1
|
Klazura G, Wong LY, Ribeiro LLPA, Kojo Anyomih TT, Ooi RYK, Berhane Fissha A, Alam SF, Daudu D, Nyalundja AD, Beltrano J, Patil PP, Wafford QE, Rapolti DI, Sullivan GA, Graf A, Veras P, Nico E, Sheth M, Shing SR, Mathur P, Langer M. Measurements of Impoverishing and Catastrophic Surgical Health Expenditures in Low- and Middle-Income Countries and Reduction Interventions in the Last 30 Years: A Systematic Review. J Surg Res 2024; 299:163-171. [PMID: 38759332 DOI: 10.1016/j.jss.2024.04.021] [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: 01/10/2024] [Revised: 03/14/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Approximately 33 million people suffer catastrophic health expenditure (CHE) from surgery and/or anesthesia costs. The aim of this systematic review is to evaluate catastrophic and impoverishing expenditure associated with surgery and anesthesia in low- and middle-income countries (LMICs). METHODS We performed a systematic review of all studies from 1990 to 2021 that reported CHE in LMICs for treatment of a condition requiring surgical intervention, including cesarean section, trauma care, and other surgery. RESULTS 77 studies met inclusion criteria. Tertiary facilities (23.4%) were the most frequently studied facility type. Only 11.7% of studies were conducted in exclusively rural health-care settings. Almost 60% of studies were retrospective in nature. The cost of procedures ranged widely, from $26 USD for a cesarean section in Mauritania in 2020 to $74,420 for a pancreaticoduodenectomy in India in 2018. GDP per capita had a narrower range from $315 USD in Malawi in 2019 to $9955 USD in Malaysia in 2015 (Median = $1605.50, interquartile range = $1208.74). 35 studies discussed interventions to reduce cost and catastrophic expenditure. Four of those studies stated that their intervention was not successful, 18 had an unknown or equivocal effect on cost and CHE, and 13 concluded that their intervention did help reduce cost and CHE. CONCLUSIONS CHE from surgery is a worldwide problem that most acutely affects vulnerable patients in LMICs. Existing efforts are insufficient to meet the true need for affordable surgical care unless assistance for ancillary costs is given to patients and families most at risk from CHE.
Collapse
Affiliation(s)
- Greg Klazura
- University of Illinois at Chicago, Chicago, Illinois
| | - Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford Hospital, Stanford, California.
| | | | | | | | - Aemon Berhane Fissha
- Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Syeda Fatema Alam
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Davina Daudu
- Faculty of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, South Kivu, Democratic Republic of Congo
| | | | - Poorvaprabha P Patil
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Gwyneth A Sullivan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Akua Graf
- University of Illinois at Chicago, Chicago, Illinois
| | - Perry Veras
- Loyola Stritch School of Medicine, Maywood, Illinois
| | - Elsa Nico
- University of Illinois at Chicago, Chicago, Illinois
| | - Monica Sheth
- Loyola Stritch School of Medicine, Oak Park, Illinois
| | - Samuel R Shing
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Priyanka Mathur
- Northwestern University Feinberg School of Medicine, Chicago Illinois
| | - Monica Langer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| |
Collapse
|
2
|
Sullivan KM, Harding-Esch EM, Batcho WE, Issifou AAB, Lopes MDFC, Szwarcwald CL, Vaz Ferreira Gomez D, Bougouma C, Christophe N, Kabore M, Bucumi V, Bella AL, Epee E, Yaya G, Trujillo-Trujillo J, Dejene M, Gebretsadik FS, Gebru G, Kebede F, Mathewos T, Cassama ETDS, Sanha S, Barasa E, Sultani HM, Watitu T, Tekeraoi R, Kalua KM, Masika MP, Traoré L, Minnih AO, Abdala M, Massangaie ME, Win Y, Apadinuwe SC, Mishra SK, Sharma S, Amza A, Kadri B, Nassirou B, Mpyet CD, Olobio N, Hussain A, Khan AA, Jambi G, Ko R, Kello AB, Badiane MD, Sarr B, Dalmar A, Elshafie BE, Kabona GE, Kaitaba O, Mwingira U, Simon A, Kanyi S, Awoussi MS, Togbey K, Baayenda G, Francis M, Tukahebwa EM, Bakhtiari A, Keil AP, Maselko J, Westreich D, Garae M, Taleo F, Al-Khateeb TQ, Mwale C, Solomon AW, Gower EW. Gender differences in the surgical management of trachomatous trichiasis: an exploratory analysis of global trachoma survey data, 2015-2019. Int Health 2023; 15:ii58-ii67. [PMID: 38048383 PMCID: PMC10695456 DOI: 10.1093/inthealth/ihad067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/28/2023] [Accepted: 07/26/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss. METHODS We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery. RESULTS The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7]). CONCLUSIONS Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences.
Collapse
Affiliation(s)
- Kristin M Sullivan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Wilfrid E Batcho
- Programme National De Lutte Contre Les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| | | | | | - Celia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Clarisse Bougouma
- Direction de la Protection de la Santé de la Population, Ministère de la Santé, Burkina Faso
| | - Nassa Christophe
- Attaché de Santé en Épidémiologie, Programme National de Lutte Contre Les MTN, Burkina Faso
| | - Martin Kabore
- L'unité d'élimination du trachome, PNMTN, Ouagadougou, Burkina Faso
| | - Victor Bucumi
- Département En Charge des Maladies Tropicales, Négligées Ministère De La Santé Publique Et De La Lutte Contre Le Sida, Bujumbura, Burundi
| | - Assumpta L Bella
- Programme National de Lutte Contre La Cecite, Ministère de la Santé Publique, Yaoundé, Cameroun
| | - Emilienne Epee
- Department Of Ophthalmology, University of Yaoundé Yaounde Centre/Ministère de la Santé Publique, Yaoundé, Cameroun
| | - Georges Yaya
- Ministère de la Santé Publique, Bangui, Central African Republic
| | - Julian Trujillo-Trujillo
- Subdirectorate of Communicable Diseases, Ministry of Health and Social Protection, Bogotá, Colombia
| | | | - Fikre Seife Gebretsadik
- Neglected Tropical Disease Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia
| | - Genet Gebru
- Neglected Tropical Disease Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia
| | - Fikreab Kebede
- Neglected Tropical Disease Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia
| | - Tsedeke Mathewos
- Neglected Tropical Disease Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Salimato Sanha
- Programa Nacional De Sau´de De Visão, Minsap, Bissau, Guinea-Bissau
| | | | | | | | | | - Khumbo M Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | - Michael P Masika
- Department of Clinical and Medical Rehabilitation Services, Ministry of Health, Lilongwe, Malawi
| | - Lamine Traoré
- National Eye Health Program, Ministry of Health and Social Development, Mali
| | - Abdallahi O Minnih
- Département Des Maladies Transmissibles, Ministère De La Santé Nouakchott, Nouakchott, Mauritania
| | - Mariamo Abdala
- Direção Nacional de Saúde Pública, Ministerio Da Saude, Maputo, Mozambique
| | | | - Ye Win
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | - Sailesh Kumar Mishra
- National Society for Comprehensive Eye Care, Nepal Netra Jyoti Sangh, Kathmandu, Nepal
| | | | - Abdou Amza
- Programme National De Santé Oculaire, Ministère De La Santé Publique, Niamey, Niger
| | - Boubacar Kadri
- Programme National De Santé Oculaire, Ministère De La Santé Publique, Niamey, Niger
| | - Beido Nassirou
- Programme National De Santé Oculaire, Ministère De La Santé Publique, Niamey, Niger
| | - Caleb D Mpyet
- Department of Ophthalmology, University of Jos, Jos, Plateau, Nigeria
| | - Nicholas Olobio
- Neglected Tropical Diseases Division, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Arif Hussain
- Community Ophthalmology, College of Ophthalmology & Allied Vision Sciences (COAVS), Mayo Hospital Lahore, Lahore, Pakistan
| | - Asad Aslam Khan
- College of Ophthalmology and Allied Vision Sciences, Mayo Hospital, Lahore, Pakistan
| | - Garap Jambi
- Prevention of Blindness Committee, PNG Eye Care, Boroko, Papua New Guinea
| | - Robert Ko
- National Department of Health, Waigani, Papua New Guinea
| | - Amir B Kello
- AF/UCU UHC/Communicable and Noncommunicable Diseases Unit, ESPEN, World Health Organization, Brazzaville, Republic of Congo
| | - Mouctar D Badiane
- Programme National de Promotion de La Santé Oculaire, Ministère de la Santé et de L'Action Sociale, Dakar, Senegal
| | - Boubacar Sarr
- Ministère de la Santé et de l'Action Sociale, Senegal
| | | | - Balgesa E Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, Khartoum, Sudan
| | - George E Kabona
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Oscar Kaitaba
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Upendo Mwingira
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Alistidia Simon
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Sarjo Kanyi
- National Eye Health Programme, Ministry of Health and Social Welfare, Banjul, The Gambia
| | | | - Kwamy Togbey
- Programme National des Maladies Tropicales Negligées, Ministry of Health, Public Hygiene and Universal Access to Care, Lomé, Togo
| | - Gilbert Baayenda
- Neglected Tropical Diseases Control, Ministry of Health, Kampala, Uganda
| | - Mugume Francis
- Neglected Tropical Diseases Control, Ministry of Health, Kampala, Uganda
| | - Edridah M Tukahebwa
- Vector-Borne and Neglected Tropical Diseases, Ministry of Health, Kampala, Uganda
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA
| | - Alexander P Keil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joanna Maselko
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mackline Garae
- Department of Neglected Tropical Diseases, Vanuatu Ministry of Health, Port Vila, Vanuatu
| | - Fasiah Taleo
- Department of Neglected Tropical Diseases, Vanuatu Ministry of Health, Port Vila, Vanuatu
| | | | - Consity Mwale
- Kitwe Teaching Eye Hospital, Ministry of Health, Kitwe, Zambia
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Emily W Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
3
|
