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Herrod S, Sherief ST, Ahmed A, Mutati GC, Welling J, Wiafe B, Gyasi M, Crookston B, West J, Hall C. Ophthalmologists' Perspective on Barriers to Cataract Surgery and Surgical Productivity in Ethiopia, Ghana, and Zambia: A Descriptive, Mixed-Methods Survey. Ophthalmic Epidemiol 2024; 31:409-419. [PMID: 38237029 DOI: 10.1080/09286586.2023.2301581] [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: 04/08/2023] [Revised: 11/09/2023] [Accepted: 12/26/2023] [Indexed: 09/08/2024]
Abstract
PURPOSE While progress was made towards the Vision 2020: The Right to Sight goals, Ethiopia, Ghana, and Zambia fell short of the recommended cataract surgical rate (CSR) on a national level. Post-operative cataract surgical outcomes are also lower compared to other regions. This study aimed to describe perceived barriers to cataract surgical uptake, factors related to surgeon surgical productivity, and surgical offerings in each of these countries. METHODS An online survey was sent to ophthalmologists practicing in Ethiopia, Ghana, and Zambia. Responses were collected between June 25, 2021 and January 30, 2022. RESULTS Responses were received from 122 ophthalmologists from Ethiopia, Ghana, and Zambia. The estimated participation rate was 47% (122/257). Distance to cataract surgical centres, lack of surgical centres, and lack of surgical equipment were among the top 10 most agreed upon barriers by respondents within each country. Many respondents reported that current financial reimbursement does not incentivise maximum productivity in themselves (56%, 68/122) or their staff (61%, 74/122). Surgeons proposed several ways to improve productivity incentives. Private practice was perceived to have the best reimbursement incentives (77%, 94/122), whereas government hospitals were least agreed upon (4%, 5/122). Discrepancies in timely post-operative refraction and eyeglasses disbursement were reported. CONCLUSIONS Overcoming the identified barriers, improving surgeon productivity, and addressing identified deficits in cataract care will likely reduce the backlog of cataract blindness while ensuring increasingly improved patient outcomes.
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Affiliation(s)
- Scott Herrod
- Department of Public Health, Brigham Young University, Provo, UT, USA
- Harvard Medical School, Boston, MA, USA
- Daybreak Vision Project, Alpine, UT, USA
| | - Sadik Taju Sherief
- Himalayan Cataract Project, Waterbury, VT, USA
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Akwasi Ahmed
- Daybreak Vision Project, Alpine, UT, USA
- The Eye Centre, Komfo Anokye Teaching Hospital, Kumasi, Ashanti Region, Ghana
| | - Grace Chipalo Mutati
- Department of Ophthalmology, University Teaching Hospital, Lusaka, Lusaka Province, Zambia
| | - John Welling
- Daybreak Vision Project, Alpine, UT, USA
- Medical Eye Center, Oregon, USA
| | - Boateng Wiafe
- Operation Eyesight Universal, Accra, Greater Accra Region, Ghana
| | - Michael Gyasi
- St. Thomas Eye Hospital, Accra, Greater Accra Region, Ghana
- Unite for Sight, North Haven, CT, USA
| | | | - Joshua West
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - Cougar Hall
- Department of Public Health, Brigham Young University, Provo, UT, USA
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Mohammed J, Assegid S, Fekadu L, Kabeta T. Cataract Surgery Visual Outcome and Associated Factors Among Adults Attended Jimma University Medical Center, Jimma, Southwest Ethiopia. Clin Ophthalmol 2023; 17:3341-3351. [PMID: 37941776 PMCID: PMC10629348 DOI: 10.2147/opth.s434453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
Background Cataract is the leading cause of blindness and the second leading cause of visual impairment worldwide, accounting for 51% and 33% of all cases, respectively, in low- and medium-income countries bearing a disproportionately high burden. Hence, this study aimed to assess the visual outcome of age-related cataract surgery and identify factors associated with patients' postoperative visual outcomes in Jimma University Medical Center, Southwest Ethiopia. Methods An institution-based cross-sectional study design was conducted among 386 cataract surgery patients from January 1, 2016, to December 30, 2017. The study participants were selected using a systematic random sampling technique. Data were collected by reviewing the selected patients' medical records using a pre-tested