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Bhattarai B, Thapa HB, Bashyal S, Thapa SK, Chaudhuri S, Agiwal V, Pant H, Singh S, Mahajan H. Structured Counselling and Regular Telephonic follow up to improve Referral flow and compliance in Nepal for Diabetic Retinopathy(SCREEN-D Study): a randomised controlled trial. BMC Health Serv Res 2024; 24:188. [PMID: 38336691 PMCID: PMC10858536 DOI: 10.1186/s12913-024-10647-3] [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: 09/06/2022] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Diabetic Retinopathy (DR) is an emerging public health issue, leading to severe visual impairment or blindness. Early identification and prompt treatment play a key role in achieving good visual outcomes. The objective of the study was to estimate the effectiveness of SCREEN package on improving referral compliance from peripheral centres to a tertiary eye centre in Nepal. METHODS In this facility-based cluster-randomized trial, ten out of 19 referring centres of the tertiary eye care centre in Lumbini zone, Nepal were randomized into intervention and control groups. A SCREEN packagewereprovided as intervention for DR patients who require advanced treatment in the tertiary centres and was compared with the current practice of the control arm, where structured counselling and follow-up mechanism are absent. Compliance was estimated by a weekly follow-up between the referring centre and the referred hospital. RESULTS We recruited 302 participantsof whom 153 were in the intervention arm. The mean age of the participants was 57.8 years (Standard deviation [SD]±11.7 years). With implementation of SCREEN package71.2% (n=109) in the intervention group and 42.9% (n=64) in the control group were compliant till three months of follow-up (Difference 28.3%, 95% CI: 17.6- 39.0, p<0.05). Compliance was 43% (n=66) with counselling alone, and 66% (n=103) with first telephonic follow-up in the intervention arm. The mean duration to reach the referral centre was 14.7 days (SD± 9.4 days) and 18.2 days (SD± 9.1 days) in the intervention and the control arm, respectively (Difference 3.5 days, 95% CI: 0.7 to 6.4 days). CONCLUSIONS Counselling& follow-up to patients is the key factor to improve the utilization of the health services by patients with DR. Health systems must be strengthened by optimizing the existing referral structure in Nepal. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration and Results System, ClinicalTrials.gov Identifier: NCT04834648 , 08/04/2021.
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Affiliation(s)
- Binita Bhattarai
- Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal.
- Lumbini Eye Institute and Research Centre, Bhairahawa, Nepal.
| | - Hari Bahadur Thapa
- Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal
| | - Sandip Bashyal
- Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal
| | | | | | - Varun Agiwal
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
| | - Hira Pant
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
| | - Samiksha Singh
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
| | - Hemant Mahajan
- Indian Institute of Public Health, Hyderabad (IIPH-H), Hyderabad, India
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Kumar S, Mohanraj R, Raman R, Kumar G, Luvies S, Machhi SS, Chakrabarty S, Surya J, Ramakrishnan R, Conroy D, Sivaprasad S. 'I don`t need an eye check-up'. A qualitative study using a behavioural model to understand treatment-seeking behaviour of patients with sight threatening diabetic retinopathy (STDR) in India. PLoS One 2023; 18:e0270562. [PMID: 37319187 PMCID: PMC10270603 DOI: 10.1371/journal.pone.0270562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Diabetic Retinopathy (DR) affects about 27% of patients with diabetes globally. According to the World Health Organization (WHO), DR is responsible for37 million cases of blindness worldwide. The SMART India study (October 2020-August 2021) documented the prevalence of diabetes, and DR in people40 years and above across ten Indian states and one Union Territory by conducting community screening. About 90% of people with sight threatening diabetic retinopathy (STDR) were referred from this screening study to eye hospitals for management, but failed to attend. This qualitative study, a component of the SMART India study, explored perceptions of referred patients regarding their susceptibility to eye related problems in diabetes and the benefits/barriers to seeking care. Perceived barriers from the viewpoint of ophthalmologists were also explored. Guided by the Health Beliefs Model (HBM), 20 semi structured interviews were carried out with consenting patients diagnosed with STDR. They included nine patients who had sought care recruited from eight eye hospitals across different states in India and eleven patients who did not seek care. Eleven ophthalmologists also participated. Four themes of analysis based on the HBM were, understanding of DR and its treatment, perceptions about susceptibility and severity, perceived barriers, perceived benefits and cues to action. Findings revealed poor understanding of the effects of diabetes on the eye contributing to low risk perception. Prohibitive costs of treatment, difficulties in accessing care services and poor social support were major barriers to seeking care. Ophthalmologists acknowledged that the absence of symptoms and the slow progressive nature of the disease deluded patients into thinking that they were fine. The study attests to the need for greater health literacy around diabetes, DR and STDR; for making treatment more affordable and accessible and for the development of effective patient education and communication strategies towards increasing compliance.
