Fellow - School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Wellcome Trust / Department of Bio-technology India Alliance fellow, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; Senior Visiting Fellow - School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Aghaji A, Burchett H, Hameed S, Webster J, Gilbert C. The Technical Feasibility of Integrating Primary Eye Care Into Primary Health Care Systems in Nigeria: Protocol for a Mixed Methods Cross-Sectional Study. JMIR Res Protoc 2020; 9:e17263. [PMID: 33107837 PMCID: PMC7655465 DOI: 10.2196/17263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Approximately 90% of the 253 million blind or visually impaired people worldwide live in low- and middle-income countries. Lack of access to eye care is why most people remain or become blind. The World Health Organization Regional Office for Africa (WHO-AFRO) recently launched a primary eye care (PEC) package for sub-Saharan Africa—the WHO-AFRO PEC package—for integration into the health system at the primary health care (PHC) level. This has the potential to increase access to eye care, but feasibility studies are needed to determine the extent to which the health system has the capacity to deliver the package in PHC facilities. Objective Our objective is to assess the technical feasibility of integrating the WHO-AFRO PEC package in PHC facilities in Nigeria. Methods This study has several components, which include (1) a literature review of PEC in sub-Saharan Africa, (2) a Delphi exercise to reach consensus among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it in PHC facilities, (3) development of PEC technical capacity assessment tools, and (4) data collection, including facility surveys and semistructured interviews with PHC staff and their supervisors and village health workers to determine the capacities available to deliver PEC in PHC facilities. Analysis will identify opportunities and the capacity gaps that need to be addressed to deliver PEC. Results Consensus was reached among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it as part of PHC. Quantitative tools (ie, structured questionnaires, in-depth interviews, and observation checklists) and topic guides based on agreed-upon technical capacities have been developed and relevant stakeholders have been identified. Surveys in 48 PHC facilities and interviews with health professionals and supervisors have been undertaken. Capacity gaps are being analyzed. Conclusions This study will determine the capacity of PHC centers to deliver the WHO-AFRO PEC package as an integral part of the health system in Nigeria, with identification of capacity gaps. Although capacity assessments have to be context specific, the tools and findings will assist policy makers and health planners in Nigeria and similar settings, who are considering implementing the package, in making informed choices. International Registered Report Identifier (IRRID) DERR1-10.2196/17263
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Affiliation(s)
- Ada Aghaji
- Department of Ophthalmology, College of Medicine, Enugu, Nigeria.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Burchett
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shaffa Hameed
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Buthelezi LM, van Staden D. Integrating eye health into policy: Evidence for health systems strengthening in KwaZulu-Natal. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Burn H, Puri L, Roshan A, Singh SK, Burton MJ. Primary Eye Care in Eastern Nepal. Ophthalmic Epidemiol 2020; 27:165-176. [PMID: 31842661 PMCID: PMC7114913 DOI: 10.1080/09286586.2019.1702217] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 10/21/2019] [Accepted: 11/28/2019] [Indexed: 11/07/2022]
Abstract
Purpose: Vision 2020 and the Global Action Plan 2013-2019 prioritise primary eye care (PEC) as an important component of reducing avoidable blindness. Studies in sub-Saharan Africa have demonstrated that current PEC provision is poor. There has been no evaluation of the current practice of PEC among primary health care workers (PHCWs) in Nepal.Methods: A mixed methods descriptive cross-sectional study with semi-structured interviews and focus group discussions (FGDs) was carried out in Eastern Nepal. Government employed PHCWs working at health posts in three districts were invited to take part in a PEC knowledge and skills assessment. Each health post was assessed for ophthalmic equipment and medications. Three focus group discussions and eight semi-structured interviews were carried out with community ophthalmic assistants, PHCWs and a district health manager.Results: 107 PHCWs in 35 health posts took part in the quantitative study. Only 8.4% had received eye care training. 27.1% PHCWs could diagnose a corneal ulcer, 83.2% conjunctivitis, 75.7% cataract and 54.2% ophthalmia neonatorum. Only 14.0% could measure visual acuity, and 5.7% of HPs had a vision chart. Ophthalmic assistants described their concern for the low level of PEC at health posts. PHCWs were keen to receive training and highlighted the need for greater government support in the provision of eye care services.Conclusion: PEC knowledge and skills among PHCWs in eastern Nepal is inadequate to provide quality PEC services. There is a pressing need for PEC training in the region, provision of ophthalmic equipment and greater government support for eye care.