Issifou AAB, Dare A, Badou GA, Harding-Esch EM, Solomon AW, Bakhtiari A, Boyd S, Jimenez C, Harte A, Burgert-Brucker CR, Sintondji FR, Dossa NI, M'Po NTN, Batcho W. Twenty-Three Population-Based Trachoma Prevalence Surveys in the Central and Northern Regions of Benin, 2018-2022. Ophthalmic Epidemiol 2023:1-11. [PMID: 38032921 DOI: 10.1080/09286586.2023.2265796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/14/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE Trachoma is an infectious eye disease caused by Chlamydia trachomatis. Infection causes conjunctival inflammation, which can be manifested by the sign known as trachomatous inflammation-follicular (TF). Repeated inflammation leads to eyelid scarring, which in susceptible individuals can cause in-turning of the eyelashes, referred to as trachomatous trichiasis (TT). This article describes 23 population-based surveys conducted in northern and central Benin to determine TF and/or TT prevalence for trachoma elimination purposes. METHODS A total of 18 surveys estimated the prevalence of both TF and TT: two baseline surveys, eight impact surveys after implementation of interventions against trachoma, and eight surveillance surveys. Five other evaluation units (EUs) were surveyed for TT only. To estimate the TF prevalence, a target sample size of 1701 (baseline) and 1164 1-9-year-olds (impact and surveillance) was required, whereas 2818 ≥ 15-year-olds were required to estimate the less prevalent TT. In each EU, individuals were selected by two-stage cluster sampling and examined by certified graders for TF and/or TT. RESULTS A total of 68,613 people were examined. TF prevalence estimates were under the 5% elimination threshold in all surveys. TT prevalence estimates were above the 0.2% elimination threshold in all five TT-only surveys and in four impact surveys, ranging from 0.2-0.57. CONCLUSION TF prevalence in Benin is low, but TT was above 0.2% in nine districts. Increased case-finding and continuing efforts to improve surgery accessibility will be needed to reduce the burden of TT in Benin.
Collapse
Affiliation(s)
| | - Aboudou Dare
- Programme National de Lutte contre les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| | | | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | | | - Anna Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| |
Collapse
|
4
|
Wang E, Kong X, Wolle M, Gasquet N, Ssekasanvu J, Mariotti SP, Bourne R, Taylor H, Resnikoff S, West S. Global trends in blindness and vision impairment due to corneal opacity 1984-2020: a meta-analysis. Ophthalmology 2023:S0161-6420(23)00187-2. [PMID: 36963570 PMCID: PMC10355344 DOI: 10.1016/j.ophtha.2023.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
TOPIC We provide global estimates of the prevalence of corneal blindness and vision impairment in adults 40 years and older and examine the burden by age, gender, and geographic region from 1984-2020. CLINICAL RELEVANCE Corneal opacities (CO) are among the top five causes of blindness worldwide, yet the global prevalence, regional differences, and risk factors are unclear. METHODS Abstracted data from the published literature and surveys were obtained from the Global Burden of Disease Vision Loss Expert Group. We supplemented this by an independent systematic literature search of PubMed, Embase, Web of Science, Scopus, and Cochrane. Studies that provided CO vision impairment data based on population-based surveys for subjects 40 years of age or older were included, for a total of 244. For each of the four outcomes of blindness and moderate to severe vision impairment (MSVI) caused by trachomatous and non-trachomatous CO (NTCO), time trends and differences in prevalence by region, age, and sex were evaluated using a Poisson log-linear model with a generalized estimating equation method. Age-standardized estimates of global prevalence of blindness and MSVI were calculated using the 2015 United Nations standard populations. RESULTS The global prevalence of blindness due to NTCO in those 40 years and older was 0.081% (95% CI=0.049% to 0.315%); MSVI was 0.130% (95% CI= 0.087% to 0.372%). There was a significant increase with age (prevalence rate ratio=2.15, 95% CI=1.99-2.32). Latin America and Europe had the lowest rates, with 2-8 fold higher rates of blindness/MSVI in the other regions. The global prevalence of blindness due to trachomatous CO in those 50 years and older was 0.013% (95% CI=0.006% to 0.043%); MSVI was 0.180% (95% CI=0.006% to 0.049%). Trachomatous CO blindness and MSVI increased with age and female gender, and rates were significantly higher in the African regions; a decrease in blindness rates over time was found (prevalence rate ratio estimate=0.91, 95% CI=0.86-0.96). CONCLUSION An estimated 5.5 million persons worldwide are bilaterally blind or with MSVI due to CO, with an additional 6.2 million unilaterally blind. Trachomatous CO blindness is declining over time, likely due to the massive scaleup of the global trachoma elimination program and overall socioeconomic development.
Collapse
Affiliation(s)
- Erin Wang
- Dana Center for Preventive Ophthalmology, Johns Hopkins Medicine, Baltimore MD
| | - Xiangrong Kong
- Dana Center for Preventive Ophthalmology, Johns Hopkins Medicine, Baltimore MD
| | - Meraf Wolle
- Dana Center for Preventive Ophthalmology, Johns Hopkins Medicine, Baltimore MD
| | - Nicolas Gasquet
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Silvio P Mariotti
- Department of Non-communicable Diseases, World Health Organization, Geneva Switzerland
| | - Rupert Bourne
- Cambridge University Hospitals, Cambridge, UK. Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney NSW Australia; Brien Holden Vision Institute, Sydney NSW Australia; Organization pour la Prévention de la Cécité, Paris, France
| | - Sheila West
- Dana Center for Preventive Ophthalmology, Johns Hopkins Medicine, Baltimore MD.
| |
Collapse
|
5
|
ul Hassan E, Kelly M, Waititu T, Olobio N, Kabona G, Mkocha H, Kivumbi P, Mwale C, Mubangizi A, Mugume F, Baayenda G, Mayeku R, Massangaie M, Mbofana MA, Cumaio M, Sisay A, Mersha T, Courtright P. OUP accepted manuscript. Int Health 2022; 14:i24-i28. [PMID: 35385863 PMCID: PMC8986360 DOI: 10.1093/inthealth/ihab086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/25/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Michaela Kelly
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BZ, UK
| | | | - Nicholas Olobio
- National Trachoma Project Manager, Federal Ministry of Health, Nigeria
| | - George Kabona
- Ministry of Health and Social Welfare, Dar es salaam, Tanzania
| | | | - Peter Kivumbi
- Sightsavers, Tanzania Office, Kinondoni District, Dar es Salaam
| | | | | | | | | | | | - Marilia Massangaie
- Department for Diseases Control and Prevention, National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Tolossa Mersha
- Neglected Tropical Disease Specialist, Oromia Regional Health Bureau, Finfinnee, Ethiopia
| | - Paul Courtright
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BZ, UK
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
6
|
Churko C, Asfaw MA, Zerdo Z. Exploring barriers for trachomatous trichiasis surgery implementation in gamo zone, Southern Ethiopia. PLoS Negl Trop Dis 2021; 15:e0009780. [PMID: 34525104 PMCID: PMC8476041 DOI: 10.1371/journal.pntd.0009780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/27/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background Trachomatous trichiasis is the leading infectious cause of blindness worldwide. The World Health Organization recommends eyelid surgery to reduce the risk of visual impairment from trichiasis. Unfortunately, the number of cases operated has grown less than expected. An understanding of barriers is fundamental for instituting measures to increase surgical uptake. Therefore, the aim of this study was to explore barriers of TT surgery implementation. Methods A qualitative study design was employed in December 2019. Purposive sampling technique was used to select three districts from Gamo zone, Southern Ethiopia. We conducted 9 FGDs and 12 in-depth interviews. Data was collected by audio tape recorder in Amharic and Gamogna languages and then transcribed to English language. The recorded interviews and focus group discussions were transcribed to verbatim (written text) and thematic analysis was done manually and reported accordingly. Findings we explored a number of barriers that hindered implementation of trichiasis surgery. The recurrence of trichiasis after surgery was the main challenges faced by operated individuals. The other barriers reported are negative perception towards trichiasis surgery, lack of logistic and supplies, transportation access problem for remote communities, inadequate trained health professional, less commitment from higher officials, lack of interest of integrated eye care workers due to incentive issues, believes of patients waiting supernatural power for healing service and carelessness of patients to undertake operation. Conclusion and recommendation Post-surgical trichiasis, lack of commitment from government officials and negative perception of patients towards the disease were considered as the reported barriers for implementation of trachomatous trichiasis. Closely supervising the integrated eye care workers would be the first task for district health offices to increase the uptake and improve the quality of service. Logistics and supplies should be made available and adequate to address all affected people in the community. Despite the scale-up of surgical services to eliminate blinding trachoma, the current surgical activity is not effectively tackling the backlog. There are limited studies done previously that explore barriers on implementation of trachomatous trichiasis surgery in Ethiopia. Therefore, understanding barriers is fundamental for instituting measures to increase surgical uptake. Hence, reliable population-based data on barriers towards trichiasis surgery implementation is very crucial for planning effective trachoma control programs, for the country like Ethiopia where trachoma ranks the first in the list of high burden countries. Our finding showed that post-surgical trichiasis, lack of commitment from government officials and negative perception of patients towards the disease were considered as the reported barriers for implementation of trachomatous trichiasis. Closely supervising the integrated eye care workers would be the first task for district health offices to increase the uptake and improve the quality of service. Logistics and supplies should be made available and adequate to address all affected people in the community.