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Affiliation(s)
- Shuba Kumar
- Social Science Department, Samarth, Chennai, Tamil Nadu, India
| | - Rani Mohanraj
- Social Science Department, Samarth, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Department of Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Geetha Kumar
- Department of Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sanjay Luvies
- Department of Ophthalmology, Giridhar Eye Institute, Cochin, Kerala, India
| | - Shivani Sunil Machhi
- Department of Ophthalmology, Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | | | - Janani Surya
- Department of Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Radha Ramakrishnan
- Department of Ophthalmology-NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Dolores Conroy
- Department of Ophthalmology-NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Sobha Sivaprasad
- Department of Ophthalmology-NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Alamri A, Al-Jahash NAS, Alsultan MSH, AlQahtani SSA, Saeed YAA, Alhamlan RAO. Awareness, knowledge, and practice regarding to diabetic retinopathy among KKU students besides medical students in Abha, Saudi Arabia. J Family Med Prim Care 2021; 10:3233-3239. [PMID: 34760736 PMCID: PMC8565152 DOI: 10.4103/jfmpc.jfmpc_86_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Diabetes mellitus (DM) is a global public health problem. Global prevalence of diabetes is 8.5% in adult population. The prevalence of diabetic retinopathy (DR) is increasing day by day, the number of persons with diabetes will double by 2030. It is a serious cause of irreversible blindness and is the most common complication of diabetes. Annual fundus examination for diabetics aids in the prevention of blindness and allows intervening at a timely manner. This study's intent to estimate and improve level of awareness (A), knowledge (K), and practice (P) among all King Khalid University (KKU) students besides medical students in Abha, Saudi Arabia. Methods and Materials: This is a cross-sectional survey that targets all KKU students besides medical students in Abha, Saudi Arabia. The researchers will use closed-end questions for awareness (A), knowledge (K), and practice (P). The data and the questionnaires will be sent to the sample by social media. The data will be analyzed by statistical package for the social sciences program (SPSS). Results: A total of 635 KKU students completed the questionnaire. Female students were more than male students, 334 (52.6%) for females and 301 (47.4%) for males, respectively. Ages ranged from 18 to 24 years with a mean 23 ± 2 years. There was a good awareness for some of the factors related to the DR which is noted in the results. Awareness of smoking and pregnancy rate is extremely low compared to the rest of the factors related to the DR. Conclusion: There was high awareness regarding DR and its risk factors among KKU students but low awareness regarding smoking and pregnancy relationship with DR. Improvement is required for smoking and pregnancy with the progression DR.
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Affiliation(s)
- Abdulrahman Alamri
- Department Ophthalmology College of Medicine, King Khalid University, Saudi Arabia
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Sindal MD, Sathe T, Sengupta S, Yadav D. Proportion of diabetic retinopathy among diabetics presenting for the first time to a tertiary eye institute in South India. Int Ophthalmol 2021; 41:2789-2796. [PMID: 33813650 DOI: 10.1007/s10792-021-01835-9] [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: 11/11/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To detect the proportion of diabetic retinopathy (DR) among diabetics visiting a tertiary eye care institute and correlate presenting symptoms to clinical diagnosis. METHODS The study recruited 1000 eyes of 1000 diabetics visiting a tertiary eye care institute in South India for the first time. Along with basic demographic data and systemic history, details of presenting complaints and clinical diagnosis were noted. RESULTS Data from 956 cases were analyzed. There were 29 (3%) newly diagnosed diabetics and 927 (97%) known diabetics. The commonest reason for the hospital visit was diminution of vision (66%) followed by "visiting for a routine checkup" (22.3%). Diabetic retinopathy was seen in 492 (51.5%), cataract in 161(17%) and refractive error in 240 patients (79.2%). Vision-threatening DR was present in 216 cases (22.59%) and clinically significant macular edema in 73 cases (7.63%) at first presentation itself. CONCLUSION The cohort from a tertiary eye care institute has higher proportion of diabetic retinopathy, with vision-threatening DR at presentation. These data emphasize the need for more robust screening for DR, along with population awareness programs.
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Affiliation(s)
- Manavi D Sindal
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Cuddalore Main Road, Pondicherry, 605007, India.