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Affiliation(s)
- Helen Burn
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lila Puri
- Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
| | | | | | - Matthew J. Burton
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Garza-Garza LA, Ruiz-Lozano RE, Rebolledo-Méndez G, Ibarra-Nava I, Morales-Garza HJ, Ancona-Lezama D. Challenge of Retinoblastoma in Mexico in 2020: Perspectives and Solutions. J Ophthalmol 2020; 2020:1953602. [PMID: 32850140 PMCID: PMC7439193 DOI: 10.1155/2020/1953602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/28/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022] Open
Abstract
Early diagnosis and positive outcomes of retinoblastoma in childhood have been positively correlated with the economic wealth of high-income countries (HICs) worldwide. Adequate curability and survival rates, adherence to treatment, presence of poor prognostic initial clinical signs, and metastatic disease at diagnosis appear to have a less favorable picture in low-income countries (LICs). However, this is not always the case. An example is Argentina, where disease-free survival rates of retinoblastoma are notably higher than expected when taking into consideration its economic situation. Unfortunately, as in other Latin American LICs, retinoblastoma outcomes in Mexico are worrisome. Interestingly, the Human Development Index (HDI) in Mexico varies widely between its different geographical regions. While in some states, the HDI resembles those of high-income countries, and in others, the opposite is observed. A unifying picture of Mexico's developmental status, health resources, indicators, and other factors possibly influencing outcomes in retinoblastoma is currently unavailable. The present review explores the previously mentioned factors in Mexico and compares them to other countries. Additionally, it recommends solutions or enhancements where possible.
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Affiliation(s)
- Lucas A. Garza-Garza
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Raúl E. Ruiz-Lozano
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Genaro Rebolledo-Méndez
- 2Writing Lab, TecLabs, Vicerrectoria de Investigación y Transferencia de Tecnología, Tecnologico de Monterrey, Monterrey, Mexico
| | - Ismael Ibarra-Nava
- 3Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Héctor J. Morales-Garza
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| | - David Ancona-Lezama
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
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Delgado MF, Abdelrahman AM, Terahi M, Miro Quesada Woll JJ, Gil-Carrasco F, Cook C, Benharbit M, Boisseau S, Chung E, Hadjiat Y, Gomes JA. Management Of Glaucoma In Developing Countries: Challenges And Opportunities For Improvement. Clinicoecon Outcomes Res 2019; 11:591-604. [PMID: 31632107 PMCID: PMC6776288 DOI: 10.2147/ceor.s218277] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
Glaucoma is the leading cause of blindness in the developed and developing world. Not only is the clinical impact of this disease considerable, but associated economic and humanistic burdens – affecting patients, caregivers, and society – are substantial. Since glaucoma is an age-related disorder and populations in many developing countries are aging at a faster pace than in the developed world, increasing attention is being focused on ways to ameliorate the burdens of illness. In this paper, we examine the burdens of glaucoma with particular focus on developing countries, discuss some of the challenges that exist in delivering optimal glaucoma management within budget constraints, and bring into perspective how we could improve current healthcare systems, leverage technology, and strike an appropriate balance between cost and quality of care, thereby offering considerations to payors and policymakers in these countries that may result in longer-term cost savings, while concurrently striving to achieve the WHO Vision on the prevention of blindness and visual impairment.
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Affiliation(s)
| | | | - Malika Terahi
- Ophthalmology Department, CHU Nafissa Hammoud, Algiers, Algeria
| | | | - Felix Gil-Carrasco
- Glaucoma Department, Hospital Luis Sánchez Bulnes, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | - Colin Cook
- Division of Ophthalmology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | | | | | - Ernestine Chung
- Mundipharma Singapore Holding Pte Limited, Singapore, Singapore
| | - Yacine Hadjiat
- Mundipharma Singapore Holding Pte Limited, Singapore, Singapore
| | - José Ap Gomes
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
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Assessing the Progress towards Achieving "VISION 2020: The Right to Sight" Initiative in Ghana. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2019; 2019:3813298. [PMID: 31428165 PMCID: PMC6679876 DOI: 10.1155/2019/3813298] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/02/2019] [Indexed: 12/03/2022]
Abstract
Purpose The aim of this study was to analyse eye health delivery in Ghana and examine the progress towards achieving VISION 2020 indicator targets. Methods This descriptive cross-sectional study was conducted between October 2017 and May 2018. It used a mixed method approach including desk-based reviews, a questionnaire-based survey of eye facilities in Ghana, and interviews with eye health system stakeholders to collect information on eye health delivery in facilities owned by the Ghana Health Service (GHS), quasigovernmental bodies (security agencies), and Christian Association of Ghana (CHAG). The information was benchmarked against the World Health Organization (WHO) targets for achieving the goals of VISION 2020. Results The magnitude of blindness and moderate to severe visual impairment (without pinhole) was 0.9% and 3.0%, respectively. The number of ophthalmologists available at the country level was 80.6% of the VISION 2020 target with optometrists and ophthalmic nurses exceeding targets for VISION 2020. The distribution of human resources was heavily skewed towards two out of the 10 regions in Ghana. Cataract surgical rate was low and met 25% of the WHO target. Basic equipment for refraction was available in the majority of facilities; however, there was a general lack of specialised eye care equipment across the country. Comparatively, CHAG facilities were better equipped than GHS facilities at the same level. Conclusion The Government of Ghana should revitalize the goals of VISION 2020 beyond the year 2020 and spearhead a concerted effort to ensure equitable distribution of human and infrastructural resources across the country.