Collapse
Affiliation(s)
- Chuchu Churko
- Collaborative Research and Training Center for Neglected Tropical Diseases, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Mekuria Asnakew Asfaw
- Collaborative Research and Training Center for Neglected Tropical Diseases, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Zerihun Zerdo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| |
Collapse
|
7
|
Adafrie Y, Redae G, Zenebe D, Adhena G. Uptake of Trachoma Trichiasis Surgery and Associated Factors Among Trichiasis-Diagnosed Clients in Southern Tigray, Ethiopia. Clin Ophthalmol 2021; 15:1939-1948. [PMID: 34007146 PMCID: PMC8121670 DOI: 10.2147/opth.s302646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Trachoma is the most common infectious cause of blindness in the globe. Trichiasis surgery is the best treatment option for this disease. Despite efforts done to eliminate blinding trachoma, there is limited evidence on the surgical uptake of trachoma trichiasis in Ethiopia. This study was aimed to assess the uptake of trachoma trichiasis surgery in Southern Tigray, Ethiopia. METHODS Mixed cross-sectional study was employed among 409 participants. Study participants were selected using a consecutive sampling technique. Pretested and interviewer-administered data were collected using a structured questionnaire. Binary and multivariable logistic regression was done to identify associated factors. Adjusted odds ratios 95% CI was estimated to show the strength and direction. Variables with p-values <0.05 were considered statistically significant. For qualitative data, 4 focus group discussions were conducted with 40 participants and described by thematic analysis then triangulated with quantitative findings. RESULTS About 234 (57.9%, 95% CI: (53.2, 62.9)) participants utilized trachoma trichiasis surgery (TT). History of trachoma trichiasis (TT) for >2 years [AOR: 0.4, 95% CI: (0.22, 0.72)], informed about surgery program by health workers [AOR: 0.3, 95% CI: (0.13, 0.71)], history of TT surgery [AOR: 0.18, 95% CI: (0.05, 0.6)], absence of someone to care the family [AOR: 14, 95% CI: (6.9, 28.6)], companion [AOR: 8.9, 95% CI: (4.3, 18.3)], nearby health facility [AOR: 2.4, 95% CI: (1.1, 5.4)], work load [AOR: 8.8, 95% CI: (4.6, 17)], fear [AOR: 4.3, 95% CI: (1.8, 10)], and believing eye drop can treat TT [AOR: 3.9, 95% CI: (1.4, 11)] were significantly associated factors. CONCLUSION More than half of the participants accepted the TT surgical uptake. Strengthening community awareness on proper eye care, and effective treatment options, and addressing the negative attitude towards surgical treatment in the community are important measures to achieve the elimination target of trachoma.
Collapse
Affiliation(s)
- Yeshialem Adafrie
- Department of Epidemiology, Ofla District Health Office, Tigray, Ethiopia
| | - Getachew Redae
- Department of Epidemiology, College of Health Science, Mekele University, Mekele, Ethiopia
| | - Dawit Zenebe
- Department of Epidemiology, College of Health Science, Mekele University, Mekele, Ethiopia
| | - Girmay Adhena
- Department of Reproductive Health, Tigray Regional Health Bureau, Tigray, Ethiopia
| |
Collapse
|
8
|
Saheb Kashaf M, Wolle MA, Muñoz BE, Mkocha H, Funga N, Gracewello C, West SK. Patient perceived barriers to surgical follow-up: Study of 6-month post-operative trichiasis surgery follow-up in Tanzania. PLoS One 2021; 16:e0247994. [PMID: 33739975 PMCID: PMC7978239 DOI: 10.1371/journal.pone.0247994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/17/2021] [Indexed: 11/19/2022] Open
Abstract
Background Post-surgical follow-up is a challenge in low- and middle-income countries. Understanding barriers to trachomatous trichiasis (TT) surgical follow-up can inform program improvements. In this study, patient perceived barriers and enabling factors to follow-up after TT surgery are identified. Methods A longitudinal study was carried out in a community-based cohort of persons who received TT surgery in Bahi district, Tanzania. Questionnaires were administered before TT surgery and again after the scheduled 6-month follow-up. Those who did not return were examined at their homes. Results At baseline, 852 participants were enrolled. Of these, 633 (74%) returned at 6 months and 128 (15%) did not and were interviewed at home. Prior to surgery, attenders were more likely to report familiarity with a community health worker (CHW) (22% vs. 14%; p = 0.01) and less likely to state that time constraints are a potential reason for failure to follow-up (66% vs. 74%; p = .04). At follow-up, non-attenders were more likely to endorse barriers pertaining to knowledge about the need for follow-up, lack of transportation, and satisfaction with surgery. There was no difference in post-operative TT between attenders and non-attenders (23% vs. 18% respectively; p = 0.25). Conclusions The outcome of surgery was not a barrier to follow-up. However, better integration of CHWs into their communities and work at coordinating post-surgical care may improve follow-up rates. Moreover, provision of transportation and implementation of effective reminder systems may address patient-perceived barriers to improve follow-up.
Collapse
Affiliation(s)
- Michael Saheb Kashaf
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
| | - Meraf A. Wolle
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
| | - Beatriz E. Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
| | - Harran Mkocha
- Kongwa Trachoma Project, Kongwa, United Republic of Tanzania
| | - Nicodemus Funga
- Kongwa Trachoma Project, Kongwa, United Republic of Tanzania
| | | | - Sheila K. West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| |
Collapse
|
9
|
Effect of repeated epilation for minor trachomatous trichiasis on lash burden, phenotype and surgical management willingness: A cohort study. PLoS Negl Trop Dis 2020; 14:e0008882. [PMID: 33315876 PMCID: PMC7769600 DOI: 10.1371/journal.pntd.0008882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/28/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022] Open
Abstract
Background WHO endorsed the use of epilation as an alternative treatment to surgery for the management of both minor unoperated TT (UTT) and postoperative TT (PTT). However, some trachoma control programmes hesitated to implement epilation citing concerns that it would hamper TT surgical acceptance and result in larger numbers of and stiffer trichiatic eyelashes than the original TT lashes. We investigated the burden and phenotypes of post-epilation trichiatic eyelashes, and willingness to accept surgical management separately in unoperated and postoperative TT cases. Methodology/Principal findings We recruited cases with minor (≤5 eyelashes from the upper eyelid touching the eye or evidence of epilation in <1/3rd of the upper eyelid) UTT (170) and PTT (169) from community-based screenings in Amhara Region, Ethiopia. Participants eyes were examined and data on present and future willingness to accept surgical management collected at baseline and every month for 6-months. Eyelashes touching the eye were counted and their phenotypes documented. Participants were trained on how to epilate. Epilation was done by the participants at home and by the examiner during follow-ups when requested by the participant. Follow-up rates were ≥97%. There was evidence of a significant reduction in the burden of trichiatic eyelashes in unoperated (mean difference = -0.90 [-1.11– -0.69]; RR = 0.50 [95% CI, 0.40–0.62]; p<0.0001), and postoperative (mean difference = -1.16 [-1.36– -0.95]; RR = 0.38 [95% CI, 0.31–0.48]; p<0.0001) cases 6-month after frequent epilation. Post-epilation trichiatic eyelashes at 6-months had higher odds of being thin (40.2% vs 55.8%, OR = 1.88 [95% CI, 1.21–2.93]; p = 0.0048), weak (39.8% vs 70.8%, OR = 3.68 [95%CI,2.30–5.88]; p<0.0001), and half-length (30.9% vs 43.3%, OR = 1.71 [1.09–2.68]; p = 0.020) than the pre-epilation trichiatic eyelashes in unoperated cases. There was a significant increase in the proportion of weak trichiatic eyelashes (OR = 1.99 [95% CI, 1.03–3.83; p = 0.039) in postoperative cases. In all 6 follow-up time points, 120/164 (73.2%) of unoperated and 134/163 (82.2%) of postoperative cases indicated that they would accept surgery if their trichiasis progressed. Conclusions/Significance In this study setting, frequent epilation neither hampers surgical acceptance nor results in more damaging trichiatic eyelashes than the pre-epilation lashes; and can be used as an alternative to the programmatic management of minor unoperated and postoperative TT cases. Trachomatous Trichiasis (TT), the blinding stage of trachoma, ranges from few peripheral eyelashes touching the eye to all eyelashes scratching the cornea. TT is mainly treated with corrective eyelid surgery. However, not all TT cases require surgical correction, and some, particularly, those with few eyelashes decline surgery. Epilation, the repeated removal of eyelashes, is a very common clinical and traditional practice in many trachoma endemic settings. The World Health Organisation recommends that epilation can be offered as an alternative management strategy to surgery for patients with few eyelashes touching the eye or refusing surgery. However, some trachoma control programmes hesitated to implement epilation with the concern that it would hamper surgical acceptance and results in larger numbers of and stiffer eyelashes touching the eye than the original TT eyelashes. In this study, we explored if these concerns are true in epilating minor (≤5 eyelashes from the upper eyelid touching the eye or evidence of epilation in <1/3rd of the upper eyelid) unoperated (170) and postoperative TT (169) cases. We found, in the contrary to these concerns, the post-epilation eyelashes touching the eye were less damaging being fewer in number, thinner, weaker and shorter than the pre-epilation eyelashes. In addition, the majority of both unoperated and postoperative cases indicated that they are willing to accept surgery if their trichiasis progressed.