checklist, entered into EpiData version 3.1, and exported to SPSS 20 for analysis. Proportions, summary statistics, and tables were used for presentations of the findings. Binary logistic regression was carried out to identify independent predictors of visual outcome. Findings were presented with adjusted odds ratios and their 95% confidence interval. A p-value <0.05 was used to declare a statistically significant association. Results About 231 individuals (59.8%) had poor visual results following cataract surgery. Furthermore, age >70 (AOR = 3.64; 95% CI [1.35-9.82]), preoperative ocular co-morbidities (AOR = 2.34; [1.32-4.15]), incision-based cataract surgery (AOR = 7.11; [3.16-16.02]), compared phacoemulsification operated by resident surgeons (AOR = 2.19; [1.23-3.89]), presence of intraoperative complication (AOR = 3.41; [1.47-7.92]), lens remnant (AOR = 2.91; [1.11-4.92]), ocular inflammation (OR = 2.56; [1.34-4.92]), and striate keratopathy/corneal edema (AOR = 1.91; [1.07-3.44]) were significantly associated with poor visual outcome. Conclusion The visual outcome following cataract surgery fall below WHO recommendation. In this study, age, ocular co-morbidities, surgical method, surgeon status, intraoperative complication, SK, and ocular inflammation associated with post-operative Uveitis and anterior chamber reaction were associated with a poor visual outcome.
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Affiliation(s)
- Jemmal Mohammed
- Department of Ophthalmology, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sahilu Assegid
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lata Fekadu
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teshome Kabeta
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Malcolm J, Bako A. Reducing the costs per patient by increasing the volume of cataract surgery. COMMUNITY EYE HEALTH 2022; 35:14-15. [PMID: 36704531 PMCID: PMC9872216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jonathan Malcolm
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ahmed Bako
- Department of Ophthalmology, Specialist Hospital, Sokoto, Nigeria
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Time to recovery from cataract and its predictors among eye cataract patients treated with cataract surgery: A retrospective cohort study in Ethiopia. Ann Med Surg (Lond) 2021; 65:102275. [PMID: 33898037 PMCID: PMC8054098 DOI: 10.1016/j.amsu.2021.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background Cataracts is the major global causes of blindness and a vision-affecting disease of the eye. Cataract surgery is a curative and cost-effective intervention. The number of people who undergo cataract surgery has increased rapidly. Hence, this study was aimed to determine predictors and the time of recovery of cataract patients after cataract surgery by using Simi parametric models of survival analysis. Methods A retrospective cohort study was conducted from January/01/2015 and January/30/2019. STATA version14.0 statistical software was used for analysis. The Kaplan-Meier survival method and log-rank test curves were applied. Weibull regression was used and adjusted hazard ratio 95% CI with a value of p less than 0.05 was used to identify a significant association. Results Two hundred twenty three cataract patients were recovered from cataract, 72.6% (95% CI 69.8%–75.9%). The overall median survival time was 23 weeks (IQR = 16 to 35) with (95% CI, 21%–25%). aged between 16 and 30year (AHR = 1.20 CI; 1.07–2.36), age 31 to 45 (AHR = 1.24 CI; 1.08–1.54), urban dwellers (AHR = 1.59; 95% CI, 1.18–2.14), medium visual acuity (AHR = 4.14 CI; 2.57–6.67), high visual acuity (AHR = 5.23 CI; 3.06–8.93), Secondary cataract (AHR = 2.59 CI; 1.01–3.02), traumatic cataract (AHR = 1.75 CI; 1.01–3.02), extra capsular cataract extraction surgery (AHR = 1.43 CI; 1.07–1.94),and diabetes mellitus (AHR = 0.75, CI; 0.41–0.96) were notably associated with time to recovery. Conclusion Time to recovery in the study area was slightly higher as compared with the global cut of time. Cataract patients with comorbidity of DM had lower recovery time. A 72.6% cataract patients were recovered and 27.4% of were censored from cataract. The overall median survival time was 23 weeks and the mean recovery time of the patients was 23.24 weeks. A significant difference seen in the recovery rate among cataract patients with/out diabetes mellitus. Time to recovery in the study area was slightly higher.