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Ormsby GM. Formative research for the development of an Eye Health Strategic Planning and Evaluation Framework and a Checklist: A health systems approach. Int J Health Plann Manage 2019; 34:e1356-e1375. [PMID: 30977559 DOI: 10.1002/hpm.2784] [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: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 11/11/2022] Open
Abstract
This formative research process aimed to develop an Eye Health Strategic Planning and Evaluation Framework and indicator Checklist. The research process utilized a multi-phased multiple methods approach including literature review, initial expert review (n = 27), findings from a Cambodian Avoidable Blindness Initiative demonstration project (2009-2012), observation and analysis of four rural sites of the Indian LV Prasad Eye Institute Pyramid Model (n = 21), and finally, a critique by Cambodian government eye health professionals/staff (n = 15), health center staff and community representatives (n = 77) and patients (n = 62). Results from three Cambodian population-based surveys (KAP n = 599, patient follow-up n = 354, and RAAB 4650) also informed the development of the Framework and the Checklist. The Framework domains include: situation analysis, determinants of accessibility, service delivery systems, operation systems, networks and linkages, outcomes, and impact. Domains were subdivided into 59 components. The Checklist consists of 253 indicator items. The Eye Health Strategic Planning and Evaluation Framework and the Checklist can assist policy makers, program planners, and evaluators to develop a comprehensive whole of systems approach to eye health care to improve coverage and utilization of services.
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Affiliation(s)
- Gail M Ormsby
- Research, Professional Studies, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Queensland, Australia.,Adjunct Lecturer, Lifestyle Research Centre, Avondale College of Higher Education, New South Wales, Australia
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Zhao J, Yu J, Wang T, Mban B. Ciliary sulcus implantation of intraocular lens in manual small incision cataract surgery complicated by large posterior capsule rupture. Exp Ther Med 2018; 17:1470-1475. [PMID: 30680030 DOI: 10.3892/etm.2018.7074] [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: 11/10/2015] [Accepted: 01/08/2018] [Indexed: 01/03/2023] Open
Abstract
The present study aimed to evaluate the safety and efficiency of ciliary sulcus implantation of intraocular lens (IOL) in patients that had undergone manual small incision cataract surgery (MSICS) complicated by large posterior capsule rupture (LPCR). A total of 11 eyes taken from 11 patients in Brazzaville, Republic of the Congo, that had experienced LPCR following MSICS were included in the current study. A rigid single-piece IOL (5.5 mm optic, 12.50 mm overall length) was implanted into the ciliary sulcus. Postoperative follow-up assessments evaluated visual acuity, anterior segment biomicroscopy, IOL centration and position, and fundus biomicroscopy. The median follow-up time was 3.7 months (range, 2-6 months). All patients experienced vision improvement: Uncorrected visual acuity 2 months following surgery was 0.3-0.5 in 9 patients and >0.5 in 2 patients. Postoperative complications included pronounced anterior segment inflammation (1 patient), mild corneal endothelium edema (3 patients), residual cortex (1 patient) and intraocular pressure elevation (1 patient). Significant IOL decentration and tilt were not observed in any patients. The results of the present study indicate that ciliary sulcus implantation of a rigid single-piece IOL may be a feasible and effective method of treating patients that have experienced LPCR complications following cataract surgery, as it provides satisfactory visual acuity outcomes. Appropriate intraoperative management may reduce the incidence of postoperative complications.