Collapse
|
10
|
Sanders AM, Adam M, Aziz N, Callahan EK, Elshafie BE. Piloting a trachomatous trichiasis patient case-searching approach in two localities of Sudan. Trans R Soc Trop Med Hyg 2020; 114:561-565. [PMID: 32307543 PMCID: PMC7405172 DOI: 10.1093/trstmh/traa022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background Approximately 1.9 million people have become blind or visually impaired from trachoma, the leading cause of infectious blindness. Trachoma prevalence surveys conducted in Sudan have shown that thousands of Sudanese suffer from the advanced stages of the disease, trachomatous trichiasis (TT), and warrant sight-saving surgery. Sudan’s National Trachoma Control Program (NTCP) provides free TT surgery; however, given that many TT patients live in remote areas with limited access to health services, identifying patients and providing eye care services has proved challenging. For this reason, the Sudan NTCP piloted a systematic TT case-finding approach to identify patients. Methods In Gedarif state, 11 villages in Baladyat el Gedarif locality and 21 villages in West Galabat locality were included in a TT case-searching activity from September to November 2018. TT case finders were selected from the villages where the activity took place and were trained by ophthalmic medical assistants to identify possible patients. Results Of 66 626 villagers examined, 491 were identified as having TT by TT case finders. Of those, 369 were confirmed as true cases by the TT surgeons, a 75.2% (369/491) success rate. Conclusions The TT case-finding approach provides an example of an effective method for identifying TT patients and should be expanded to other parts of the country known to be endemic for trachoma.
Collapse
Affiliation(s)
| | | | | | | | - Belgesa E Elshafie
- National Program for Prevention of Blindness, Federal Ministry of Health, Khartoum, Sudan
| |
Collapse
|
11
|
Djore D, Djibrine D, Ali AB, Tyau-Tyau H, Hiron D, Kali B, Biao JE, Bernasconi J, Bengraïne K, Resnikoff S. Pilot Audit of Trichiasis Surgery Outcomes Using a Mobile App in the Republic of Chad. Middle East Afr J Ophthalmol 2020; 27:14-21. [PMID: 32549719 PMCID: PMC7276166 DOI: 10.4103/meajo.meajo_75_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/06/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE: The purpose of the study was to assess the feasibility of a mobile data collection app for use in trichiasis surgical audits in the Melfi and Mangalme districts of the Guera region of the Republic of Chad and to perform a cost analysis to determine if the auditing mechanism could be implemented nationally. MATERIALS AND METHODS: Patients who underwent trichiasis surgery 6 months prior and who had follow-up 7–14 days after surgery were included in the study. Each surgeon had a sample of 20% of operated eyelids; nine surgeons with data for ≥20 eyelids were included. A trichiasis recurrence rate of ≥25% suggested that the surgeon needed retraining. Smartphones captured data using the data collection app, which transmitted data to an online server. Direct costs and supervision costs were collated and summed. RESULTS: There were 916 eyelids operated on; 170 patients (269 eyelids, 29% follow-up rate) participated in the audit. Twenty participants (11.8%) had recurrence. The mean recurrence rate among surgeons was 8.3% (standard deviation: 0.07%; range: 0%–17.9%). None had a recurrence rate of ≥25%; thus, no retraining was necessary. The total cost of the audit was US$15,111.25 ($12,882.28 in direct costs and $2,228.97 in supervision costs). CONCLUSIONS: The simple, easy-to-use, and low-cost mobile auditing mechanism is a practical solution for conducting surgical audits in remote and resource-limited settings and is undergoing national scale-up by the Chadian trachoma elimination program.
Collapse
Affiliation(s)
| | - Djada Djibrine
- Faculty of Medicine of N'Djamena, N'Djamena, Chad.,Department of Ophtalmology, National Referral Hospital, N'Djamena, Chad
| | | | | | - Doniphan Hiron
- Organization for the Prevention of Blindness, Paris, France
| | - Barka Kali
- Organization for the Prevention of Blindness, N'Djamena, Chad
| | - Jean-Eudes Biao
- Organization for the Prevention of Blindness, N'Djamena, Chad
| | | | | | | |
Collapse
|
12
|
Are Corneal Patients Accepting the Transplantation? The Cases of University of Gondar, Tertiary Eye Care and Training Center, Ethiopia. J Ophthalmol 2020; 2019:4560649. [PMID: 31915540 PMCID: PMC6930795 DOI: 10.1155/2019/4560649] [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: 08/10/2019] [Revised: 10/06/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
Background For so long, corneal diseases have been known as one of the leading causes to blindness in the global. This blindness might be due to failure to accept the corneal transplantation. Therefore, this study aimed to determine the prevalence and the root challenges for corneal transplantation acceptance at the University of Gondar tertiary eye care and training center, Ethiopia. Methods An institution-based cross-sectional study was conducted among patients who had an indication for corneal transplantation at the University of Gondar tertiary eye care and training center since January 1, 2017, up to October 30, 2018. A structured questionnaire was used to collect the data and entered into Epi-Info 7 software and analyzed using SPSS version 20. Simple logistic regression was used to identify the associated factors of corneal transplantation acceptance. Associations between outcome and exposure variables were expressed by the adjusted odds ratio with a 95% confidence interval and p value <0.05. Result A total of 116 patients with a mean age of 51 (±21) years participated in the study. The overall acceptance level of corneal transplantation was only 38.8% (95% CI: 29.93, 47.66). Patients with poor knowledge [AOR = 2.41; 95% CI: 1.90, 6.48] and an unfavorable attitude [AOR = 6.33; 95% CI: 2.42, 16.54] were significantly associated with the acceptance of corneal transplantation. Conclusion The study revealed that the corneal transplantation acceptance level was very low. Hence, the government and other concerned stakeholders should give due emphasis to the awareness creation and behavior change communication strategies to increase the acceptance level of corneal transplantation.
Collapse
|
13
|
Mpyet C, Ramyil A, Dami N, Courtright P. Use of an inexpensive magnifier with light source in the diagnosis of trichiasis among community-based case finders in Nigeria. Ophthalmic Epidemiol 2019; 25:138-142. [PMID: 30806539 DOI: 10.1080/09286586.2018.1546876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Trichiasis case finding is challenging in many trachoma endemic countries. We sought to determine how the use of an inexpensive hand-held magnifier with light source aids in the diagnosis of people with trichiasis. METHODS We undertook a study on the use of the "Wilson", an inexpensive hand-held magnifier with light source between two groups of trained case finders: community drug distributors (CDD) volunteers and non-health volunteers. Each group was randomly allocated to be provided a Wilson or not. We compared the number of people with suspected trichiasis and the proportion of true cases referred by each group. Focus group discussions explored the perceptions of the case finders that used the Wilson on its utility in the diagnosis of trichiasis and its ease of use. RESULTS Among the 121 case finders, 61 were CDD volunteers (31 were provided the Wilson) and 60 were non-health worker volunteers (30 were provided the Wilson). Case finders that used the Wilson were 4.57 times (95% CI 2.46-8.47) more likely to have patients presenting confirmed as trichiasis compared to those not using the Wilson. Case finders that used the Wilson felt the instrument was easy to use, enlarged the eyelashes and made diagnoses of trichiasis easier. DISCUSSION In Nigeria it appears that the Wilson is easy to handle and use among trichiasis case finders enhances the diagnosis of trichiasis.