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Willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia. PLoS One 2021; 16:e0248618. [PMID: 33760830 PMCID: PMC7990211 DOI: 10.1371/journal.pone.0248618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction In Ethiopia, cataract surgery is mainly provided by donors free of charge through outreach programs. Assessing willingness to pay for patients for cataract surgery will help explain how the service is valued by the beneficiaries and design a domestic source of finance to sustain a program. Although knowledge concerning willingness to pay for cataract surgery is substantive for developing a cost-recovery model, the existed knowledge is limited and not well-addressed. Therefore, the study aimed to assess willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia. Methods A cross-sectional outreach-based study was conducted on 827 cataract patients selected through a simple random sampling method in Tebebe Gion Specialized Hospital, North West Ethiopia, from 10/11/2018 to 14/11/2018. The data were collected using a contingent valuation elicitation approach to elicit the participants’ maximum willingness to pay through face to face questionnaire interviews. The descriptive data were organized and presented using summary statistics, frequency distribution tables, and figures accordingly. Factors assumed to be associate with a willingness to pay were identified using a Tobit regression model with a p-value of <0.05 and confidence interval (CI ≠ 0). Results The study involved 827 cataract patients, and their median age was 65years. About 55% of the participants were willing to pay for the surgery. The average amount of money willing to pay was 17.5USD (95% CI; 10.5, 35.00) and It was significantly associated with being still worker (β = 26.66, 95% CI: 13.03, 40.29), being educated (β = 29.16, 95% CI: 2.35, 55.97), free from ocular morbidity (β = 28.48, 95% CI: 1.08, 55.90), duration with the condition, (β = -1.69, 95% CI: -3.32, -0.07), admission laterality (β = 21.21, 95% CI: 3.65, 38.77) and remained visual ability (β = -0.29, 95% CI (-0.55, -0.04). Conclusions Participants’ willingness to pay for cataract surgery in outreach Sites is much lower than the surgery’s actual cost. Early intervention and developing a cost-recovery model with multi-tiered packages attributed to the neediest people as in retired, less educated, severely disabled is strategic to increase the demand for service uptake and service accessibility.
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Ophthalmology training in sub-Saharan Africa: a scoping review. Eye (Lond) 2020; 35:1066-1083. [PMID: 33323984 DOI: 10.1038/s41433-020-01335-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 11/08/2022] Open
Abstract
Sub-Saharan Africa is home to 12% of the global population, and 4.3 million are blind and over 15 million are visually impaired. There are only 2.5 ophthalmologists per million people in SSA. Training of ophthalmologists is critical. We designed a systematic literature review protocol, searched MEDLINE Ovid and Embase OVID on 1 August 2019 and limited these searches to the year 2000 onwards. We also searched Google Scholar and websites of ophthalmic institutions for additional information. We include a total of 49 references in this review and used a narrative approach to synthesise the results. There are 56 training institutions for ophthalmologists in eleven Anglophone, eleven Francophone, and two Lusophone SSA countries. The median duration of ophthalmology training programmes was 4 years. Most curricula have been regionally standardised. National, regional and international collaborations are a key feature to ophthalmology training in more than half of ophthalmology training programmes. There is a drive, although perhaps not always evidence-based, for sub-specialisation in the region. Available published scientific data on ophthalmic medical and surgical training in SSA is sparse, especially for Francophone and Lusophone countries. However, through a broad scoping review strategy it has been possible to obtain a valuable and detailed view of ophthalmology training in SSA. Training of ophthalmologists is a complex and multi-faceted task. There are challenges in appropriate selection, capacity, and funding of available training institutions. Numerous learning outcomes demand curriculum, time, faculty, support, and appropriate assessment. There are opportunities provided by modern training approaches. Partnership is key.
