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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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Soboka JG, Teshome TT, Salamanca O, Calise A. Evaluating eye health care services progress towards VISION 2020 goals in Gurage Zone, Ethiopia. BMC Health Serv Res 2022; 22:768. [PMID: 35689276 PMCID: PMC9188140 DOI: 10.1186/s12913-022-08144-6] [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: 09/13/2021] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Ethiopia signed the VISION 2020 Global Declaration and launched its eye health program in 2002. Since then, there has been limited systematic and comprehensive evaluation of the progress towards VISION 2020 goals in Ethiopia. Objective To evaluate Gurage Zone progress towards VISION 2020 targets and process indicators. Method An institutional-based cross-sectional study was conducted among all public and private eye health care facilities in the Gurage Zone within the Southern Nations, Nationalities, and People Region of Ethiopia. The evaluation protocol was adopted from the VISION 2020 situational analysis data collection tool. We used this structure to evaluate progress in terms of human resources for eye health, infrastructure, and service delivery at the zonal health office and health facilities. At the time of the study, Gurage Zone had a 1.7 million catchment area population. There were a total of five eye care centers, one of which was established by a non-governmental organization. Three of these facilities were secondary eye care centers with an operating theatre and two facilities were primary eye care centers. At the zonal level, there was no survey data available on the prevalence of blindness. Result There was no systemic evaluation of VISION 2020 process indicators. The budget allocation specific to eye health care was less than 0.7% of the total budget of the zonal health office. The human resources for eye health (HReH) in the catchment area were: one ophthalmologist, two cataract surgeons, five optometrists, and 12 ophthalmic nurses, which is below the VISION 2020 targets for HReH. In terms of equipment, neither primary eye care center had a slit lamp biomicroscope, and two of the three secondary eye care centers did not have intraocular pressure measuring equipment. Only one secondary eye care center was providing glaucoma surgical services, and no center provided emergency and elective pediatric surgery. The cataract surgical rate determined by the study was 1967. Conclusion Gurage Zone showed significant improvement in terms of cataract surgical rate. But it had not achieved VISION 2020 goals in terms of critical HReH and service delivery. We recommend that the zonal health office carries out a focused and baseline evaluation of eye health care service achievements. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08144-6.
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Affiliation(s)
- Jibat Gemida Soboka
- Department of Ophthalmology, College of Health and Medical Science, Haramaya University, Harar, Ethiopia.
| | - Tiliksew T Teshome
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Omar Salamanca
- Orbis International, New York, NY, USA.,Service of OphthalmologyGrupo de Investigación en Visión Y Salud Ocular, VISOC, Universidad del Valle, Cali, Colombia
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Safety and Efficacy of Corneal Minimized-Volume Ablation With Accelerated Cross-Linking in Improving Visual Function for Keratoconus. Cornea 2021; 39:1485-1492. [PMID: 32826646 DOI: 10.1097/ico.0000000000002462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of corneal minimized-volume ablation with accelerated cross-linking in improving visual function in keratoconus eyes. METHODS Through a pilot study, 25 eyes of 25 consecutive patients with keratoconus grade I-III were recruited that underwent corneal transepithelial photorefractive keratectomy with "minimized volume" ablation profile and accelerated corneal cross-linking in the same session. Corrected and uncorrected distance visual acuities, manifest refraction, corneal curvature and higher-order aberrations, endothelial cells, and the ocular modulation transfer function were assessed preoperatively and postoperatively, with a minimum follow-up of 6 months. A P value < 0.05 was the threshold of statistical significance. RESULTS At 8.2 ± 3.6 months postoperatively, the mean corrected and uncorrected distance visual acuities (LogMAR) were 0.07 ± 0.15 and 0.45 ± 0.39, significantly improving from the baseline of 0.24 ± 0.24 (P8m-before = 0.005) and 1.12 ± 0.33 (P8m-before < 0.001), respectively. Spherical equivalent was -2.80 ± 2.72 diopters (D), significantly decreasing from the baseline of -6.61 ± 3.06 D (P8m-before < 0.001), whereas the attempted corrected spherical equivalent was-2.30 ± 1.22 D. Meanwhile, a significant reduction was found in higher-order aberration, along with the postoperative improvement in ocular modulation transfer function. Corneal surface morphological parameters were found with significant decreases postoperatively (index of surface variance: P8m-before = 0.003; index of vertical asymmetry: P8m-before = 0.005; keratoconus index: P8m-before = 0.004; center keratoconus index: P8m-before = 0.003; and index of height decentration: P8m-before < 0.001). Nevertheless, no significant change was found in posterior corneal curvature or endothelial cell density between pre- and post-operative periods. CONCLUSIONS Corneal minimized-volume ablation with accelerated cross-linking was an effective and safe option for correction of mild refractive error, leading to significant improvement of visual function in patients with keratoconus.