Collapse
Affiliation(s)
- Caleb Mpyet
- a Department of Ophthalmology , University of Jos , Jos , Nigeria.,b Sightsavers , Kaduna , Nigeria.,c Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| | - Alice Ramyil
- a Department of Ophthalmology , University of Jos , Jos , Nigeria
| | - Nantok Dami
- d Department of Community Health , University of Jos , Jos , Nigeria
| | - Paul Courtright
- c Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology , University of Cape Town , Cape Town , South Africa
| |
Collapse
|
14
|
Achieving the endgame: Integrated NTD case searches. PLoS Negl Trop Dis 2018; 12:e0006623. [PMID: 30571758 PMCID: PMC6319769 DOI: 10.1371/journal.pntd.0006623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/04/2019] [Accepted: 11/17/2018] [Indexed: 12/02/2022] Open
Abstract
Trachoma and Guinea Worm Disease (GWD) are neglected tropical diseases (NTD) slated for elimination as a public health problem and eradication respectively by the World Health Organization. As these programs wind down, uncovering the last cases becomes an urgent priority. In 2010, Ghana Health Services, along with The Carter Center, Sightsavers, and other partners, conducted integrated case searches for both GWD and the last stage of trachoma disease, trachomatous trichiasis (TT), as well as providing surgical treatment for TT to meet elimination (and eradication targets). House to house case searches for both diseases were conducted and two case management strategies were explored: a centralized referral to services method and a Point of Care (POC) delivery method. 835 suspected TT cases were discovered in the centralized method, of which 554 accepted surgery. 482 suspected TT cases were discovered in the POC method and all TT cases accepted surgery. The cost per TT case examined was lower in the POC searches compared to the centralized searches ($19.97 in the POC searches and $20.85 in the centralized searches). Both strategies resulted in high surgical uptake for TT surgery, with average uptakes of 72.4% and 83.9% for the centralized and POC searches respectively. We present here that house to house case searches offering services at POC are feasible and a potential tool for elimination and eradication programs nearing their end. Trachoma and Guinea Worm Disease (GWD) are neglected tropical diseases slated for elimination as a public health problem and eradication respectively by the World Health Organization. As these programs wind down, uncovering the last cases becomes an urgent priority in order to confirm that eradiation and elimination targets have been reached. Active case searches are one method of finding these last vestiges of disease. Searches that look for multiple diseases are referred to as integrated searches. We piloted here integrated house-to-house case searches for GWD and Trachoma with two case management strategies; a referral approach to a central location and a point of care approach (POC)–offering services at the household or ‘point of care’ location. POC approaches can be difficult to implement in low resource settings because they require extensive personnel, financial commitment, and logistical support. However, POC approaches remove one of the biggest barriers to treatment, time spent traveling to a health center, and thus can improve treatment acceptance. We found here that integrated active case searches with a POC case management approach can be implemented in a low resource setting; and improve acceptance and uptake of trachoma examination and trichiasis surgery respectively, without costing much more than a referral-based case management approach.
Collapse
|
15
|
Mpyet C, Muhammad N, Adamu MD, Umar MM, Tafida A, Ogoshi C, Maidaura A, Isiyaku S, William A, Willis R, Bakhtiari A, Olobio N, Solomon AW, for the Global Trachoma Mapping Project. Prevalence of Trachoma in Four Local Government Areas of Jigawa State, Nigeria. Ophthalmic Epidemiol 2018; 25:86-92. [PMID: 30806552 PMCID: PMC6444196 DOI: 10.1080/09286586.2018.1467468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/17/2018] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the prevalence of trachoma and water and sanitation coverage in four local government areas (LGAs) of Jigawa State, Nigeria: Birnin Kudu, Buji, Dutse and Kiyawa. METHODOLOGY A population-based cross-sectional survey was conducted in each LGA using Global Trachoma Mapping Project (GTMP) protocols. From each LGA, 25 villages were selected using probability-proportional-to-population size sampling; in each village, 25 households were selected using the random walk technique. All residents aged ≥1 year in selected households were examined by GTMP-certified graders for trachomatous inflammation - follicular (TF) and trichiasis, defined according to the WHO simplified trachoma grading scheme definitions. Water, sanitation and hygiene data were also collected through questioning and direct observation. RESULTS In 2458 households of four LGAs, 10,669 residents were enumerated. A total of 9779 people (92% of residents) were examined, with slightly more females examined (5012; 51%) than men. In children aged 1-9 years, the age-adjusted prevalence of TF ranged from 5.1% (95% CI 2.5-9.0%) in Birnin Kudu to 12.8% (95% CI 7.6-19.4%) in Kiyawa, while the age- and gender-adjusted trichiasis prevalence in persons aged ≥15 years ranged from 1.9% (95% CI 1.4-2.5%) in Birnin Kudu to 3.1% (95% CI 2.2-4.0) in Dutse. Access to improved water sources was above 80% in all LGAs surveyed but access to improved sanitation facilities was low, ranging from 23% in Buji to 50% in Kiyawa. CONCLUSION Trachoma is a public health problem in all four LGAs surveyed. The full SAFE strategy needs to be implemented to achieve trachoma elimination.
Collapse
Affiliation(s)
- Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria
- Sightsavers, Kaduna, Nigeria
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Nasiru Muhammad
- Ophthalmology Unit, Surgery Department, Usmanu Danfodiyo University, Sokoto, Nigeria
| | | | | | | | | | | | | | | | | | | | | | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | |
Collapse
|
16
|
Meshesha TD, Senbete GH, Bogale GG. Determinants for not utilizing trachomatous trichiasis surgery among trachomatous trichiasis patients in Mehalsayint District, North-East Ethiopia. PLoS Negl Trop Dis 2018; 12:e0006669. [PMID: 30020941 PMCID: PMC6066252 DOI: 10.1371/journal.pntd.0006669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/30/2018] [Accepted: 07/09/2018] [Indexed: 11/23/2022] Open
Abstract
Background Globally, trachoma is the leading cause of infectious blindness. In Ethiopia, the overall Trachomatous Trichiasis (TT) surgical coverage is 41%. Identifying determinants for not utilizing TT surgery among TT patients is important to design and monitor effective intervention programs. Therefore, this study aimed to identify determinants for not utilizing TT surgery among TT patients in Mehalsayint District, North East Ethiopia. Methodology/Principal findings A community based unmatched case control study was employed from March 30, 2017 to April 13, 2017. A total of 482 study participants (241 cases and 241 controls) with age of ≥15 years were included in the study. The data were entered with Epi info version 7.2 software and exported to SPSS version 20 for analysis. Bivariate analysis was fitted to screen candidate variables with p<0.2 for the final model. Finally, multivariable logistic regression analysis was employed to identify significant factors (p<0.05) for not utilizing TT surgery. Respondents’ age of 16–30 years (AOR: 10.11; 95% CI: 2.72, 37.59) and widowed respondents (AOR: 0.40; 95% CI: 0.21, 0.77), time to reach the service (AOR: 0.46; 95% CI: 0.24, 0.87), unavailability of TT surgeon (AOR: 5.00; 95% CI: 1.16, 21.38), symptoms of trichiasis (AOR: 7.49; 95% CI: 2.41, 23.26), duration of the problem (AOR: 2.56; 95% CI: 1.44, 4.54), the affected eye (AOR: 2.16; 95% CI: 1.23, 3.80), epilation practice (AOR: 3.22; 95% CI: 1.84, 5.64), and place of TT surgery given (AOR: 4.21; 95% CI: 2.48, 7.14) were significant determinants for not utilizing TT surgical services. Conclusions/Significance In this study, TT surgery against trachoma is very low and TT remains public health problem in the district. Being younger age and widowed, time taken to reach the service, absence of TT surgeon, symptoms of trichiasis, duration of problem, the affected eye, epilation practice, and service place were determinants for the inability of TT surgical services. The findings of this study would help in designing effective interventions to reduce trachoma in that district. Trachoma is the common ophthalmic infection and cause of blindness worldwide. It is caused by ocular infections with causative agent of Chlamydia trachomatis that might effect in chronic inflammation of the eyelids, which produces scarring of the conjunctiva that can consequently cause entropion trichiasis, resulting in interned eyelashes. The interned eyelashes as well as other changes of the eye, harm the cornea causing severe pain, corneal opacity and resulting vision loss. Over a million people in Ethiopia are estimated to have Trachomatous trichiasis (TT). Trachomatous trichiasis surgery is the backbone treatment option. Though the provision of free surgical services in the country exists, utilization rates are very low. Identifying the determinants for not utilizing the service is mandatory to take measures towards surgical uptake. A total of 482 study participants (241 cases and 241 controls) with age of ≥15 years were included in the study. The determinants for not use of surgical services were respondents in the younger age group (16–30 years) and widowed participants, lengthy distance from the service, unavailability of TT surgeon, no trichiasis symptoms, long time knowing the problem, right/left eye affected, no experience of epilation practice, and participants who knew place of service was given at health center.