| | - Tejashree Sathe
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Cuddalore Main Road, Pondicherry, 605007, India
| | | | - Divya Yadav
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Cuddalore Main Road, Pondicherry, 605007, India
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Thapa R, Bajimaya S, Pradhan E, Sharma S, Kshetri BB, Paudel M, Paudyal G. Agreement and Diagnostic Test Accuracy on Grading Diabetic Retinopathy Using Fundus Photographs by Allied Medical Personnel at a Community Diabetic Retinopathy Screening Program in Nepal. Ophthalmic Epidemiol 2021; 28:509-515. [PMID: 33502930 DOI: 10.1080/09286586.2021.1877730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Diabetic retinopathy (DR) is a leading cause of blindness in low- and middle-income countries. This study aims to assess the agreement and diagnostic test accuracy of DR grading using fundus photographs by the allied medical personnel (AMP) as compared to ophthalmologist at DR screening program.Methods: Two 45 degree disc-centred and macula centred fundus photographs captured using digital fundus camera from 1344 eyes were graded by six AMP twice at three months and six months of training. DR grading was done using Early Treatment Diabetic Retinopathy Study criteria. Retina specialist grading was taken as the reference standard. Percentage agreement using kappa coefficient (k) and diagnostic test accuracy were assessed.Results: Intra-rater agreement of most AMP was almost perfect for detection of any DR and vision-threatening diabetic retinopathy (VTDR) at three and six months. Inter-rater agreement at 3 months at second grading was substantial for any DR (k = 0.62; 95% confidence interval (CI): 0.67-0.68) and VTDR (k = 0.63; 95% CI: 0.47-0.75). Inter-rater agreement in 6 months at second grading was also substantial for any DR (k = 0.66; 95% CI: 0.61-0.71) and VTDR (k = 0.64; 95% CI: 0.52-0.75). The sensitivity and specificity for any DR at second grading in 3 months was 94.99% and 63.97% and at 6 months was 95.55% and 66.91%, respectively.Conclusion: The inter-rater agreement of AMP as compared to ophthalmologists for any DR or VTDR was substantial at both 3 and 6 months. AMP can support as first-level DR graders for timely referral and treatment of VTDR.
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Affiliation(s)
- Raba Thapa
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Sanyam Bajimaya
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Eli Pradhan
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Sanjita Sharma
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Bal Bahadur Kshetri
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Manish Paudel
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Govinda Paudyal
- Vitreo-retina service, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
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Singh S, Shukla AK, Sheikh A, Gupta G, More A. Effect of health education and screening location on compliance with diabetic retinopathy screening in a rural population in Maharashtra. Indian J Ophthalmol 2020; 68:S47-S51. [PMID: 31937729 PMCID: PMC7001165 DOI: 10.4103/ijo.ijo_1976_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To compare the acceptance of diabetic retinopathy (DR) screening by the proximity of care and health education in rural Maharashtra. Methods: Study was done in the public health facilities in four blocks (in two blocks at community health center (CHC) level and in other two blocks at primary health center (PHC) level with the provision of transport from villages to PHCs) over 3 months. Health education was not imparted in one block in each segment. Health education consisted of imparting knowledge on diabetes mellitus (DM) and DR by trained village-level workers. The screening was done using non-mydriatic fundus camera and teleophthalmology supported remote grading of DR. Results: In the study period, 1,472 people with known diabetes were screened in four blocks and 86.6% (n = 1275) gradable images were obtained from them. 9.9% (n = 126) were detected having DR and 1.9% (n = 24) having sight-threatening DR (STDR). More people accepted screening closer to their residence at the PHC than CHC (24.4% vs 11.4%; P < 0.001). Health education improved the screening uptake significantly (14.4% vs 18.7%; P < 0.01) irrespective of the place of screening—at CHC, 9.5% without health education vs 13.1% with health education; at PHC, 20.1% without health education versus 31.6% with health education. Conclusion: Conducting DR screening closer to the place of living at PHCs with the provision of transport and health education was more effective for an increase in the uptake of DR screening by people with known diabetes in rural Maharashtra.
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Affiliation(s)
- Smita Singh
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
| | - Ajay K Shukla
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
| | - Azhar Sheikh
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
| | - Girdharilal Gupta
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
| | - Aarti More
- Department of Ophthalmology, Mahatma Gandhi Institute of Medical Sciences, Sewagram Wardha, Maharashtra, India
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Thapa R, Bajimaya S, Pradhan E, Sharma S, Kshetri B, Paudyal G. Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal. Clin Ophthalmol 2020; 14:2731-2737. [PMID: 33061255 PMCID: PMC7518769 DOI: 10.2147/opth.s269002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Diabetic retinopathy (DR) is the emerging cause of blindness in developing countries. This study aimed to assess the accuracy of grading retinal findings of patients with diabetes using fundus photographs by allied medical personnel (AMP) when compared to an ophthalmologist. Materials and Methods Six AMPs were enrolled for grading fundus photographs of patients with diabetes after three and six months of training twice at two weeks interval. The total number of fundus photographs graded were 1,344. Grading by a retina specialist was used as the gold standard. Intra-rater and inter-rater agreement was assessed using the kappa coefficient (k). Results The intra-rater agreement of half of the AMPs in both three months and six months was almost perfect for grading of any retinal abnormalities, and substantial for retinal hemorrhages. In three months, the overall inter-rater agreement at the second rating was moderate for any retinal abnormalities (k=0.60) and retinal hemorrhage (k=0.48) and was fair for macular exudates (k=0.35). The overall inter-rater agreement of AMPs in six months at the second rating was substantial for any retinal abnormalities (k=0.61), fair for retinal hemorrhage (k=0.30), and moderate for macular exudates (k=0.49). The overall inter-rater agreement at first rating was almost similar to the second rating in both three months and six months. Conclusion Intra-rater agreement of AMPs was almost perfect for any retinal abnormalities and substantial for retinal hemorrhage. The inter-rater agreement of AMP was substantial for any retinal abnormalities and moderate for retinal hemorrhages and macular exudates. The agreement results were almost similar at three months and six months. AMPs could be utilized in screening of DR and other retinal pathologies for timely referral to reduce the blindness in low-resource settings.