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Akuffo KO, Asare AK, Yelbert EE, Kobia-Acquah E, Addo EK, Agyei-Manu E, Brusah T, Asenso PA. Job satisfaction and its associated factors among opticians in Ghana: a cross-sectional study. HUMAN RESOURCES FOR HEALTH 2021; 19:68. [PMID: 34001133 PMCID: PMC8130430 DOI: 10.1186/s12960-021-00612-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/07/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Job satisfaction refers to the feeling of contentment one experiences with their job. Job satisfaction among opticians is a crucial variable in determining their motivation and has consequential influence on the quality of eye health care, systems and services. Nevertheless, little has been done to assess job satisfaction levels among human resources for eye-health, such as opticians, in Ghana. This study assessed (for the first time) the job satisfaction level among opticians in Ghana, and the factors associated with their job satisfaction. METHODS This was a cross-sectional survey involving all registered and licensed opticians working in Ghana. A validated, well-structured job satisfaction questionnaire was distributed to 195 opticians across all regions of the country. The questionnaire was composed of 15-item job satisfaction variables which were measured on a five-point Likert scale ('1-strongly disagree' to '5-strongly agree'). Logistic regression analyses were used to investigate the association between sociodemographic characteristics and factors of job satisfaction, and the overall job satisfaction level. RESULTS A total of 101 opticians responded to the study. The mean presenting age of all participants was 25.3 ± 5.0 years (21 to 47 years), with majority being males (57.4%). The mean score of the overall job satisfaction level reported by participants was 2.65, with 12.9% (95% confidence interval [CI]: 7.0-21.0%) of them being satisfied with their jobs. There was no statistically significant association between overall job satisfaction and sociodemographic characteristics (p > 0.05; for all). Only salary was significantly associated with overall level of job satisfaction (odds ratio [OR]: 16.5; 95% CI: 2.06-132.86; p = 0.008). CONCLUSION Majority of opticians working in Ghana were not satisfied with their jobs. Enhancing salary/remuneration would improve the job satisfaction level among opticians in the country. There is the need for effective management of human resources for eye-health (particularly opticians) and policy revision on ophthalmic healthcare administration in Ghana.
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Affiliation(s)
- Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Akosua Kesewah Asare
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Ghana
| | - Elsie Emelia Yelbert
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Kobia-Acquah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Center for Eye Research Ireland, Technological University Dublin, Dublin, Ireland
| | - Emmanuel Kofi Addo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Centre, University of Utah, Salt Lake City, UT, USA
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Eldad Agyei-Manu
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Usher Institute for Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Thomas Brusah
- Optical Department, Sight for Africa Eye Clinic, Accra, Ghana
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Lin S, Ma Y, Hou Z, Congdon N, Lu L, Zou H. Andersen's utilization model for cataract surgical rate and empirical evidence from economically-developing areas. BMC Ophthalmol 2021; 21:107. [PMID: 33637052 PMCID: PMC7908707 DOI: 10.1186/s12886-021-01858-x] [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: 02/25/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen’s utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China. Methods The study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately. Results Cataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn’t impact cataract surgical resources (β = 0.29, 95% CI: − 0.12, 0.75). In China, residents’ average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; βCSR-paying = 0.77, 95% CI: 0.25, 0.90; βpaying-GDP/P = 0.89, 95% CI: 0.82, 0.93). Conclusions In sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.