Collapse
Affiliation(s)
- Tedla Desta Meshesha
- Trachoma Program at East Amhara Sub-Regional Office, The Carter Center, Dessie, Ethiopia
- * E-mail:
| | - Goitom Halefom Senbete
- Department of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Getahun Gebre Bogale
- Department of Health Information Technology, Dessie Health Science College, Dessie, Ethiopia
| |
Collapse
|
17
|
Gupta KM, Harding JC, Othman MS, Merbs SL, Gower EW. Why do patients refuse trichiasis surgery? Lessons and an education initiative from Mtwara Region, Tanzania. PLoS Negl Trop Dis 2018; 12:e0006464. [PMID: 29902219 PMCID: PMC6001945 DOI: 10.1371/journal.pntd.0006464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/19/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trachomatous trichiasis is one of the leading causes of preventable blindness worldwide. A relatively simple surgery can spare vision. Although this surgery is usually performed free of charge in endemic regions, multiple studies indicate that surgical refusal is common. Prior studies have attempted to examine these reasons, although they generally rely on patient recall months to years after the surgery was offered. This study set out to determine major decision-making factors at the time of refusal. In addition, this study looked for ways to help increase surgical uptake by targeting modifiable factors. METHODOLOGY/PRINCIPAL FINDINGS We used a combination of focus groups, interviews with community health workers, and individual interviews with trichiasis patients who refused surgery to understand their decision-making. We found that several factors influenced surgical refusals, including misconception regarding recovery time, inability to find a post-surgical caregiver, and the time of year of the surgical campaign. Fear of the surgery itself played a minimal role in refusals. CONCLUSIONS/SIGNIFICANCE Trichiasis patients refuse surgery for many reasons, but a large percentage is due to lack of information and education, and is, therefore, modifiable within the structure of a surgical outreach project. To address this, we developed a "frequently asked questions" (FAQ) document aimed at community health workers, which may have helped to decrease some of the misconceptions that had led to prior refusals.
Collapse
Affiliation(s)
- Katherine M. Gupta
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | | | | | - Shannath L. Merbs
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Emily W. Gower
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
18
|
Identifying Patient Perceived Barriers to Trichiasis Surgery in Kongwa District, Tanzania. PLoS Negl Trop Dis 2017; 11:e0005211. [PMID: 28052070 PMCID: PMC5215731 DOI: 10.1371/journal.pntd.0005211] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trachomatous trichiasis (TT), inturned eyelashes from repeated infection with Chlamydia trachomatis, is the leading infectious cause of blindness in the world. Though surgery will correct entropion caused by trachoma, uptake of TT surgery remains low. In this case-control study, we identify barriers that prevent TT patients from receiving sight-saving surgery. METHODOLOGY/PRINCIPAL FINDINGS Participants were selected from a database of TT cases who did (acceptors) and did not (non-acceptors) have surgery as of August 2015. We developed an in-home interview questionnaire, using open and closed-ended questions on perceived barriers to accessing surgical services. We compared responses between the acceptors and non-acceptors, examining differences in reasons for and against surgery, sources of TT information, and suggestions for improving surgical delivery. 167 participants (mean age 61 years, 79.7% females) were interviewed. Compared to acceptors, non-acceptors were more likely to report they had no one to accompany them to surgery (75.3% vs. 42.6%, p<0.0001), they could manage TT on their own (69.9% vs. 31.5%, p<0.0001), and the surgery camp was too far (53.4% vs. 28.7%, p = 0.001). Over 90% of both acceptors and non-acceptors agreed on the benefits of having surgery. Fear of surgery was the biggest barrier stated by both groups. Despite this fear, acceptors were more likely than non-acceptors to also report fear of losing further vision without surgery. CONCLUSIONS/SIGNIFICANCE Barriers included access issues, familial and/or work responsibilities, the perception that self-management was sufficient, and lack of education about surgery. Fear of surgery was the biggest barrier facing both acceptors and non-acceptors. Increasing uptake will require addressing how surgery is presented to community residents, including outlining treatment logistics, surgical outcomes, and stressing the risk of vision loss.
Collapse
|
19
|
Redekop WK, Lenk EJ, Luyendijk M, Fitzpatrick C, Niessen L, Stolk WA, Tediosi F, Rijnsburger AJ, Bakker R, Hontelez JAC, Richardus JH, Jacobson J, de Vlas SJ, Severens JL. The Socioeconomic Benefit to Individuals of Achieving the 2020 Targets for Five Preventive Chemotherapy Neglected Tropical Diseases. PLoS Negl Trop Dis 2017; 11:e0005289. [PMID: 28103243 PMCID: PMC5313231 DOI: 10.1371/journal.pntd.0005289] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 02/16/2017] [Accepted: 12/28/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminths (STH) and trachoma represent the five most prevalent neglected tropical diseases (NTDs). They can be controlled or eliminated by means of safe and cost-effective interventions delivered through programs of Mass Drug Administration (MDA)-also named Preventive Chemotherapy (PCT). The WHO defined targets for NTD control/elimination by 2020, reinforced by the 2012 London Declaration, which, if achieved, would result in dramatic health gains. We estimated the potential economic benefit of achieving these targets, focusing specifically on productivity and out-of-pocket payments. METHODS Productivity loss was calculated by combining disease frequency with productivity loss from the disease, from the perspective of affected individuals. Productivity gain was calculated by deducting the total loss expected in the target achievement scenario from the loss in a counterfactual scenario where it was assumed the pre-intervention situation in 1990 regarding NTDs would continue unabated until 2030. Economic benefits from out-of-pocket payments (OPPs) were calculated similarly. Benefits are reported in 2005 US$ (purchasing power parity-adjusted and discounted at 3% per annum from 2010). Sensitivity analyses were used to assess the influence of changes in input parameters. RESULTS The economic benefit from productivity gain was estimated to be I$251 billion in 2011-2020 and I$313 billion in 2021-2030, considerably greater than the total OPPs averted of I$0.72 billion and I$0.96 billion in the same periods. The net benefit is expected to be US$ 27.4 and US$ 42.8 for every dollar invested during the same periods. Impact varies between NTDs and regions, since it is determined by disease prevalence and extent of disease-related productivity loss. CONCLUSION Achieving the PCT-NTD targets for 2020 will yield significant economic benefits to affected individuals. Despite large uncertainty, these benefits far exceed the investment required by governments and their development partners within all reasonable scenarios. Given the concentration of the NTDs among the poorest households, these investments represent good value for money in efforts to share the world's prosperity and reduce inequity.
Collapse
Affiliation(s)
- William K. Redekop
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Edeltraud J. Lenk
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marianne Luyendijk
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Louis Niessen
- Centre for Applied Health Research and Delivery, Department of International Public Health, Liverpool School of Tropical Medicine and University of Liverpool, Liverpool, United Kingdom
| | - Wilma A. Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | | | - Roel Bakker
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A. C. Hontelez
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan H. Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Julie Jacobson
- Bill & Melinda Gates Foundation, Seattle, WA, United States of America
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan L. Severens
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
20
|
Mpyet C, Muhammad N, Adamu MD, Muazu H, Umar MM, Abdull M, Alada J, Goyol M, Onyebuchi U, Olamiju F, Isiyaku S, William A, Nwobi BC, Willis R, Flueckiger RM, Pavluck A, Chu BK, Olobio N, Solomon AW. Prevalence of Trachoma in Bauchi State, Nigeria: Results of 20 Local Government Area-Level Surveys. Ophthalmic Epidemiol 2016; 23:39-45. [PMID: 27846369 PMCID: PMC5706969 DOI: 10.1080/09286586.2016.1238945] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE To determine the prevalence of trachomatous inflammation - follicular (TF) and trichiasis in each of the 20 local government areas (LGAs) of Bauchi State, Nigeria. METHODS We undertook a population-based prevalence survey in each LGA in Bauchi State, employing the Global Trachoma Mapping Project methodology. We used a 2-stage, systematic and quasi-random sampling strategy. Using probability proportional to size, we selected 25 clusters, in each of which 25 households were selected by random walk. All residents of selected households 1 year and older were examined for TF, trachomatous inflammation - intense, and trichiasis, using the World Health Organization simplified grading scheme. RESULTS Only two LGAs in Bauchi State had TF prevalences in 1-9-year-olds over 5%, with none having TF prevalences of 10% or greater. Only one LGA had a trichiasis prevalence in adults below the elimination threshold; all the others had trichiasis at levels suggestive of public health significance. In all 20 LGAs, more than 60% of households were within 1 km of an improved source of water for hygiene. CONCLUSION Efforts need to be made in Bauchi State to provide trichiasis surgery in order to avert trachomatous blindness. Water supplies needs to be sustained and good personal hygiene practices assured so that elimination of trachoma as a public health problem will be achieved and sustained.