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Affiliation(s)
- Jinrong Zhao
- Department of Refractive Surgery Centre, Tianjin Eye Hospital, Tianjin 300121, P.R. China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Tiecheng Wang
- Department of Cataract, Tianjin Medical University Eye Hospital and The College of Optometry and Ophthalmology, Tianjin 300384, P.R. China
| | - Bertin Mban
- Department of Ophthalmology, Sino-Congo Friendship Hospital, Brazzaville B.P. 869, Republic of the Congo
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Yip JLY, Bright T, Ford S, Mathenge W, Faal H. Process evaluation of a National Primary Eye Care Programme in Rwanda. BMC Health Serv Res 2018; 18:950. [PMID: 30526579 PMCID: PMC6286556 DOI: 10.1186/s12913-018-3718-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/15/2018] [Indexed: 12/05/2022] Open
Abstract
Background Visual impairment is a global public health problem, with an estimated 285 million affected globally, of which 43% are due to refractive error. A lack of specialist eye care in low and middle-income countries indicates a new model of care would support a task-shifting model and address this urgent need. We describe the features and results of the process evaluation of a national primary eye care (PEC) programme in Rwanda. Methods We used the Medical Research Council process evaluation framework to examine the implementation of the PEC programme, and to determine enablers and challenges to implementation. The process evaluation uses a mixed methods approach, drawing on results from several sources including a survey of 574 attendees at 50 PEC clinics, structured clinical observations of 30 PEC nurses, in-depth interviews with 19 key stakeholders, documentary review and a participatory process evaluation workshop with key stakeholders to review collated evidence and contextualize the results. Results Structured clinical assessment indicated that the PEC provided is consistent with the PEC curriculum, with over 90% of the clinical examination processes conducted correctly. In 4 years, programme monitoring data showed that nearly a million PEC eye examinations had been conducted in every health centre in Rwanda, with 2707 nurses trained. The development of the eye health system was an important enabler in the implementation of PEC, where political support allowed key developments such as inclusion of eye-drops on the essential medicines list, the inclusion of PEC on insurance benefits, the integration of PEC indicators on the health management information systems and integration of the PEC curriculum into the general nursing school curriculum. Challenges included high turnover of primary care nurses, lack of clarity and communication on the future funding of the programme, competing priorities for the health sector and sustained supervision to assure quality of care. Conclusions A model of a national primary eye care programme is presented, with service delivery to all areas in Rwanda. Key learning from this evaluation is the importance of strengthening the eye health care system, together with a strong focus on training primary care nurses using a PEC curriculum. Electronic supplementary material The online version of this article (10.1186/s12913-018-3718-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer L Y Yip
- International Centre for Evidence on Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1V, UK. .,International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Tess Bright
- International Centre for Evidence on Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1V, UK
| | | | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr Agarwal's Eye Hospital, Kigali, Rwanda
| | - Hannah Faal
- Africa Vision Research Institute, Durban, South Africa, University of Calabar, Calabar, Nigeria
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Decentralised clinical training in optometry: a developmental strategy for eye health in KwaZulu Natal? Prim Health Care Res Dev 2018; 20:e35. [PMID: 29921342 PMCID: PMC6536766 DOI: 10.1017/s1463423618000397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Decentralised clinical training (DCT) in optometry is an emerging concept in South Africa. In 2016, the University of KwaZulu Natal (UKZN) implemented this adaptive model of clinical training for undergraduate health professions. The initiative, which emanated through an agreement between UKZN’s College of Health Sciences and the KwaZulu Natal Department of Health, centres on the placement of undergraduate optometry students within public health facilities for clinical training purposes. Optometry services in South Africa have, however, had a historical bias towards a private sector model of training and a curative practice approach resulting in access barriers for the rural poor and high levels of unmet need. It has further contributed to a general state of underdevelopment of eye health services within the public sector. Discussion DCT challenges historical undergraduate programme structures and modes of teaching and learning in optometry. It is largely underpinned by a need to strengthen health service delivery through a primary health care-centred, community-based training approach and produce ‘fit-for-purpose’ graduates who have contextually appropriate competencies for effective, local health service delivery. The historical absence of optometry services within the public sector has, however, contributed to limited planning for, and development of eye health services in this sector. This has inadvertently contributed to the burden of avoidable vision impairment in the country. The public health system in South Africa, therefore, faces various developmental challenges which impact eye health services and student clinical training. Conclusion While the model is still in a developmental state and resourcing challenges potentially affecting DCT are noted, early experiences of the Discipline of Optometry at the UKZN are that DCT shows promise in terms of its potential contribution towards the development of eye health services within the public health sector from graduate readiness, resource strengthening, access improvement and health service development perspectives.