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The Association between Socioeconomic Factors and Visual Function among Patients with Age-Related Cataracts. J Ophthalmol 2020; 2020:7236214. [PMID: 33335783 PMCID: PMC7722637 DOI: 10.1155/2020/7236214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background With the development of the economy, socioeconomic factors, such as inequalities in the status of regional economies and the subsequent effects on health systems, have influenced the status of health. We explored the association between age-related cataracts and socioeconomic indicators, including the regional economy, health systems, and energy industries. Methods This was a prospective, multicenter, Chinese population-based, cross-sectional study. A total of 830 participants from seven centers were enrolled. Data on the best-corrected visual acuity (BCVA), Lens Opacities Classification System III (LOCS III) score, Visual Function Index-14 (VF-14) score, total and subscale scores of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), per capita disposable income (PCDI), medical resource-related indicators, and investments in the energy industry were obtained. Associations among these parameters were analyzed. Results The PCDI ranking was correlated with the VF-14 score (R = -0.426, P < 0.01), total score of NEI-VFQ-25 (r = -0.500, P < 0.01), and BCVA (r = 0.278, P < 0.01). The number of health agencies (r1 = 0.267, r2 = -0.303, r3 = -0.291,), practicing or assistant practicing doctors (r1 = -0.283, r2 = 0.427, r3 = 0.502,), registered nurses (r1 = -0.289, r2 = 0.409, r3 = 0.469, P < 0.01), and health technicians (r1 = -0.278, r2 = 0.426, r3 = 0.500, P < 0.01) per 10,000 of the population was each correlated with the BCVA, VF-14 score, and total score of NEI-VFQ-25, respectively. Health expenditure per capita was correlated with the VF-14 score (r = 0.287, P < 0.01) and total score of NEI-VFQ-25 (r = 0.459, P < 0.01). The LOCS III P score was correlated with investments in the energy industry (r = 0.485, P < 0.001). Conclusions Patients in higher economic regions with greater medical resources show a greater demand to undergo cataract surgery at a better subjective and objective visual function. The energy industry has a significant effect on cataracts, especially the posterior subcapsular cataract, and thus more attention should be paid to people in regions with abundant energy industries.
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Rono H, Bastawrous A, Macleod D, Wanjala E, Gichuhi S, Burton M. Peek Community Eye Health - mHealth system to increase access and efficiency of eye health services in Trans Nzoia County, Kenya: study protocol for a cluster randomised controlled trial. Trials 2019; 20:502. [PMID: 31412937 PMCID: PMC6694474 DOI: 10.1186/s13063-019-3615-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/26/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Globally, eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services; in addition, specialist services are over-utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smartphone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteers (CV) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualising service delivery. We hypothesise that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. STUDY DESIGN A single masked, cluster randomised controlled trial design will be used. The unit of randomisation will be the 'community unit', defined as a dispensary or health centre with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitisation, where attendance will be ascertained. During triage, participants will be assessed and treated and, if necessary, referred onwards to Kitale Eye Unit. DISCUSSION We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. TRIAL REGISTRATION The Pan African Clinical Trials Registry (PACTR), 201807329096632 . Registered on 8 June 2018.