Collapse
Affiliation(s)
- Caleb Mpyet
- a Department of Ophthalmology , University of Jos , Jos , Nigeria.,b Sightsavers , Kaduna , Nigeria.,c Department of Ophthalmology , Jos University Teaching Hospital , Jos , Nigeria
| | - Nasiru Muhammad
- d Department of Ophthalmology , Usmanu Danfodiyo University Teaching Hospital, Sokoto , Nigeria
| | - Mohammed Dantani Adamu
- d Department of Ophthalmology , Usmanu Danfodiyo University Teaching Hospital, Sokoto , Nigeria
| | | | | | - Mohammed Abdull
- g Abubakar Tafawa Balewa University Teaching Hospital , Bauchi , Nigeria
| | - Joel Alada
- c Department of Ophthalmology , Jos University Teaching Hospital , Jos , Nigeria
| | - Musa Goyol
- h Netherlands Leprosy Relief, Jos , Nigeria
| | - Uwaezuoke Onyebuchi
- i National Trachoma Control Program, Department of Public Health, Federal Ministry of Health , Abuja , Nigeria
| | | | | | | | - Benjamin C Nwobi
- i National Trachoma Control Program, Department of Public Health, Federal Ministry of Health , Abuja , Nigeria
| | | | | | - Alex Pavluck
- k Task Force for Global Health , Decatur , GA , USA
| | - Brian K Chu
- k Task Force for Global Health , Decatur , GA , USA
| | - Nicholas Olobio
- i National Trachoma Control Program, Department of Public Health, Federal Ministry of Health , Abuja , Nigeria
| | - Anthony W Solomon
- l Clinical Research Department, London School of Hygiene & Tropical Medicine , London , UK.,m London Centre for Neglected Tropical Disease Research , London , UK
| |
Collapse
|
21
|
Gichangi M, Kalua K, Barassa E, Eliah E, Lewallen S, Courtright P. Task Shifting for Eye Care in Eastern Africa: General Nurses as Trichiasis Surgeons in Kenya, Malawi, and Tanzania. Ophthalmic Epidemiol 2016; 22:226-30. [PMID: 26158581 DOI: 10.3109/09286586.2015.1040924] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE There are approximately 8 million people with trachomatous trichiasis globally; in the year 2009, less than 160,000 people had surgery. These numbers are too low in order to achieve the goal of elimination of blinding trachoma by the year 2020. Task shifting approaches have led to the training of general nurses in trichiasis surgery in eastern Africa. The overall aim of this study was to determine the attrition and productivity (and the factors associated with productivity) of trichiasis surgeons in Kenya, Tanzania, and Malawi. METHODS A 3-year cohort study of trichiasis surgeons. RESULTS The overall response rate was 86%. Defining high productivity as 50+ operations per year per surgeon, only 16.1% of the trichiasis surgeons were highly productive. Among the surgeons, 27.9% were no longer at their site and ceased providing surgery (attrition) over the 3 years of study. High productivity was associated with having been trained by an experienced trainer, supervised by a clinical officer, having more than three surgical sets, and having an outreach program. CONCLUSION Attrition of general nurses trained in trichiasis surgery was high. Surgical productivity of trichiasis surgeons remained too low. It is likely that other approaches are needed to address the burden of trichiasis in the three countries. In terms of recommendations, training of trichiasis surgeons should be done in a "package," including a plan for provision of surgical equipment, continuous support and supervision, and outreach.
Collapse
|
22
|
Mousa A, Courtright P, Kazanjian A, Bassett K. A Community-based Eye Care Intervention in Southern Egypt: Impact on Trachomatous Trichiasis Surgical Coverage. Middle East Afr J Ophthalmol 2015; 22:478-83. [PMID: 26692721 PMCID: PMC4660536 DOI: 10.4103/0974-9233.167808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: The purpose of this study was to measure the impact of a community-based intervention on uptake of trichiasis surgery in Southern Egypt. Methods: Four villages where trachoma is endemic were randomly selected in the Samalout district, Egypt. Two villages were selected for intervention (intervention villages) and two matched villages for nonintervention (nonintervention villages). The intervention model provided community information sessions, door-to-door health education, screening, and improvements in the clinical capacity of eye care providers. The intervention was evaluated through two pre- and post-intervention community-based surveys that included the prevalence of trachoma and the utilization of eye care services at local hospitals. All patients with trichiasis answered a questionnaire regarding surgical utilization and barriers. Results: In the baseline survey, the trachomatous trichiasis (TT) surgical coverage was 22.7% (38.9% males, 16.7% females) in all villages. Following the intervention, the TT surgical coverage increased to 68% in villages that received the intervention (81.5% males, 60% females). Nonintervention villages had a TT surgical coverage of 26.1% (37.5% males, 20% females). In the intervention villages, the prevalence of TT significantly decreased from 9.4% (5.7% males, 11.8% females) to 3.8% (1.9% males, 5.1% females) (P = 0.013), in 2008. In nonintervention villages, there was a slight, but insignificant decrease in TT from 10.1% (3.1% males, 14.4% females) to 8.2% (3% males, 11.5% females) (P = 0.580). The major barriers to uptake of TT surgical services were: “Feeling no problem” (17.3%), “fear of surgery” (12.7%) and “cost” (12.7%). Conclusion: A community-based eye health education program with door-to-door screening significantly increased the uptake of TT surgical services. Although improvements to the delivery of surgical service are essential, they did not lead to any significant improvements in the nonintervention villages.
Collapse
Affiliation(s)
- Ahmed Mousa
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; Department of Ophthalmology, Gluaocma Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa ; School of Population and Public Health, University of British Columbia, Vancouver, Canada ; British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia, Vancouver, Canada
| | - Arminee Kazanjian
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Ken Bassett
- British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia, Vancouver, Canada
| |
Collapse
|
23
|
Assessment of a Novel Approach to Identify Trichiasis Cases Using Community Treatment Assistants in Tanzania. PLoS Negl Trop Dis 2015; 9:e0004270. [PMID: 26658938 PMCID: PMC4676626 DOI: 10.1371/journal.pntd.0004270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/08/2015] [Indexed: 11/29/2022] Open
Abstract
Background Simple surgical intervention advocated by the World Health Organization can alleviate trachomatous trichiasis (TT) and prevent subsequent blindness. A large backlog of TT cases remain unidentified and untreated. To increase identification and referral of TT cases, a novel approach using standard screening questions, a card, and simple training for Community Treatment Assistants (CTAs) to use during Mass Drug Administration (MDA) was developed and evaluated in Kongwa District, a trachoma-endemic area of central Tanzania. Methodology/Principal Findings A community randomized trial was conducted in 36 communities during MDA. CTAs in intervention villages received an additional half-day of training and a TT screening card in addition to the training received by CTAs in villages assigned to usual care. All MDA participants 15 years and older were screened for TT, and senior TT graders confirmed case status by evaluating all screened-positive cases. A random sample of those screened negative for TT and those who did not present at MDA were also evaluated by the master graders. Intervention CTAs identified 5.6 times as many cases (n = 50) as those assigned to usual care (n = 9, p < 0.05). While specificity was above 90% for both groups, the sensitivity for the novel screening tool was 31.2% compared to 5.6% for the usual care group (p < 0.05). Conclusions/Significance CTAs appear to be viable resources for the identification of TT cases. Additional training and use of a TT screening card significantly increased the ability of CTAs to recognize and refer TT cases during MDA; however, further efforts are needed to improve case detection and reduce the number of false positive cases. Surgical management of trachomatous trichiasis (TT) is recommended by the WHO as a cost-effective strategy to mitigate blinding trachoma. However, a large surgical backlog exists and many individuals suffering with TT remain unknown to the health system. To identify TT cases, we designed a standard set of screening questions, a card, and simple training for Community Treatment Assistants (CTAs) to identify trichiasis during community-wide Mass Drug Administrations (MDA). To evaluate the sensitivity, specificity, and positive predictive value of this approach, we conducted a community randomized trial in 36 communities in trachoma-endemic Kongwa District, Tanzania. Additional training and the use of a TT screening card increased the sensitivity of TT identification and resulted in more cases identified compared to the usual training of CTAs. The positive predictive value was low, indicating a need for further verification of TT cases identified by the enhanced screening. MDA appears to be a good opportunity for TT screening by CTAs, but further training to improve screening sensitivity is suggested.