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Affiliation(s)
- Raba Thapa
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
| | - Sanyam Bajimaya
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
| | - Eli Pradhan
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
| | - Sanjita Sharma
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
| | | | - Govinda Paudyal
- Vitreo-Retina Specialist, Vitreo-Retina Service, Tilganga Institute of Ophthalmology, Bagmati Bridge, Kathmandu, Nepal
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Venugopal D, Lal B, Fernandes S, Gavde D. Awareness and knowledge of diabetic retinopathy and associated factors in Goa: A hospital-based cross-sectional study. Indian J Ophthalmol 2020; 68:383-390. [PMID: 31957734 PMCID: PMC7003591 DOI: 10.4103/ijo.ijo_1218_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/01/2019] [Accepted: 11/27/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose To assess the awareness and knowledge about diabetic retinopathy (DR) and associated factors among patients visiting the tertiary health center in Goa. Methods A cross-sectional descriptive study was conducted using a standard predesigned and pretested closed-ended structured questionnaire to assess the awareness, knowledge, attitude and practice about DR among patients visiting a tertiary health center. Results Three hundred and fifty-eight subjects participated in the study. Only 125 (34.9% [95% CI: 30.0-40.1]) subjects were aware of DR and 122 (34.1% [95% CI: 29.2-39.2]) had adequate knowledge about DR. Awareness and knowledge of DR were significantly high among the subjects who completed college level of education (66.7%, OR = 2.78; 95% CI: 1.73-4.48, P < 0.001 and 55.9%, OR = 3.92; 95% CI: 2.41-6.38, P < 0.001) and who spoke English (52.5%, OR = 3.37; 95% CI: 2.14-5.30, P < 0.001 and 50.4%, OR = 3.26; 95% CI: 2.07-5.14, P < 0.001). Christians reported better knowledge about DR compared to other religions (48.8%, OR = 2.27; 95% CI: 1.38-3.75, P = 0.005). Negative association was noted between the knowledge of DR and presence of diabetes (29.4%, OR = 0.64; 95% CI: 0.41-0.99, P = 0.048). The practice pattern was strongly associated (OR = 7.47; 95% CI: 4.51-12.38, P < 0.001) with the knowledge of DR. Attitude was not influenced by any of the factors. Conclusion We found that awareness and knowledge about DR were unsatisfactory; literacy contributed significantly toward it. These findings also suggest that there is an immediate need to enhance the awareness and knowledge of diabetic eye diseases in order to reduce the burden of visual impairment.
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Affiliation(s)
- Dinesh Venugopal
- Optometry Division, Allied Health Science Course, Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India
| | - Barsha Lal
- Optometry Division, Allied Health Science Course, Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Shawnicka Fernandes
- Optometry Division, Allied Health Science Course, Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India
| | - Deepali Gavde
- Optometry Division, Allied Health Science Course, Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India
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Paudyal G, Shrestha MK, Poudel M, Tabin GC, Ruit S, Thomas BJ. Prevalence and Severity of Diabetic Retinopathy among Diabetic Patients Presenting to a Tertiary Eye Hospital in Nepal. Middle East Afr J Ophthalmol 2019; 26:210-215. [PMID: 32153332 PMCID: PMC7034152 DOI: 10.4103/meajo.meajo_65_18] [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] [Received: 03/11/2018] [Revised: 09/23/2019] [Accepted: 10/07/2019] [Indexed: 12/02/2022] Open
Abstract
PURPOSE: The purpose of the study is to evaluate the prevalence and severity of diabetic retinopathy (DR) among all diabetic patients presenting to a tertiary eye care center in Nepal over a 3-year period. MATERIALS AND METHODS: This was a retrospective review of all clinical records from the initial presentations of diabetic patients at the Tilganga Institute of Ophthalmology (TIO) from 2012 to 2014. RESULTS: In total, 8855 patients were identified who presented to TIO with a prior diagnosis of diabetic mellitus (DM) during the study period. DR was found in 1714 patients (19.4%) at the time of initial presentation, 1305 (14.7%) of which had nonproliferative DR (PDR), while 617 (6.9%) demonstrated diabetic macular edema (DME) and 409 (4.6%) demonstrated PDR. Of the 1714 patients with DR, 825 (48.1%) required treatment at initial presentation for DME and/or PDR. Male gender, hypertension, age at presentation, and interval from diagnosis of DM to initial eye consultation were significantly associated with the presence of DR (P < 0.05). CONCLUSIONS: The prevalence of DR among patients with DM was 19.4%, which is lower than previously published estimates. However, among patients diagnosed with DR, over half presented with a vision-threatening complication warranting some measure of initial treatment.