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Strengthening primary eye care in South Africa: An assessment of services and prospective evaluation of a health systems support package. PLoS One 2018; 13:e0197432. [PMID: 29758069 PMCID: PMC5951550 DOI: 10.1371/journal.pone.0197432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/02/2018] [Indexed: 11/19/2022] Open
Abstract
Visual impairment is a significant public health concern, particularly in low- and middle-income countries where eye care is predominantly provided at the primary healthcare (PHC) level, known as primary eye care. This study aimed to perform an evaluation of primary eye care services in three districts of South Africa and to assess whether an ophthalmic health system strengthening (HSS) package could improve these services. Baseline surveys were conducted in Cape Winelands District, Johannesburg Health District and Mopani District at 14, 25 and 36 PHC facilities, respectively. Thereafter, the HSS package, comprising group training, individual mentoring, stakeholder engagement and resource provision, was implemented in 20 intervention sites in Mopani District, with the remaining 16 Mopani facilities serving as control sites. At baseline, less than half the facilities in Johannesburg and Mopani had dedicated eye care personnel or sufficient space to measure visual acuity. Although visual acuity charts were available in most facilities, <50% assessed patients at the correct distance. Median score for availability of nine essential drugs was <70%. Referral criteria knowledge was highest in Cape Winelands and Johannesburg, with poor clinical knowledge across all districts. Several HSS interventions produced successful outcomes: compared to control sites there was a significant increase in the proportion of intervention sites with eye care personnel and resources such as visual acuity charts (p = 0.02 and <0.01, respectively). However, engaging with district pharmacists did not improve availability of essential drugs (p = 0.47). Referral criteria knowledge improved significantly in intervention sites (p<0.01) but there was no improvement in clinical knowledge (p = 0.76). Primary eye care in South Africa faces multiple challenges with regard to organisation of care, resource availability and clinical competence. The HSS package successfully improved some aspects of this care, but further development is warranted together with debate regarding the positioning of eye services at PHC level.
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Jolley E, Mafwiri M, Hunter J, Schmidt E. Integration of eye health into primary care services in Tanzania: a qualitative investigation of experiences in two districts. BMC Health Serv Res 2017; 17:823. [PMID: 29237503 PMCID: PMC5729236 DOI: 10.1186/s12913-017-2787-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/07/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Visual impairment is a public health problem in sub-Saharan Africa, affecting nearly 5% of the population. Efforts to combat avoidable causes have been hampered by weak health systems and little evidence exists to suggest what interventions may be effective to improve the situation. Despite this, there are calls to promote some specific interventions, one of which being the closer integration of eye health services into health systems, often focusing on training primary health workers to deliver basic eye health services. This study seeks to understand how eye health services are delivered by primary health workers who have received training and what constraints remain to effective service provision. METHODS This was a qualitative investigation into the experiences of 20 primary health workers trained in primary eye care and eight key informants working within specialist eye health services or regional and district health management positions in two districts in Tanzania. RESULTS Despite feeling confident in their own eye care skills, most primary health workers felt constrained in the services they could provide to their communities by insufficient resources needed for diagnosis and treatment, and by lack of systematic supportive supervision to their work. Specialist ophthalmic staff were aware of this issue, although for the most part they felt it was not within their capacity to remedy and that it fell within the remit of general health managers. Many participants discussed the low support to eye health from the national government, evidenced through the lack of dedicated funding to the area and traditional reliance on outside funds including international charities. CONCLUSIONS Although training of primary health workers is useful, it is recognised that is not sufficient to address the burden of eye health disease present in rural communities in Tanzania. It is likely that broader engagement with the general health system, and most likely with the private sector, will be necessary to improve the coverage of eye health care to remote and poor communities such as those in Morogoro. Further investment is needed to develop innovative approaches to delivering eye health services, including preventative, curative and rehabilitative services.
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Affiliation(s)
- Emma Jolley
- Sightsavers, 35 Perrymount Road, Haywards Heath, UK.