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Affiliation(s)
- Senlin Lin
- Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China.,Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Yingyan Ma
- Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China
| | - Zhiyuan Hou
- Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 S. Xianlie Road, Guangzhou, 510060, China. .,Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK. .,Orbis International, 520 8th Ave #12, New York, NY, 10018, USA.
| | - Lina Lu
- Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China. .,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China.
| | - Haidong Zou
- Shanghai Eye Diseases Prevention & Treatment Center / Shanghai Eye Hospital, No. 380 Kang Ding Road, Shanghai, 200000, China. .,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, No. 100 Hai Ning Road, Shanghai, 200000, China.
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Akuffo KO, Agyei-Manu E, Kumah DB, Danso-Appiah A, Mohammed AS, Asare AK, Addo EK. Job satisfaction and its associated factors among optometrists in Ghana: a cross-sectional study. Health Qual Life Outcomes 2021; 19:12. [PMID: 33413410 PMCID: PMC7791777 DOI: 10.1186/s12955-020-01650-3] [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: 06/03/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Job satisfaction describes an employee’s motivation and/or feeling of satisfaction towards his/her work. Globally, healthcare professionals’ turnover and retention play a critical role in the delivery of essential health services. In Ghana, however, little has been done to ascertain job satisfaction levels among human resources for eye-health. The objective of this study therefore was to assess job satisfaction and its associated factors among optometrists in Ghana.
Methods A cross-sectional survey was conducted among 304 registered and licensed optometrists of the Ghana Optometric Association between September 2018 and June 2019. A validated, well-structured questionnaire was used to elicit information on socio-demographic characteristics of participants and measures on job satisfaction. Scores from a five-point Likert scale was employed to examine job satisfaction and its associated factors. Linear regression analyses were used to evaluate the association between overall job satisfaction and its associated factors using Rasch logit scores. Results A total of 214 optometrists gave valid responses to the questionnaires used for the final analysis. The mean (± SD) score of the overall perception of job satisfaction among optometrists was 3.36 (± 1.00), with 74.3% of them being satisfied with their jobs. After statistical adjustment, Good work-life balance (Unstandardized co-efficient (β) = 0.288, p = 0.001), Salary (β = 0.222, p < 0.0005), Supervision (β = 0.117, p = 0.044), and Continuing Education Opportunities (β = 0.138, p = 0.017) were all significantly associated with higher levels of overall job satisfaction. Conclusions Most optometrists were satisfied with their jobs. Effective strategic planning and management of human resources for eye-health in Ghana are essential in the development of quality eye-health systems and the provision of high-quality eyecare services.
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Affiliation(s)
- Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Eldad Agyei-Manu
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Usher Institute for Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David Ben Kumah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.,University of Ghana Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Legon, Ghana
| | - Abubakar Sadik Mohammed
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Akosua Kesewah Asare
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Emmanuel Kofi Addo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Ophthalmology and Visual Sciences, Moran Eye Centre, University of Utah, Salt Lake City, Utah, USA.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, USA
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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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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: 20] [Impact Index Per Article: 5.0] [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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Manuelle Kleinschnitt-Kataraktchirurgie. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Magyezi J, Arunga S. Eye care where there are no ophthalmologists: the Uganda experience. COMMUNITY EYE HEALTH 2020; 33:48-50. [PMID: 34007108 PMCID: PMC8115714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Joseph Magyezi
- Ophthalmic Clinical Officer: Ruharo Eye Centre, Ruharo Mission Hospital, Mbarara, Uganda
| | - Simon Arunga
- Consultant Ophthalmologist: Mbarara University of Science and Technology, Mbarara, Uganda
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Arunga S, Kyomugasho N, Kwaga T, Onyango J, Leck A, Macleod D, Hu V, Burton M. The management of microbial keratitis within Uganda's primary health system: a situational analysis. Wellcome Open Res 2019; 4:141. [PMID: 32090170 PMCID: PMC7014927 DOI: 10.12688/wellcomeopenres.15463.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 10/28/2022] Open
Abstract
Background: Microbial keratitis (MK) frequently leads to sight-loss, especially when the infection is severe and/or appropriate treatment is delayed. The primary health system as an entry point plays a central role in facilitating and directing patient access to appropriate care. The purpose of this study was to describe the capacity of primary health centres in Uganda in managing MK. Methods: We carried out a rigorous assessment of primary health centres and mid-cadre training schools in South Western Uganda. Through interviews, checklists and a picture quiz, we assessed capacity and knowledge of MK management. In addition, we interviewed the heads of all the mid-cadre training schools to determine the level of eye health training provided in their curricula. Results: In total, 163 health facilities and 16 training schools were enrolled. Of the health facilities, only 6% had an Ophthalmic Clinical Officer. Only 12% of the health workers could make a diagnosis of MK based on the clinical signs in the picture quiz. Although 35% of the facilities had a microscope, none reported doing corneal scraping. None of the facilities had a stock of the recommended first line treatment options for MK (ciprofloxacin and natamycin eye drops). Among the training schools, 15/16 had an eye health component in the curriculum. However, the majority (56%) of tutors had no formal expertise in eye health. In 14/16 schools, students spent an average of two weeks in an eye unit. Conclusions: Knowledge among health workers and capacity of health facilities in diagnosis and management of MK was low. Training for eye health within mid-cadre training schools was inadequate. More is needed to close these gaps in training and capacity.