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Affiliation(s)
| | | | - Manish Poudel
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Geoffrey C Tabin
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Sanduk Ruit
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
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Piyasena MMPN, Zuurmond M, Yip JLY, Murthy GVS. Process of adaptation, development and assessment of acceptability of a health educational intervention to improve referral uptake by people with diabetes in Sri Lanka. BMC Public Health 2019; 19:614. [PMID: 31113393 PMCID: PMC6528317 DOI: 10.1186/s12889-019-6880-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One major barrier to uptake of diabetic retinopathy (DR) services is lack of knowledge and awareness of DR among the people with diabetes (PwDM). Targeted health education (HE) can be a key element in improving the uptake of eye care services. Such interventions are lacking in Sri Lanka. METHODS A local context specific HE intervention (HEI) was developed by adopting available resources and incorporating views from PwDM and key stakeholders. Four sessions of participatory workshops with PwDM (20 Sinhala and 13 Tamil speaking) and two stage 12 stakeholder interviews were conducted to both develop and pre-test the material. The products were a video and a leaflet, delivered at a medical clinic to a sample of 45 PwDM identified as having DR. Semi-structured interviews were conducted after 4 weeks, to evaluate the acceptability and comprehension of the HEI. Additionally, nine interviews were conducted with clinical providers to explore process issues related to delivery of the HEI. Data analysis was conducted using thematic analysis. RESULTS The lack of knowledge and awareness on DR, and of the importance of regular DR screening and follow up, combined with poor information on referral pathways were key elements identified from the workshops with PwDM. The stakeholders prioritised the importance of using simple language, and the need for emphasis on improving understanding about the asymptomatic phase of DR. The overall acceptability of the HEI material was satisfactory, although there was some difficulty with interpretation of medical images. Overall, although PwDM liked the ideas of the video, the leaflet was seen as a more practical option, given the busy clinic environment. The key issue was both formats required interaction with the provider, in order to support understanding of the messages. CONCLUSIONS The process of adapting HE material is not simply translation into the appropriate language. Instead, a tailored approach in a country, context and particular health services setting is needed. This study illustrates the value of using a participatory approach and involving PwDM and stakeholders in the adaptation and pilot testing of a HEI to improve uptake of screening for DR in the context of Sri Lanka.
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Affiliation(s)
- M. M. P. N. Piyasena
- Vitreo-retina unit, National Eye Hospital, Colombo 10, Sri Lanka
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Maria Zuurmond
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Jennifer L. Y. Yip
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - G. V. S. Murthy
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Piyasena MMPN, Murthy GVS, Yip JLY, Gilbert C, Peto T, Premarathna M, Zuurmond M. A qualitative study on barriers and enablers to uptake of diabetic retinopathy screening by people with diabetes in the Western Province of Sri Lanka. Trop Med Health 2019; 47:34. [PMID: 31139011 PMCID: PMC6525343 DOI: 10.1186/s41182-019-0160-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/01/2019] [Indexed: 01/17/2023] Open
Abstract
Background Blindness and visual impairment from diabetic retinopathy (DR) are avoidable through early detection and timely treatment. The Western Province of Sri Lanka has the highest prevalence of diabetes mellitus (DM) (18.6%) in the country. A situational analysis identified a significant gap in DR screening services (DRSS) uptake in this region. Barriers that hinder people with DM (PwDM) from attending DRSS are poorly understood. The purpose of this study is to understand the factors which influence the uptake of DRSS and follow-up to inform health promotion strategies and improve the uptake of these services. Methods Eleven focus group discussions (FGDs) were conducted with PwDM who presented to medical, general eye and vitreoretinal services in three public sector institutions (two tertiary and one secondary level) in the Western Province between October 2016 and March 2017. We enrolled six groups (four Sinhala speaking, two Tamil) of women and five groups (three Sinhala and two Tamil) of men representing ethnicity and gender. We performed a thematic analysis and described the main themes and subthemes using the socio-ecological model as a framework. Results We identified lack of knowledge of both the condition and the need for screening as key barriers to access DRSS. Socio-cultural factors in the family environment, economic reasons and institutional factors were also important barriers. Additional reasons include long waiting time at eye clinics and poor referrals exacerbated by the lack of a systematic DRSS. In addition, attitudes to DRSS such as fear of discomfort from the procedure and the need for accompaniment following mydriasis were also deterrents to follow-up screening. Conclusion This study has shown that there are inter-related user, family, and institutional factors which affect the uptake of DRSS. Understanding how DR is conceptualised by PwDM in this region is essential to refine strategies to improve access to DRSS. Strategies to improve knowledge need to be more culturally acceptable and relevant to PwDM and their families, with increased availability of DRSS at convenient locations may increase timely uptake of screening. Electronic supplementary material The online version of this article (10.1186/s41182-019-0160-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Gudlavalleti Venkata S Murthy
- 1Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Jennifer L Y Yip