| | - Milka Mafwiri
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
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Mulwafu W, Kuper H, Viste A, Goplen FK. Feasibility and acceptability of training community health workers in ear and hearing care in Malawi: a cluster randomised controlled trial. BMJ Open 2017; 7:e016457. [PMID: 29025832 PMCID: PMC5652500 DOI: 10.1136/bmjopen-2017-016457] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the feasibility and acceptability of training community health workers (CHWs) in ear and hearing care, and their ability to identify patients with ear and hearing disorders. DESIGN Cluster randomised controlled trial (RCT). SETTING Health centres in Thyolo district, Malawi. PARTICIPANTS Ten health centres participated, 5 intervention (29 CHWs) and 5 control (28 CHWs). INTERVENTION Intervention CHWs received 3 days of training in primary ear and hearing care, while among control CHWs, training was delayed for 6 months. Both groups were given a pretest that assessed knowledge about ear and hearing care, only the intervention group was given the posttest on the third day of training. The intervention group was given 1 month to identify patients with ear and hearing disorders in their communities, and these people were screened for hearing disorders by ear, nose and throat clinical specialists. OUTCOME MEASURES Primary outcome measure was improvement in knowledge of ear and hearing care among CHWs after the training. Secondary outcome measures were number of patients with ear or hearing disorders identified by CHWs and number recorded at health centres during routine activities, and the perceived feasibility and acceptability of the intervention. RESULTS The average overall correct answers increased from 55% to 68% (95% CI 65 to 71) in the intervention group (p<0.001). A total of 1739 patients with potential ear and hearing disorders were identified by CHWs and 860 patients attended the screening camps, of whom 400 had hearing loss (73 patients determined through bilateral fail on otoacoustic emissions, 327 patients through audiometry). Where cause could be determined, the most common cause of ear and hearing disorders was chronic suppurative otitis media followed by impacted wax. The intervention was perceived as feasible and acceptable to implement. CONCLUSIONS Training was effective in improving the knowledge of CHW in ear and hearing care in Malawi and allowing them to identify patients with ear and hearing disorders. This intervention could be scaled up to other CHWs in low-income and middle-income countries. TRIAL REGISTRATION NUMBER Pan African Clinical Trial Registry (201705002285194); Results.
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Affiliation(s)
- Wakisa Mulwafu
- Department of Surgery, College of Medicine Blantyre Malawi, Blantyre, Malawi
| | - Hannah Kuper
- Department of Clinical Research, The London School of Hygiene & Tropical Medicine, London, UK
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Rodrigues Junior JC, Rebouças CBDA, Castro RCMB, Oliveira PMPD, Almeida PCD, Pagliuca LMF. DEVELOPMENT OF AN EDUCATIONAL VIDEO FOR THE PROMOTION OF EYE HEALTH IN SCHOOL CHILDREN. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017006760015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objetive: to build an educational video for early detection of trouble seeing in schoolers. Method: technology development study in three stages: pre-production, production and post-production in the period from March to December 2014. The recordings were made in a public school in Fortaleza (Brazil) and Health Communication Laboratory in the Universidade Federal do Ceará in the Department of Nursing. Results: about the evaluation of content, the script was considered valid by all experts. Four (44.4%) approved the script of the video and five (55.5%) approved with modifications. For technical experts, three (60%) considered it approved with modifications, while two (40%) judged it as approved (IVC≥0,8). In post-production, it was suggested changes in length, audio and esthetics. The video ended with 16 minutes and 14 seconds. CONCLUSION: it is believed that the educational video together to health professionals interventions contribute to the public understanding of the subject, resulting in early diagnosis of trouble seeing and resolving eye problems.
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Rolnick K, Buck S, Mezu-Nnabue K, Eickhoff J, Esenwah E, Mezu-Ndubuisi OJ. Influence of socio-economic status and educational achievement on cataract formation in a rural community in Imo State, South-Eastern Nigeria. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1326212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Kevin Rolnick
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Sean Buck
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Kelechi Mezu-Nnabue
- Department of Global Health, Mezu International Foundation, Pikesville, MD, USA
| | - Jens Eickhoff
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Emma Esenwah
- Department of Optometry, Federal University of Technology Owerri (FUTO), Imo State, Nigeria
| | - Olachi J. Mezu-Ndubuisi
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- Department of Ophthalmology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, H4-415, Madison, WI 53792, USA
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Mafwiri MM, Jolley E, Hunter J, Gilbert CE, Schmidt E. Mixed methods evaluation of a primary eye care training programme for primary health workers in Morogoro Tanzania. BMC Nurs 2016; 15:41. [PMID: 27390550 PMCID: PMC4936119 DOI: 10.1186/s12912-016-0163-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are 285 million people with visual impairment (VI) worldwide including 39 million who are blind; 15 % of those with VI live in Africa, and around 80 % of VI is preventable or treatable with the right equipment, information and skills. The scarcity of human resources for eye health, particularly in Sub-Saharan Africa, is a key challenge towards achieving this goal. Therefore training primary health workers (PHW) in providing eye-care services has been seen by some authors as a way to improve access to eye-care services in remote communities. However, the package of interventions which could be effectively delivered for eye-care at the primary-care level or the set of skills and competencies that PHWs need has not yet been delineated. The aim of the study was to evaluate the effectiveness of a four day training programme of PHWs in primary eye-care conducted in Morogoro, Tanzania in 2010/2011. METHODS A mixed methods study using pre- and immediate post-training knowledge assessment of 60 trainees, and in-depth face to face interviews with 20 PHWs and 8 service managers 2 to 3 years after the training. RESULTS Pre-and immediate post-training assessments indicated improvement in health worker knowledge about eye-care in the short term. Qualitative investigations 2 to 3 years after the training showed that although staff could make the correct management decisions when presented with eye-health problems, they often could not make a correct diagnosis. PHWs and managers reported satisfaction with the content of the training but some of the less well qualified staff found it overwhelming. Theoretical teaching was appreciated by most participants but almost all suggested increasing the time spent on acquiring skills. The training manual was accepted by many and some improvements were recommended. All interviewed PHWs were keen to improve their skills and knowledge. Acquired skills and knowledge were used for identification, referral of patients and for eye-health promotion. CONCLUSION The training program in Morogoro was considered by PHWs as broadly successful and satisfying in terms of content, methods and duration of training. However, any future programme needs to be considered within the context of strengthening wider health systems.