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Affiliation(s)
- Hillary Rono
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Kitale County referral and teaching Hospital, Ravine Road, P.O. Box 98, Kitale, 30200 Kenya
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- The Peek Vision Foundation, 1 Fore Street, London, EC2Y 9DT UK
| | - David Macleod
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Emmanuel Wanjala
- Kitale County referral and teaching Hospital, Ravine Road, P.O. Box 98, Kitale, 30200 Kenya
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, P.O. Box 19676, Nairobi, 00202 Kenya
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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NOVEL USE OF STERILIZED DISPOSABLE SURGICAL LENSES FOR POSTERIOR SEGMENT EXAMINATION. Retina 2018; 38:1256-1259. [DOI: 10.1097/iae.0000000000001662] [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]
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Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
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Palmer JJ, Gilbert A, Choy M, Blanchet K. Circumventing 'free care' and 'shouting louder': using a health systems approach to study eye health system sustainability in government and mission facilities of north-west Tanzania. Health Res Policy Syst 2016; 14:68. [PMID: 27612454 PMCID: PMC5017067 DOI: 10.1186/s12961-016-0137-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 08/09/2016] [Indexed: 11/21/2022] Open
Abstract
Background Little is known about the contributions of faith-based organisations (FBOs) to health systems in Africa. In the specialist area of eye health, international and domestic Christian FBOs have been important contributors as service providers and donors, but they are also commonly critiqued as having developed eye health systems parallel to government structures which are unsustainable. Methods In this study, we use a health systems approach (quarterly interviews, a participatory sustainability analysis exercise and a social network analysis) to describe the strategies used by eye care practitioners in four hospitals of north-west Tanzania to navigate the government, church mission and donor rules that govern eye services delivery there. Results Practitioners in this region felt eye care was systemically neglected by government and therefore was ‘all under the NGOs’, but support from international donors was also precarious. Practitioners therefore adopted four main strategies to improve the sustainability of their services: (1) maintain ‘sustainability funds’ to retain financial autonomy over income; (2) avoid granting government user fee exemptions to elderly patients who are the majority of service users; (3) expand or contract outreach services as financial circumstances change; and (4) access peer support for problem-solving and advocacy. Mission-based eye teams had greater freedom to increase their income from user fees by not implementing government policies for ‘free care’. Teams in all hospitals, however, found similar strategies to manage their programmes even when their management structures were unique, suggesting the importance of informal rules shared through a peer network in governing eye care in this pluralistic health system. Conclusions Health systems research can generate new evidence on the social dynamics that cross public and private sectors within a local health system. In this area of Tanzania, Christian FBOs’ investments are important, not only in terms of the population health outcomes achieved by teams they support, but also in the diversity of organisational models they contribute to in the wider eye health system, which facilitates innovation. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0137-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer J Palmer
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.,Centre of African Studies, School of Political and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Alice Gilbert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
| | - Michelle Choy
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, United Kingdom
| | - Karl Blanchet
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, United Kingdom.
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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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HASHEMI H, KHABAZKHOOB M, REZVAN F, ETEMAD K, GILASI H, ASGARI S, MAHDAVI A, SOROUSH S, YEKTA A, FOTOUHI A. Cataract Surgical Rate between 2006 and 2010 in Tehran Province. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:1204-11. [PMID: 26587494 PMCID: PMC4645777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Considering population aging in Iran and the importance of cataract surgery in the old age, this study was performed to show the cataract surgical rate (CSR) between 2006 and 2010 in Tehran Province. METHODS Eighteen centers were randomly selected from cataract surgery centers in Tehran. In each center, one week in every season was randomly selected and the number of cataract surgeries in the week was calculated. In total, 20 weeks were selected in each center in five years. RESULTS The CSR increased linearly from 8011 cases per 1,000,000 population in 2006 to 12465 cases per 1,000,000 population in 2010. As for patients below 40 years of age, the percentage of the male patients was more while after the age of 40 years, the percentage of the female patients was more in all age groups. At least 96.2% of the surgeries in each year were performed using the phacoemulsification method. From 2006 to 2010, the percentage of outpatient surgery increased from 48.7% to 72.5%. On the other hand, hospitalization for one night or more had a decreasing trend from 2006 to 2010. CONCLUSION During 2006-2010, the CSR was acceptable in Tehran in comparison with other studies. However, attention should be paid to the increase in the population of the elderly people. Although more than 95% of the surgeries in the Province of Tehran are performed using the phacoemulsification method, the rate should increase to 100% in the eligible cases.