- 1Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Clare Gilbert
- 1Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Tunde Peto
- 2School of Medicine, Dentistry and Biomedical Sciences, Queen's University, 97 - Lisburn Rd, Belfast, BT9 7BL Northern Ireland
| | - Mahesh Premarathna
- 3Department of Sociology, University of Colombo, Reid Avenue, Colombo 03, Colombo, Sri Lanka
| | - Maria Zuurmond
- 4Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
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Piyasena MMPN, Murthy GVS, Yip JLY, Gilbert C, Zuurmond M, Peto T, Gordon I, Hewage S, Kamalakannan S. Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings. PLoS One 2019; 14:e0198979. [PMID: 31013274 PMCID: PMC6478270 DOI: 10.1371/journal.pone.0198979] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 04/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) can lead to visual impairment and blindness if not detected and treated in time. Knowing the barriers/enablers in advance in contrasting different country income settings may accelerate development of a successful DR screening (DRS) program. This would be especially applicable in the low-income settings with the rising prevalence of DR. OBJECTIVES The aim of this systematic review is to identify and contrast the barriers/enablers to DRS for different contexts using both consumers i.e., people with diabetes (PwDM) and provider perspectives and system level factors in different country income settings. METHODS We searched MEDLINE, Embase, CENTRAL in the Cochrane Library from the databases start date to December 2018. We included the studies reported on barriers and enablers to access DRS services based at health care facilities. We categorised and synthesized themes related to the consumers (individuals), providers and the health systems (environment) as main dimensions according to the constructs of social cognitive theory, supported by the quantitative measures i.e., odds ratios as reported by each of the study authors. MAIN RESULTS We included 77 studies primarily describing the barriers and enablers. Most of the studies were from high income settings (72.7%, 56/77) and cross sectional in design (76.6%, 59/77). From the perspectives of consumers, lack of knowledge, attitude, awareness and motivation were identified as major barriers. The enablers were fear of blindness, proximity of screening facility, experiences of vision loss and being concerned of eye complications. In providers' perspectives, lack of skilled human resources, training programs, infrastructure of retinal imaging and cost of services were the main barriers. Higher odds of uptake of DRS services was observed when PwDM were provided health education (odds ratio (OR) 4.3) and having knowledge on DR (OR range 1.3-19.7). CONCLUSION Knowing the barriers to access DRS is a pre-requisite in development of a successful screening program. The awareness, knowledge and attitude of the consumers, availability of skilled human resources and infrastructure emerged as the major barriers to access to DRS in any income setting.
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Affiliation(s)
- Mapa Mudiyanselage Prabhath Nishantha Piyasena
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Gudlavalleti Venkata S. Murthy
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer L. Y. Yip
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clare Gilbert
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Zuurmond
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tunde Peto
- Centre for Public Health, Faculty of Medicine, Health and Life Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, Northern Ireland
| | - Iris Gordon
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suwin Hewage
- Retina Unit, Department of Vitreo-retina, National Eye Hospital, Colombo, Sri Lanka
| | - Sureshkumar Kamalakannan
- Department of Eye Health and Disability, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
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Alzahrani SH, Bakarman MA, Alqahtani SM, Alqahtani MS, Butt NS, Salawati EM, Alkatheri A, Malik AA, Saad K. Awareness of diabetic retinopathy among people with diabetes in Jeddah, Saudi Arabia. Ther Adv Endocrinol Metab 2018; 9:103-112. [PMID: 29619207 PMCID: PMC5871062 DOI: 10.1177/2042018818758621] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/20/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the foremost cause of blindness. This study aimed to assess the level of awareness of DR and its related risk factors among patients with DM in Jeddah, Saudi Arabia. METHODS A cross-sectional study was conducted among patients with DM attending primary health care centers at the Ministry of Health in Jeddah. A structured, pretested, self-administered questionnaire was used to collect information on the sociodemographic and DM- and DR-related characteristics of the patients. RESULTS A total of 377 patients were enrolled. About 82.6% of the patients were aware that DM can affect their eyes, and they listed physicians, ophthalmologists, television, and family members as common sources of information on the topic. About 36% of the patients reported that their doctors had not advised them about it. More than half responded that they did not feel their vision to be affected by DM. More than 58% had never been diagnosed with DR. About 35% did not go to their eye checkups, even though around 59% thought that DR could lead to blindness. Of the 64% of patients whose DM was well controlled, 11% and 25% listed surgery and laser treatment, respectively, as available treatment options for DR. The following factors were found to be significant in relation to the subjects' awareness that DM can affect their eyes: the patients' perception of their doctors' advice about DR; the experience of having their vision affected by DM; the knowledge that DR may lead to blindness; the practice of going to eye checkups. CONCLUSIONS Despite having good awareness about DM and its effects on eyes, the patients exhibited a relative lack of awareness about DR. Considering the association of DR with DM, its increasing magnitude is a potential burden on the community and health systems.