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Affiliation(s)
- Simon Arunga
- Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda.,International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Naome Kyomugasho
- Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Teddy Kwaga
- Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda.,Ruharo Eye Centre, Ruharo Mission Hospital, Mbara, Uganda
| | - John Onyango
- Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Astrid Leck
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - David Macleod
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Victor Hu
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Resnikoff S, Lansingh VC, Washburn L, Felch W, Gauthier TM, Taylor HR, Eckert K, Parke D, Wiedemann P. Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs? Br J Ophthalmol 2019; 104:588-592. [PMID: 31266774 PMCID: PMC7147181 DOI: 10.1136/bjophthalmol-2019-314336] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/02/2019] [Accepted: 06/07/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To estimate 2015 global ophthalmologist data and analyse their relationship to income groups, prevalence rates of blindness and visual impairment and gross domestic product (GDP) per capita. METHODS Online surveys were emailed to presidents/chairpersons of national societies of ophthalmology and Ministry of Health representatives from all 194 countries to capture the number and density (per million population) of ophthalmologists, the number/density performing cataract surgery and refraction, and annual ophthalmologist population growth trends. Correlations between these data and income group, GDP per capita and prevalence rates of blindness and visual impairment were analysed. RESULTS In 2015, there were an estimated 232 866 ophthalmologists in 194 countries. Income was positively associated with ophthalmologist density (a mean 3.7 per million population in low-income countries vs a mean 76.2 in high-income countries). Most countries reported positive growth (94/156; 60.3%). There was a weak, inverse correlation between the prevalence of blindness and the ophthalmologist density. There were weak, positive correlations between the density of ophthalmologists performing cataract surgery and GDP per capita and the prevalence of blindness, as well as between GDP per capita and the density of ophthalmologists doing refractions. CONCLUSIONS Although the estimated global ophthalmologist workforce appears to be growing, the appropriate distribution of the eye care workforce and the development of comprehensive eye care delivery systems are needed to ensure that eye care needs are universally met.