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Affiliation(s)
- Hassan HASHEMI
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Mehdi KHABAZKHOOB
- Dept. of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad REZVAN
- Dept. of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Koroush ETEMAD
- Dept. of Epidemiology, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza GILASI
- Dept. of Public Health and Biostatistics, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran,Corresponding Author: Tel: +92-21-5689860
| | - Soheila ASGARI
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
| | - Alireza MAHDAVI
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Sara SOROUSH
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Abbasali YEKTA
- Dept. of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akbar FOTOUHI
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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15
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Lewallen S, Schmidt E, Jolley E, Lindfield R, Dean WH, Cook C, Mathenge W, Courtright P. Factors affecting cataract surgical coverage and outcomes: a retrospective cross-sectional study of eye health systems in sub-Saharan Africa. BMC Ophthalmol 2015; 15:67. [PMID: 26122748 PMCID: PMC4485868 DOI: 10.1186/s12886-015-0063-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 06/23/2015] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Recently there has been a great deal of new population based evidence on visual impairment generated in sub-Saharan Africa (SSA), thanks to the Rapid Assessment of Avoidable Blindness (RAAB) survey methodology. The survey provides information on the magnitude and causes of visual impairment for planning services and measuring their impact on eye health in administrative "districts" of 0.5-5 million people. The survey results describing the quantity and quality of cataract surgeries vary widely between study sites, often with no obvious explanation. The purpose of this study was to examine health system characteristics that may be associated with cataract surgical coverage and outcomes in SSA in order to better understand the determinants of reducing the burden of avoidable blindness due to cataract. METHODS This was a descriptive study using secondary and primary data. The outcome variables were collected from existing surveys. Data on potential district level predictor variables were collected through a semi-structured tool using routine data and key informants where appropriate. Once collected the data were coded and analysed using statistical methods including t-tests, ANOVA and the Kruskal-Wallis analysis of variance test. RESULTS Higher cataract surgical coverage was positively associated with having at least one fixed surgical facility in the area; availability of a dedicated operating theatre; the number of surgeons per million population; and having an eye department manager in the facility. Variables that were associated with better outcomes included having biometry and having an eye department manager in the facility. CONCLUSIONS There are a number of health system factors at the district level that seem to be associated with both cataract surgical coverage and post-operative visual acuity outcomes. This study highlights the needs for better indicators and tools by which to measure and monitor the performance of eye health systems at the district level. It is unlikely that epidemiological data alone is sufficient for planning eye health services within a district and health managers and study coordinators need to consider collecting supplementary information in order to ensure appropriate planning can take place.
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Affiliation(s)
- Susan Lewallen
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
| | - Elena Schmidt
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BW, West Sussex, UK.
| | - Emma Jolley
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BW, West Sussex, UK.
| | - Robert Lindfield
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
| | | | - Colin Cook
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
| | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr Agarwal's Eye Hospital, Kigali, Rwanda.
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
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16
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Katibeh M, Blanchet K, Akbarian S, Hosseini S, Ahmadieh H, Burton MJ. "Planning eye health services in Varamin district, Iran: a cross-sectional study". BMC Health Serv Res 2015; 15:140. [PMID: 26021828 PMCID: PMC4517388 DOI: 10.1186/s12913-015-0797-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent survey of avoidable blindness in Varamin District, Iran, identified moderately high levels of visual impairment (10%) and blindness (1.5%) in people >50 years. This study aimed to define current provision, identify gaps and suggest practical solutions for improving eye health services in this area. METHODS The World Health Organization (WHO) framework for analyzing health systems has several key components: service delivery, health workforce, information system, medical products and technologies, financing, and governance. We used this structure to investigate the strengths and weaknesses of the eye health system in Varamin. All public and private eye care facilities and a random selection of primary health care (PHC) units were assessed using semi-structured researcher-administered questionnaires. RESULTS Varamin has 16 ophthalmic clinics, including two secondary hospitals that provide cataract surgery. There were ten ophthalmologists (1:68,000 population), two ophthalmic nurses and five optometrists working in Varamin district. There were no eye care social or community workers, ophthalmic counsellors, low vision rehabilitation staff. Although the Vision 2020 target for ophthalmologists has been met, numbers of other eye care staff were insufficient. The majority of patients travel to Tehran for surgery. The recent survey identified cataract as the leading cause of blindness, despite the availability of surgical services in the district and high health insurance coverage. Poor awareness is a major barrier. No units had a written blindness prevention plan, formal referral pathways or sufficient eye health promotion activities. Only one of the PHC units referred people with diabetes for retinal examination. There is partial integration between eye care services and the general health system particularly for prevention of childhood blindness: chemo-prophylaxis for ophthalmia neonatorum, school vision tests, measles immunization and Vitamin A supplementation. CONCLUSIONS This analysis demonstrated the need for better integration between eye care services and the general health system, local planning for prevention of blindness, an information system, a better staff mix and health education to increase community awareness and service uptake. There is the capacity to deliver far more surgery locally. All aspects of a health system need to be developed to deliver comprehensive and efficient eye care.