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Affiliation(s)
- Sami H. Alzahrani
- Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, PO Box 80205, Jeddah 21589, Saudi Arabia
| | - Marwan A. Bakarman
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Maha S. Alqahtani
- Public Health Administration, Ministry of Health, Jeddah, Saudi Arabia
| | - Nadeem Shafique Butt
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Emad M. Salawati
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Alkatheri
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Azam Malik
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University Assiut, Egypt
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Thapa R, Twyana SN, Paudyal G, Khanal S, van Nispen R, Tan S, Thapa SS, van Rens G. Prevalence and risk factors of diabetic retinopathy among an elderly population with diabetes in Nepal: the Bhaktapur Retina Study. Clin Ophthalmol 2018; 12:561-568. [PMID: 29615832 PMCID: PMC5870654 DOI: 10.2147/opth.s157560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Aim Diabetic retinopathy (DR) is an emerging cause of blindness in developing countries. This study aimed to explore the prevalence and risk factors of DR in an elderly population in Nepal. Subjects and methods This is a population-based, cross-sectional study. A total of 1860 subjects at the age 60 years and above participated (response rate 88.6%). A detailed history was obtained, presenting and best-corrected visual acuity were measured, and anterior segment and posterior segment examinations were carried out. Blood pressure and random blood sugar were recorded; body mass index was calculated, and abdominal girth was measured. DR was graded by clinical examination using Early Treatment Diabetic Retinopathy Study criteria. Results Diabetes was found in 168 (9%) subjects (mean age 69.6 years), 31 (18.5%) of whom were newly diagnosed. The prevalence of DR was 23.8% (95% confidence interval [CI]: 17.7%–31%) among the persons with diabetes. The prevalence of DR among newly diagnosed subjects with diabetes was 6.5% (95% CI: 0.8%–21.4%). The prevalence of vision-threatening DR was 9.5% (95% CI: 5.5%–15%) and was higher in males. The prevalence of DR was 83.3% (95% CI: 35.9%–99.6%) among those with diabetes for over 20 years. In multivariable logistic regression analysis, duration of diabetes, hypertension, and alcohol consumption were significantly associated with DR. Conclusion DR is a common problem among the elderly population with diabetes in Nepal. The duration of diabetes, hypertension, and alcohol consumption are the risk factors for the development of DR. Strategies have to be developed for timely diagnosis of diabetes and screening for DR.
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Affiliation(s)
- Raba Thapa
- Vitreo-retina Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Shankha N Twyana
- Department of Eye Bank, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Govinda Paudyal
- Vitreo-retina Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Ruth van Nispen
- Department of Ophthalmology and the Amsterdam Public Health Research Institute, Vrije University Medical Center, Amsterdam, the Netherlands
| | - Stevie Tan
- Department of Ophthalmology and the Amsterdam Public Health Research Institute, Vrije University Medical Center, Amsterdam, the Netherlands
| | - Suman S Thapa
- Glaucoma Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Ghmb van Rens
- Department of Ophthalmology and the Amsterdam Public Health Research Institute, Vrije University Medical Center, Amsterdam, the Netherlands
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Sapkota RP, Upadhyaya T, Gurung G, Parker M, Raman R, Pardhan S. Need to improve awareness and treatment compliance in high-risk patients for diabetic complications in Nepal. BMJ Open Diabetes Res Care 2018; 6:e000525. [PMID: 29755757 PMCID: PMC5942410 DOI: 10.1136/bmjdrc-2018-000525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/23/2018] [Accepted: 04/19/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE/INTRODUCTION It is known that knowledge, awareness, and practice influence diabetic control. We compared factors pertaining to healthy lifestyle (exercising, avoiding smoking), self-help (attending appointments, following treatment regimens), and diabetic awareness in high-risk patients for diabetic complications, specifically, those on insulin versus non-insulin treatment, and also those with a longer diabetic duration (≥5 years) versus a shorter duration. METHODS 200 consecutive patients with type 2 diabetes (52.0±11.6 years) attending diabetic clinic at a referral hospital in Nepal were recruited. A structured questionnaire explored non-clinical parameters including age, gender, diabetic duration, awareness about diabetes control, self-help, and lifestyle. Clinical data were also measured: HbA1c, fasting blood sugar (FBS), blood pressure, and treatment type (insulin, diet/tablet). RESULTS A significantly higher proportion of patients on insulin (vs non-insulin) or with diabetic duration ≥5 years (vs <5 years) self-reported not doing regular exercise, forgetting to take medicine, and not knowing whether their diabetes was controlled (p≤0.005). HbA1c/FBS levels were significantly higher for patients on insulin or with a longer diabetic duration (p≤0.001). 92% of those on insulin (vs 31% on non-insulin) and 91% with diabetic duration ≥5 years (vs 28% of <5 years) self-reported to seeking medical help due to episodes of uncontrolled blood sugar in the last year (p<0.001). CONCLUSION Poor self-help/lifestyle and reduced knowledge/awareness about diabetic control was found in patients on insulin or with longer diabetic duration. This is a worrying finding as these patients are already at high risk for developing diabetic complications. The findings highlight need for targeting this more vulnerable group and provide more support/diabetic educational tools.