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Affiliation(s)
- Serge Resnikoff
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | | | - Lindsey Washburn
- International Council of Ophthalmology, San Francisco, California, USA
| | - William Felch
- International Council of Ophthalmology, San Francisco, California, USA
| | | | - Hugh R Taylor
- Melbourne School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - David Parke
- American Academy of Ophthalmology, San Francisco, California, USA
| | - Peter Wiedemann
- International Council of Ophthalmology, San Francisco, California, USA
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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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14
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Fortané M, Bensaid P, Resnikoff S, Seini K, Landreau N, Paugam JM, Nagot N, Mura T, Serrand C, Villain M, Daien V. Outcomes of cataract surgery performed by non-physician cataract surgeons in remote North Cameroon. Br J Ophthalmol 2018; 103:1042-1047. [PMID: 30291137 DOI: 10.1136/bjophthalmol-2018-312428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/12/2018] [Accepted: 08/28/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the outcomes of cataract surgery performed by non-physician cataract surgeons due to lack of ophthalmologists in remote areas of North Cameroon. DESIGN Prospective cohort study. SETTING The main centre of the non-governmental organisation Ophtalmo Sans Frontières in Lagdo. PARTICIPANTS AND INTERVENTIONS Age-related cataract surgery performed between 28 November 2016 and 17 May 2017. MAIN OUTCOMES MEASURES The main outcome measure was presenting visual acuity (PVA) 1-4 weeks after surgery, classified according to the WHO as good (PVA ≥6/18), borderline (PVA 6/60-6/18) and poor (PVA <6/60). The WHO definition of blindness (visual acuity <3/60) and severe visual acuity (visual acuity 3/60-6/60) was used to assess the proportion of patients with a change in WHO category. RESULTS We included 474 eyes of 474 patients; the mean (SD) age was 63.9 (15) years (42.2% female). At 1-4 weeks after surgery, the surgical outcome was good for 170 patients (41.1%), borderline for 213 (51.5%) and poor for 31 (7.5%). In all, 224 patients (47.2%) had blindness or severe visual impairment before cataract surgery and 22 (5.3%) at 1-4 weeks after surgery. Poor visual outcome was associated with older age (p=0.018), preoperative blindness or severe impairment (p=0.012) and surgical complications (p=0.019). CONCLUSION Blindness and severe visual impairment were significantly decreased in the early postoperative period. Poor outcomes were associated with older age, low preoperative binocular visual acuity and intraoperative complications. Non-physician cataract surgeons may compensate for the lack of ophthalmologists in remote areas of low-income and middle-income countries.
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Affiliation(s)
- Magali Fortané
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | | | - Serge Resnikoff
- Brien Holden Vision Institute, University of New South Wales, Sydney, New South Wales, Australia.,Organisation Pour la prévention de la Cécité (OPC), Paris, France
| | - Kali Seini
- Ophtalmo Sans Frontières, Lagdo, Cameroon
| | | | | | - Nicolas Nagot
- Department of Medical Information, La Colombière Hospital, Montpellier, France
| | - Thibault Mura
- Department of Medical Information, La Colombière Hospital, Montpellier, France.,INSERM (Institut National de la Santé Et de la Recherche Médicale), Montpellier, France
| | - Chris Serrand
- Department of Medical Information, La Colombière Hospital, Montpellier, France
| | - Max Villain
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Vincent Daien
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France .,INSERM (Institut National de la Santé Et de la Recherche Médicale), Montpellier, France.,The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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16
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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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17
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Affiliation(s)
- Timothy E. Yap
- Imperial College Healthcare NHS Trust (ICHNT), The Western Eye Hospital, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Eduardo M. Normando
- Imperial College Healthcare NHS Trust (ICHNT), The Western Eye Hospital, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Maria Francesca Cordeiro
- Imperial College Healthcare NHS Trust (ICHNT), The Western Eye Hospital, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
- Department of Visual Neuroscience, Glaucoma and Retinal Neurodegeneration Group, UCL Institute of Ophthalmology, London, UK
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Abstract
Globally, 32.4 million individuals are blind and 191 million have moderate or severe visual impairment (MSVI); 80% of cases of blindness and MSVI are avoidable. However, great efforts are needed to tackle blindness and MSVI, as eye care in most places is delivered in isolation from and without significant integration with general health sectors. Success stories, including control of vitamin A deficiency, onchocerciasis, and trachoma, showed that global partnerships, multisectoral collaboration, public-private partnerships, corporate philanthropy, support from nongovernmental organizations-both local and international-and governments are responsible for the success of these programs. Hence, the World Health Organization's universal eye health global action plan for 2014-2019 has a goal of reducing the public health problem of blindness and ensuring access to comprehensive eye care; the plan aims to integrate eye health into health systems, thus providing universal eye health coverage (UEHC). This article discusses the challenges faced by low- and middle-income countries in strengthening the six building blocks of the health system. It discusses how the health systems in these countries need to be geared toward tackling the issues of emerging noncommunicable eye diseases, existing infectious diseases, and the common causes of blindness and visual impairment, such as cataract and refractive error. It also discusses how some of the comprehensive eye care models in the developing world have addressed these challenges. Moving ahead, if we are to achieve UEHC, we need to develop robust, sustainable, good-quality, comprehensive eye care programs throughout the world, focusing on the areas of greatest need. We also need to develop public health approaches for more complex problems such as diabetic retinopathy, glaucoma, childhood blindness, corneal blindness, and low vision. There is also a great need to train high-level human resources of all cadres in adequate numbers and quality. In addition to this, we need to exploit the benefits of modern technological innovations in information, communications, biomedical technology, and other domains to enhance quality of, access to, and equity in eye care.