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Affiliation(s)
- Marzieh Katibeh
- Ophthalmic Epidemiology Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Karl Blanchet
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Shadi Akbarian
- Ophthalmic Epidemiology Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sara Hosseini
- Ophthalmic Epidemiology Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid Ahmadieh
- Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
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17
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Hashemi H, Fotouhi A, Rezvan F, Etemad K, Gilasi H, Asgari S, Mahdavi A, Khabazkhoob M. Cataract Surgical Rate in Iran. Optom Vis Sci 2014; 91:1355-9. [DOI: 10.1097/opx.0000000000000389] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Palmer JJ, Chinanayi F, Gilbert A, Pillay D, Fox S, Jaggernath J, Naidoo K, Graham R, Patel D, Blanchet K. Trends and implications for achieving VISION 2020 human resources for eye health targets in 16 countries of sub-Saharan Africa by the year 2020. HUMAN RESOURCES FOR HEALTH 2014; 12:45. [PMID: 25128287 PMCID: PMC4237790 DOI: 10.1186/1478-4491-12-45] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/19/2014] [Indexed: 05/09/2023]
Abstract
BACKGROUND Development of human resources for eye health (HReH) is a major global eye health strategy to reduce the prevalence of avoidable visual impairment by the year 2020. Building on our previous analysis of current progress towards key HReH indicators and cataract surgery rates (CSRs), we predicted future indicator achievement among 16 countries of sub-Saharan Africa by 2020. METHODS Surgical and HReH data were collected from national eye care programme coordinators on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and 'mid-level refractionists' and combined them with publicly available population data to calculate practitioner-to-population ratios and CSRs. Data on workforce entry and exit (2008 to 2010) was used to project practitioner population and CSR growth between 2011 and 2020 in relation to projected growth in the general population. Associations between indicator progress and the presence of a non-physician cataract surgeon cadre were also explored using Wilcoxon rank sum tests and Spearman rank correlations. RESULTS In our 16-country sample, practitioner per million population ratios are predicted to increase slightly for surgeons (ophthalmologists/cataract surgeons, from 3.1 in 2011 to 3.4 in 2020) and ophthalmic nurses/clinical officers (5.8 to 6.8) but remain low for refractionists (including optometrists, at 3.6 in 2011 and 2020). Among countries that have not already achieved target indicators, however, practitioner growth will be insufficient for any additional countries to reach the surgeon and refractionist targets by year 2020. Without further strategy change and investment, even after 2020, surgeon growth is only expected to sufficiently outpace general population growth to reach the target in one country. For nurses, two additional countries will achieve the target while one will fall below it. In 2011, high surgeon practitioner ratios were associated with high CSR, regardless of the type of surgeon employed. The cataract surgeon workforce is growing proportionately faster than the ophthalmologist. CONCLUSIONS The HReH workforce is not growing fast enough to achieve global eye health targets in most of the sub-Saharan countries we surveyed by 2020. Countries seeking to make rapid progress to improve CSR could prioritise investment in training new cataract surgeons over ophthalmologists and improving surgical output efficiency.