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Affiliation(s)
- Milka Madaha Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, P.O. Box 65405, Dar-es-Salaam, Tanzania
| | | | | | - Clare Elizabeth Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Courtright P, Mathenge W, Kello AB, Cook C, Kalua K, Lewallen S. Setting targets for human resources for eye health in sub-Saharan Africa: what evidence should be used? HUMAN RESOURCES FOR HEALTH 2016; 14:11. [PMID: 26984773 PMCID: PMC4794905 DOI: 10.1186/s12960-016-0107-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/09/2016] [Indexed: 05/13/2023]
Abstract
With a global target set at reducing vision loss by 25% by the year 2019, sub-Saharan Africa with an estimated 4.8 million blind persons will require human resources for eye health (HReH) that need to be available, appropriately skilled, supported, and productive. Targets for HReH are useful for planning, monitoring, and resource mobilization, but they need to be updated and informed by evidence of effectiveness and efficiency. Supporting evidence should take into consideration (1) ever-changing disease-specific issues including the epidemiology, the complexity of diagnosis and treatment, and the technology needed for diagnosis and treatment of each condition; (2) the changing demands for vision-related services of an increasingly urbanized population; and (3) interconnected health system issues that affect productivity and quality. The existing targets for HReH and some of the existing strategies such as task shifting of cataract surgery and trichiasis surgery, as well as the scope of eye care interventions for primary eye care workers, will need to be re-evaluated and re-defined against such evidence or supported by new evidence.
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Affiliation(s)
- Paul Courtright
- />Kilimanjaro Centre for Community Ophthalmology International c/o Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Wanjiku Mathenge
- />Rwanda International Institute of Ophthalmology, Kigali, Rwanda
- />Dr. Agarwal’s Eye Hospital, Kigali, Rwanda
| | | | - Colin Cook
- />Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Khumbo Kalua
- />Blantyre Institute of Community Ophthalmology, Blantyre, Malawi
| | - Susan Lewallen
- />Kilimanjaro Centre for Community Ophthalmology International c/o Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
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Affiliation(s)
- Leah A Owen
- From the University of Utah, Salt Lake City, UT
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Boadi-Kusi SB, Ntodie M, Mashige KP, Owusu-Ansah A, Antwi Osei K. A cross-sectional survey of optometrists and optometric practices in Ghana. Clin Exp Optom 2015; 98:473-7. [PMID: 25944332 DOI: 10.1111/cxo.12291] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/06/2014] [Accepted: 11/14/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The study was conducted to profile optometrists and optometric practices in Ghana. METHODS An online survey was conducted among 146 optometrists, who were registered with the Ghana Optometric Association (GOA). It included questions on their demographics, equipment, ophthalmic procedures routinely conducted and the barriers to providing a full scope of optometric services. RESULTS Ninety registered optometrists (62 per cent) responded, their mean age being 28.97 ± 3.36 years. There were more males (68.9 per cent) than females and most had the Doctor of Optometry (OD) degree, the profession's highest degree in Ghana. There were more practitioners in urban centres (71.1 per cent) and most practices had basic optometric instruments, such as direct ophthalmoscopes, slitlamp biomicroscopes and retinoscopes. Many optometrists routinely conducted direct ophthalmoscopy (100 per cent), slitlamp biomicroscopy (87.5 per cent) and contact tonometry (55.7 per cent); however, few provided contact lens (10.2 per cent) and low vision (9.1 per cent) assessments, with 76 per cent stating that it was due to the unavailability of low vision devices, poor sources of contact lenses (27 per cent) and perceived insufficient training (11.2 per cent). Many practitioners (97 per cent) reported the use of diagnostic pharmaceutical agents and therapeutic pharmaceutical agents (96.6 per cent). Most practitioners (52.9 per cent) preferred conferences for the delivery of continuous professional development over publications (26.4 per cent) and internet resources (12.6 per cent). CONCLUSION The data elicited in this study provide a basis for addressing the country's unmet eye-care needs and can be used to determine training and support guidelines for the profession.