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Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India.,Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Gullapalli N Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad 500086, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad 500034, India
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Gilbert S, Patel D. Recruiting and distributing eye health workers. COMMUNITY EYE HEALTH 2018; 31:45-47. [PMID: 30220801 PMCID: PMC6134457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Suzanne Gilbert
- Senior Director: Innovation & Sight Programs, Seva Foundation, Berkeley, California USA
| | - Daksha Patel
- E-learning Director: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
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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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Kyari F, Gilbert C, Blanchet K, Wormald R. Improving services for glaucoma care in Nigeria: implications for policy and programmes to achieve universal health coverage. Br J Ophthalmol 2017; 101:543-547. [PMID: 28202479 DOI: 10.1136/bjophthalmol-2016-310040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/17/2017] [Accepted: 01/21/2017] [Indexed: 01/23/2023]
Abstract
Glaucoma in Africa is sometimes referred to as the silent thief of sight. In Nigeria, glaucoma is common, it is serious, ophthalmologists face many constraints in managing it, people do not even know they have it until it is advanced, patients do not understand or comply with treatment after they are diagnosed and the poor are more likely to be glaucoma blind. Available evidence indicates that the health system in Nigeria is failing to meet the needs of patients with glaucoma. Based on evidence, we propose future directions for improving services for glaucoma care in Nigeria, and the implications for policy and programmes to control glaucoma blindness, using a health system-oriented approach. Three complementary strategies are required: (i) strengthening clinical services for glaucoma-by developing models of glaucoma care, improving clinical treatment options, making medicines and equipment available, financing glaucoma care and training eye care workers; (ii) introducing initiatives for earlier detection of glaucoma in the clinic and approaches in the community and (iii) strengthening health system governance. Glaucoma is a complex disease to manage and addressing it as a public health problem is challenging. However, we need to change the paradigm to recognise that glaucoma is a potentially avoidable cause of blindness in Africa.
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Affiliation(s)
- Fatima Kyari
- Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,Baze University, Abuja, Nigeria
| | - Clare Gilbert
- Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Karl Blanchet
- Department of Global Health and Development, Health in Humanitarian Crisis Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Wormald
- Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Ophthalmology, Moorfields Eye Hospital, London, UK
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22
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23
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Kyari F, Nolan W, Gilbert C. Ophthalmologists' practice patterns and challenges in achieving optimal management for glaucoma in Nigeria: results from a nationwide survey. BMJ Open 2016; 6:e012230. [PMID: 27729348 PMCID: PMC5073544 DOI: 10.1136/bmjopen-2016-012230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/20/2016] [Accepted: 08/25/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE OF THE STUDY Glaucoma, a chronic non-communicable disease, and leading cause of irreversible blindness worldwide is a public health problem in Nigeria, with a prevalence of 5.02% in people aged ≥40 years. The purpose of this nationwide survey was to assess Nigerian ophthalmologists' practice patterns and their constraints in managing glaucoma. STUDY DESIGN Ophthalmologists were sent a semistructured questionnaire on how they manage glaucoma, their training in glaucoma care, where they practice, their access to equipment for diagnosis and treatment, whether they use protocols and the challenges they face in managing patients with glaucoma. RESULTS 153/250 ophthalmologists in 80 centres completed questionnaires. Although 79% felt their training was excellent or good, 46% needed more training in glaucoma diagnosis and surgery. All had ophthalmoscopes, 93% had access to applanation tonometers, 81% to visual field analysers and 29% to laser machines (in 19 centres). 3 ophthalmologists had only ophthalmoscopes and schiøtz tonometers. For 85%, a glaucomatous optic disc was the most important feature that would prompt glaucoma work-up. Only 56% routinely performed gonioscopy and 61% used slit-lamp stereoscopic biomicroscopy for disc assessment. Trabeculectomy (with/without antimetabolites) was the only glaucoma surgery performed with one mention of canaloplasty. Poor compliance with medical treatment (78%) and low acceptance of surgery (71%) were their greatest challenges. CONCLUSIONS This study indicates that a systems-oriented approach is required to enhance ophthalmologist's capability for glaucoma care. Strategies to improve glaucoma management include strengthening poorly equipped centres including provision of lasers and training, and improving patients' awareness and education on glaucoma.