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Affiliation(s)
- Jennifer J Palmer
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London WC1B 7HT, UK
| | - Farai Chinanayi
- African Vision Research Institute, 172 Umbilo Road, Umbilo, Durban 4001, South Africa
| | - Alice Gilbert
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London WC1B 7HT, UK
| | - Devan Pillay
- African Vision Research Institute, 172 Umbilo Road, Umbilo, Durban 4001, South Africa
| | - Samantha Fox
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London WC1B 7HT, UK
| | - Jyoti Jaggernath
- African Vision Research Institute, 172 Umbilo Road, Umbilo, Durban 4001, South Africa
| | - Kovin Naidoo
- African Vision Research Institute, 172 Umbilo Road, Umbilo, Durban 4001, South Africa
| | - Ronnie Graham
- International Agency for the Prevention of Blindness (Africa Region), 172 Umbilo Road, Umbilo, Durban 4001, South Africa
| | - Daksha Patel
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London WC1B 7HT, UK
| | - Karl Blanchet
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London WC1B 7HT, UK
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Palmer JJ, Chinanayi F, Gilbert A, Pillay D, Fox S, Jaggernath J, Naidoo K, Graham R, Patel D, Blanchet K. Mapping human resources for eye health in 21 countries of sub-Saharan Africa: current progress towards VISION 2020. HUMAN RESOURCES FOR HEALTH 2014; 12:44. [PMID: 25128163 PMCID: PMC4237800 DOI: 10.1186/1478-4491-12-44] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 07/28/2014] [Indexed: 05/04/2023]
Abstract
BACKGROUND Development of human resources for eye health (HReH) is a major focus of the Global Action Plan 2014 to 2019 to reduce the prevalence of avoidable visual impairment by 25% by the year 2019. The eye health workforce is thought to be much smaller in sub-Saharan Africa than in other regions of the world but data to support this for policy-making is scarce. We collected HReH and cataract surgeries data from 21 countries in sub-Sahara to estimate progress towards key suggested population-based VISION 2020 HReH indicators and cataract surgery rates (CSR) in 2011. METHODS Routinely collected data on practitioner and surgery numbers in 2011 was requested from national eye care coordinators via electronic questionnaires. Telephone and e-mail discussions were used to determine data collection strategies that fit the national context and to verify reported data quality. Information was collected on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and 'mid-level refractionists' and combined with publicly available population data to calculate practitioner to population ratios and CSRs. Associations with development characteristics were conducted using Wilcoxon rank sum tests and Spearman rank correlations. RESULTS HReH data was not easily available. A minority of countries had achieved the suggested VISION 2020 targets in 2011; five countries for ophthalmologists/cataract surgeons, four for ophthalmic nurses/clinical officers and two for CSR. All countries were below target for optometrists, even when other cadres who perform refractions as a primary duty were considered. The regional (sample) ratio for surgeons (ophthalmologists and cataract surgeons) was 2.9 per million population, 5.5 for ophthalmic clinical officers and nurses, 3.7 for optometrists and other refractionists, and 515 for CSR. A positive correlation between GDP and CSR as well as many practitioner ratios was observed (CSR P = 0.0042, ophthalmologists P = 0.0034, cataract surgeons, ophthalmic nurses and optometrists 0.1 > P > 0.05). CONCLUSIONS With only a minority of countries in our sample having reached suggested ophthalmic cadre targets and none having reached targets for refractionists in 2011, substantially more targeted investment in HReH may be needed for VISION 2020 aims to be achieved in sub-Saharan Africa.
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Affiliation(s)
- Jennifer J Palmer
- International Centre for Eye Health Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St., London WC1B 7HT, UK
| | - Farai Chinanayi
- African Vision Research Institute, 172 Umbilo Road Umbilo, Durban 4001, South Africa
| | - Alice Gilbert
- International Centre for Eye Health Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St., London WC1B 7HT, UK
| | - Devan Pillay
- African Vision Research Institute, 172 Umbilo Road Umbilo, Durban 4001, South Africa
| | - Samantha Fox
- International Centre for Eye Health Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St., London WC1B 7HT, UK
| | - Jyoti Jaggernath
- African Vision Research Institute, 172 Umbilo Road Umbilo, Durban 4001, South Africa
| | - Kovin Naidoo
- African Vision Research Institute, 172 Umbilo Road Umbilo, Durban 4001, South Africa
| | - Ronnie Graham
- International Agency for the Prevention of Blindness (Africa Region), 172 Umbilo Road Umbilo, Durban 4001, South Africa
| | - Daksha Patel
- International Centre for Eye Health Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St., London WC1B 7HT, UK
| | - Karl Blanchet
- International Centre for Eye Health Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St., London WC1B 7HT, UK
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