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Affiliation(s)
- Samuel Bert Boadi-Kusi
- Discipline of Optometry, University of KwaZulu-Natal, South Africa.,Department of Optometry, University of Cape Coast, Ghana
| | - Michael Ntodie
- Department of Optometry, University of Cape Coast, Ghana
| | | | | | - Kwaku Antwi Osei
- College of Optometry, University of Houston, Houston, Texas, USA
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Sithole HL. An overview of the National Health Insurance and its possible impact on eye healthcare services in South Africa. AFRICAN VISION AND EYE HEALTH 2015. [DOI: 10.4102/aveh.v74i1.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The National Health Insurance (NHI) is an important development that underpins democracy in South Africa. It aims to redress the inequities of public healthcare delivery by implementing transformational policies towards establishing inclusive public healthcare coverage for the entire population of South Africa, with more emphasis on health promotion. The implementation of this initiative has created some hope amongst primary eye healthcare professionals, such as optometrists, that their profession may finally be given the recognition it deserves. Although the government is contemplating introducing a new directorate for eye healthcare and forming an advisory committee on eye healthcare reporting to the Minister of Health, the extent to which eye healthcare will be incorporated into the NHI is currently not clear. It is believed that the white paper on the NHI will shed some light on these issues. Unfortunately, current indications are that the initiative has serious challenges to overcome such as poor infrastructure, budgetary constraints and lack of interest from other healthcare professionals. Furthermore, corruption issues may also need to be addressed if the NHI is to be implemented successfully. Nevertheless, the NHI remains a positive proposition for universal health coverage for the people of South Africa, and there is hope that primary eye care providers, such as optometrists and other eye care professionals, will also play a greater role in the NHI than they currently do in the public healthcare system.
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Senyonjo L, Lindfield R, Mahmoud A, Kimani K, Sanda S, Schmidt E. Ocular morbidity and health seeking behaviour in Kwara state, Nigeria: implications for delivery of eye care services. PLoS One 2014; 9:e104128. [PMID: 25165984 PMCID: PMC4148257 DOI: 10.1371/journal.pone.0104128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 07/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is currently limited information as to which conditions are most prevalent in communities in developing countries. This makes effective planning of eye services difficult. METHODS 3,899 eligible individuals were recruited and examined in a cross-sectional survey in Asa Local Government Area, Nigeria. Those who self-reported an ocular morbidity were also asked about their health-seeking behaviour. Health records of local facilities were reviewed to collect information on those presenting with ocular morbidities. RESULTS 25.2% (95% CI: 22.0-28.6) had an ocular morbidity in at least one eye. Leading causes were presbyopia and conditions affecting the lens and conjunctiva. The odds of having an ocular morbidity increased with age and lower educational attainment. 10.1% (7.7-13.0) self-reported ocular morbidity; 48.6% (40.4-56.8) of them reported seeking treatment. At the facility level, 344 patients presented with an ocular morbidity over one month, the most common conditions were red (26.3%) or itchy (20.8%) eyes. CONCLUSION Ocular morbidities, including many non vision impairing conditions, were prevalent with a quarter of the population affected. The delivery of eye care services needs to be tailored in order to address this need and ensure delivery in a cost-effective and sustainable manner.
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Affiliation(s)
- Laura Senyonjo
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
- * E-mail:
| | - Robert Lindfield
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abdulraheem Mahmoud
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Elena Schmidt
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
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Blanchet K, Gilbert C, de Savigny D. Rethinking eye health systems to achieve universal coverage: the role of research. Br J Ophthalmol 2014; 98:1325-8. [PMID: 24990874 PMCID: PMC4174128 DOI: 10.1136/bjophthalmol-2013-303905] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Achieving universal coverage in eye care remains a tremendous challenge as 226 million people in the world remain visually impaired, the majority from avoidable causes. The impact of eye care interventions has been constrained by the limited capacities of health systems in low-income and middle-income countries to deliver effective eye care services. Services for eye health are still not adequately integrated into the health systems of low-income and middle-income countries. We contend that radical rethinking and deeper development of eye health systems are necessary to achieve VISION 2020 goals. Responding to the challenges of chronic eye diseases will require systems thinking, analysis and action, based on evidence from health systems research.
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Affiliation(s)
- Karl Blanchet
- Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Gilbert
- Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Don de Savigny
- Swiss Tropical and Public Health Institute, London, UK University of Basel, Basel, Switzerland
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