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Affiliation(s)
- Fatima Kyari
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
- Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | | | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
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Stewart MW. Treatment of diabetic retinopathy: Recent advances and unresolved challenges. World J Diabetes 2016; 7:333-341. [PMID: 27625747 PMCID: PMC4999649 DOI: 10.4239/wjd.v7.i16.333] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/08/2016] [Accepted: 07/13/2016] [Indexed: 02/05/2023] Open
Abstract
Diabetic retinopathy (DR) is the leading cause of blindness in industrialized countries. Remarkable advances in the diagnosis and treatment of DR have been made during the past 30 years, but several important management questions and treatment deficiencies remain unanswered. The global diabetes epidemic threatens to overwhelm resources and increase the incidence of blindness, necessitating the development of innovative programs to diagnose and treat patients. The introduction and rapid adoption of intravitreal pharmacologic agents, particularly drugs that block the actions of vascular endothelial growth factor (VEGF) and corticosteroids, have changed the goal of DR treatment from stabilization of vision to improvement. Anti-VEGF injections improve visual acuity in patients with diabetic macular edema (DME) from 8-12 letters and improvements with corticosteroids are only slightly less. Unfortunately, a third of patients have an incomplete response to anti-VEGF therapy, but the best second-line therapy remains unknown. Current first-line therapy requires monthly visits and injections; longer acting therapies are needed to free up healthcare resources and improve patient compliance. VEGF suppression may be as effective as panretinal photocoagulation (PRP) for proliferative diabetic retinopathy, but more studies are needed before PRP is abandoned. For over 30 years laser was the mainstay for the treatment of DME, but recent studies question its role in the pharmacologic era. Aggressive treatment improves vision in most patients, but many still do not achieve reading and driving vision. New drugs are needed to add to gains achieved with available therapies.
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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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Campbell JP, Swan R, Jonas K, Ostmo S, Ventura CV, Martinez-Castellanos MA, Anzures RGAS, Chiang MF, Chan RVP. Implementation and evaluation of a tele-education system for the diagnosis of ophthalmic disease by international trainees. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:366-375. [PMID: 26958168 PMCID: PMC4765571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tele-education systems are increasingly being utilized in medical education worldwide. Due to limited human resources in healthcare in low and middle-income countries, developing online systems that are accessible to medical trainees in underserved areas potentially represents a highly efficient and effective method of improving the quantity and quality of the health care workforce. We developed, implemented, and evaluated an interactive web-based tele-education system (based on internationally accepted, image-based guidelines) for the diagnosis of retinopathy of prematurity among ophthalmologists-in-training in Brazil, Mexico, and the Philippines. We demonstrate that participation in this tele-education program improved diagnostic accuracy and reliability, and was preferred to standard pedagogical methods. This system may be employed not only in training, but also in international certification programs, and the process may be generalizable to other image-based specialties, such as dermatology and radiology.
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Affiliation(s)
- J Peter Campbell
- Department of Ophthalmology, Oregon Health & Science University, Portland, OR
| | - Ryan Swan
- Department of Ophthalmology, Oregon Health & Science University, Portland, OR; Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Karyn Jonas
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Susan Ostmo
- Department of Ophthalmology, Oregon Health & Science University, Portland, OR
| | | | - Maria A Martinez-Castellanos
- Department of Retina Service, Asociacion para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Mexico City, Mexico
| | | | - Michael F Chiang
- Department of Ophthalmology, Oregon Health & Science University, Portland, OR; Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - R V Paul Chan
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
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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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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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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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