Collapse
|
24
|
Habtamu E, Rajak SN, Tadesse Z, Wondie T, Zerihun M, Guadie B, Gebre T, Kello AB, Callahan K, Mabey DCW, Khaw PT, Gilbert CE, Weiss HA, Emerson PM, Burton MJ. Epilation for minor trachomatous trichiasis: four-year results of a randomised controlled trial. PLoS Negl Trop Dis 2015; 9:e0003558. [PMID: 25768796 PMCID: PMC4358978 DOI: 10.1371/journal.pntd.0003558] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022] Open
Abstract
Background Trachomatous trichiasis (TT) needs to be managed to reduce the risk of vision loss. The long-term impact of epilation (a common traditional practice of repeated plucking of lashes touching the eye) in preventing visual impairment and corneal opacity from TT is unknown. We conducted a randomized controlled trial of epilation versus surgery for the management of minor TT (fewer than six lashes touching the eye) in Ethiopia. Here we report the four-year outcome and the effect on vision and corneal opacity. Methodology/ Principal Findings 1300 individuals with minor TT were recruited and randomly assigned to quality trichiasis surgery or repeated epilation using high quality epilation forceps by a trained person with good near vision. Participants were examined six-monthly for two-years, and then at four-years after randomisation. At two-years all epilation arm participants were offered free surgery. At four-years 1151 (88.5%) were re-examined: 572 (88%) and 579 (89%) from epilation and surgery arms, respectively. At that time, 21.1% of the surgery arm participants had recurrent TT; 189/572 (33%) of the epilation arm had received surgery, while 383 (67%) declined surgery and had continued epilating (“epilation-only”). Among the epilation-only group, 207 (54.1%) fully controlled their TT, 166 (43.3%) had minor TT and 10 (2.6%) had major TT (>5 lashes). There were no differences between participants in the epilation-only, epilation-to-surgery and surgery arm participants in changes in visual acuity and corneal opacity between baseline and four-years. Conclusions/ Significance Most minor TT participants randomised to the epilation arm continued epilating and controlled their TT. Change in vision and corneal opacity was comparable between surgery and epilation-only participants. This suggests that good quality epilation with regular follow-up is a reasonable second-line alternative to surgery for minor TT for individuals who either decline surgery or do not have immediate access to surgical treatment. Trachoma causes visual impairment through the effect of in-turned eyelashes (trichiasis) on the surface of the eye. Epilation is a common traditional practice of intermittent plucking of lashes touching the eye, however, its long-term effectiveness in preventing visual impairment is unknown. We conducted a randomized controlled trial of epilation versus eyelid surgery (the main treatment option) in 1300 people with mild trichiasis in Ethiopia. We defined mild trichiasis as fewer than six lashes touching the eye. We have previously reported results to two years and have now re-assessed these individuals at four years. Overall, we found no difference between the epilation and surgery groups in terms of change in vision and corneal opacity between baseline and four years. Most mild trichiasis participants randomised to the epilation arm continued epilating and controlled their trichiasis. This suggests that good quality epilation is a reasonable second-line alternative to surgery for mild trichiasis for individuals who either decline surgery or do not have immediate access to surgical treatment.
Collapse
Affiliation(s)
- Esmael Habtamu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Carter Center, Addis Ababa, Ethiopia
| | - Saul N. Rajak
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | | | - Teshome Gebre
- International Trachoma Initiative, Addis Ababa, Ethiopia
| | | | - Kelly Callahan
- The Carter Center, Atlanta, Georgia, United States of America
| | - David C. W. Mabey
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peng T. Khaw
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Clare E. Gilbert
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paul M. Emerson
- International Trachoma Initiative, Atlanta, Georgia, United States of America
| | - Matthew J. Burton
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- * E-mail:
| |
Collapse
|
25
|
Yeh HJ, Chou YJ, Yang NP, Huang N. Receipt of physical therapy among osteoarthritis patients and its influencing factors. Arch Phys Med Rehabil 2015; 96:1021-7. [PMID: 25701638 DOI: 10.1016/j.apmr.2015.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To explore major patient and provider characteristics influencing the receipt of physical therapy (PT) among patients newly diagnosed with osteoarthritis. DESIGN A population-based, cross-sectional study on outpatient PT for patients newly diagnosed with osteoarthritis within the period of 2005 to 2010. SETTING Sample of 1 million National Health Insurance enrollees. PARTICIPANTS People aged ≥18 years with an incidence of osteoarthritis and receiving initial outpatient treatment. A total of 29,012 patients were included (N=29,012). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The outcome variable of interest was the probability of receiving PT within 1 year of osteoarthritis diagnosis. Both individual and provider characteristics were investigated to determine their influence on PT receipt. RESULTS Of the 29,012 included patients with osteoarthritis, only 24.8% of them received PT within the first year of diagnosis. Men and older adults were less likely to receive PT. In addition, low-income patients with osteoarthritis were less likely to receive PT. Furthermore, PT receipt was increased in patients treated by physicians who were women and by physicians who specialized in rehabilitation medicine. In addition, we observed a pattern indicating that the lower the accreditation level of the practice setting, the greater the probability of receiving PT. CONCLUSIONS Because of the National Health Insurance program in Taiwan, direct medical costs of PT have been substantially reduced; however, variations are still observed among different patient and provider characteristics. The major role of providers in PT receipt for patients with osteoarthritis should not be ignored.
Collapse
Affiliation(s)
- Huan-Jui Yeh
- Department of Physical Medicine and Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Nan-Ping Yang
- Department of Orthopedics, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
26
|
Campion A, Tamiru A, Tsegay G, Davey G. Reasons for loss to follow-up of patients with podoconiosis in the Amhara Region, northern Ethiopia. Int Health 2015; 7:367-73. [PMID: 25576138 DOI: 10.1093/inthealth/ihu099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/22/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Podoconiosis is a non-infectious form of tropical lymphoedema characterised by swelling of the feet and lower legs. Treatment is simple and effective yet evidence indicates that a proportion of patients become lost to follow-up. METHODS This study was a quantitative questionnaire-based study which aimed to identify the most common reasons for loss to follow-up of patients. A total of 191 participants registered with the International Orthodox Christian Charities (IOCC) who had become lost to follow-up were included in a cross-sectional survey based in the Amhara Region, northern Ethiopia. RESULTS The most common reason was distance, stated by 26.7% (51/191). This was significantly associated with living further from the treatment site (p=0.02). Having had podoconiosis for longer was protective against this (p=0.03). For each additional hour of travel time a patient lived from the treatment centre, the odds of them reporting 'distance' as the main reason for becoming lost to follow-up increased by 1.61 (95% CI: 1.25-2.08). CONCLUSIONS The consequences of podoconiosis are exacerbated by walking long distances, but in most areas, this is currently required of patients in order to receive treatment. We recommend expansion of services to widen treatment availability, since provision of transport to and from treatment centres is unlikely to be feasible.
Collapse
Affiliation(s)
- Alice Campion
- Brighton and Sussex Medical School, Falmer, East Sussex, BN1 9PX, UK
| | - Abreham Tamiru
- International Orthodox Christian Charities, Debre Markos, Ethiopia
| | | | - Gail Davey
- Brighton and Sussex Medical School, Falmer, East Sussex, BN1 9PX, UK
| |
Collapse
|
27
|
Abstract
Trachoma is the most common infectious cause of blindness. Repeated episodes of infection with Chlamydia trachomatis in childhood lead to severe conjunctival inflammation, scarring, and potentially blinding inturned eyelashes (trichiasis or entropion) in later life. Trachoma occurs in resource-poor areas with inadequate hygiene, where children with unclean faces share infected ocular secretions. Much has been learnt about the epidemiology and pathophysiology of trachoma. Integrated control programmes are implementing the SAFE Strategy: surgery for trichiasis, mass distribution of antibiotics, promotion of facial cleanliness, and environmental improvement. This strategy has successfully eliminated trachoma in several countries and global efforts are underway to eliminate blinding trachoma worldwide by 2020.
Collapse
Affiliation(s)
- Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.
| | - Matthew J Burton
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Danny Haddad
- Global Vision Initiative, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Sheila West
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Heathcote Wright
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, VIC, Australia
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Lavett DK, Lansingh VC, Carter MJ, Eckert KA, Silva JC. Will the SAFE strategy be sufficient to eliminate trachoma by 2020? Puzzlements and possible solutions. ScientificWorldJournal 2013; 2013:648106. [PMID: 23766701 PMCID: PMC3671555 DOI: 10.1155/2013/648106] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/13/2013] [Indexed: 11/18/2022] Open
Abstract
Since the inception of (the Global Elimination of Blinding Trachoma) GET 2020 in 1997 and the implementation of the SAFE strategy a year later, much progress has been made toward lowering the prevalence of trachoma worldwide with elimination of the disease in some countries. However, high recurrence of trichiasis after surgery, difficulty in controlling the reemergence of infection after mass distribution of azithromycin in some communities, the incomplete understanding of environment in relation to the disease, and the difficulty in establishing the prevalence of the disease in low endemic areas are some of the issues still facing completion of the GET 2020 goals. In this narrative review, literature was searched from 1998 to January 2013 in PubMed for original studies and reviews. Reasons for these ongoing problems are discussed, and several suggestions are made as avenues for exploration in relation to improving the SAFE strategy with emphasis on improving surgical quality and management of the mass treatment with antibiotics. In addition, more research needs to be done to better understand the approach to improve sanitation, hygiene, and environment. The main conclusion of this review is that scale-up is needed for all SAFE components, and more research should be generated from communities outside of Africa and Asia.
Collapse
Affiliation(s)
- Diane K. Lavett
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
| | - Van C. Lansingh
- International Agency for the Prevention of Blindness/VISION 2020 Latin America, 3720 San Simeon Circle, Weston, FL 33331, USA
- Hamilton Eye Institute, University of Memphis, Memphis, TN 38152, USA
| | - Marissa J. Carter
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
| | - Kristen A. Eckert
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
| | | |
Collapse
|