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Affiliation(s)
- Raju P Sapkota
- Vision & Eye Research Unit (VERU), School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Tirthalal Upadhyaya
- Department of Internal Medicine, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | - Govind Gurung
- Department of Ophthalmology, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | - Mike Parker
- Clinical Trial Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, UK
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Shahina Pardhan
- Vision & Eye Research Unit (VERU), School of Medicine, Anglia Ruskin University, Cambridge, UK
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Pandey A, Lamichhane G, Khanal R, Rai SKC, Bhari AM, Borroni D, Gautam N. Assessment of visual morbidity amongst diabetic retinopathy at tertiary eye care center, Nepal: a cross-sectional descriptive study. BMC Ophthalmol 2017; 17:263. [PMID: 29282017 PMCID: PMC5745597 DOI: 10.1186/s12886-017-0656-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the leading causes of preventable blindness in low and middle income countries. In Nepal, there are less studies regarding DR and they too are limited around Kathmandu valley. This study was done to assess visual morbidity in patients with DR at a peripheral tertiary eye care center of Nepal. METHODS This was a prospective, hospital based, cross-sectional study in which all consecutive cases of DR were evaluated. DR was classified according to Early Treatment Diabetic Retinopathy Study Research Group - report no. 10 Table A5-1 (Modified Airlie House Classification). Data entry and analysis was done in an SPSS unit version 20. Wherever applicable, variables were set as 100 eyes. RESULTS Total number of patients included in this study was 50. Commonest age group was 50-69 yrs. (43/77 yrs.; min/max) comprising 80% of the total population (n = 50) and the predominant population was male (76%). Non proliferative diabetic retinopathy (NPDR) was found in 69%, proliferative diabetic retinopathy (PDR) in 31% and advanced diabetic eye disease (ADED) in 3% (n = 100). CONCLUSIONS All the stages of DR were present at significant proportions in this study, noteworthy was the percentage of PDR. This study shows an urgency to gather a national data on DR, raise awareness among diabetics and train effective man power at a local level to diagnose DR at an early stage.
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Affiliation(s)
| | | | | | | | | | | | - Narayan Gautam
- Universal College of Medical Sciences, Bhairahawa, Nepal
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Prasad A, Sedlářová M, Kale RS, Pospíšil P. Lipoxygenase in singlet oxygen generation as a response to wounding: in vivo imaging in Arabidopsis thaliana. Sci Rep 2017; 7:9831. [PMID: 28851974 PMCID: PMC5575249 DOI: 10.1038/s41598-017-09758-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/28/2017] [Indexed: 11/09/2022] Open
Abstract
Wounding, one of the most intensive stresses influencing plants ontogeny and lifespan, can be induced by herbivory as well as by physical factors. Reactive oxygen species play indispensable role both in the local and systemic defense reactions which enable "reprogramming" of metabolic pathways to set new boundaries and physiological equilibrium suitable for survival. In our current study, we provide experimental evidence on the formation of singlet oxygen (1O2) after wounding of Arabidopsis leaves. It is shown that 1O2 is formed by triplet-triplet energy transfer from triplet carbonyls to molecular oxygen. Using lipoxygenase inhibitor catechol, it is demonstrated that lipid peroxidation is initiated by lipoxygenase. Suppression of 1O2 formation in lox2 mutant which lacks chloroplast lipoxygenase indicates that lipoxygenase localized in chloroplast is predominantly responsible for 1O2 formation. Interestingly, 1O2 formation is solely restricted to chloroplasts localized at the wounding site. Data presented in this study might provide novel insight into wound-induced signaling in the local defense reaction.
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Affiliation(s)
- Ankush Prasad
- Department of Biophysics, Centre of the Region Haná for Biotechnological and Agricultural Research, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71, Olomouc, Czech Republic
| | - Michaela Sedlářová
- Department of Botany, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71, Olomouc, Czech Republic
| | - Ravindra Sonajirao Kale
- Department of Biophysics, Centre of the Region Haná for Biotechnological and Agricultural Research, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71, Olomouc, Czech Republic
| | - Pavel Pospíšil
- Department of Biophysics, Centre of the Region Haná for Biotechnological and Agricultural Research, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71, Olomouc, Czech Republic.
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Murthy GVS, Das T. Diabetic care initiatives to prevent blindness from diabetic retinopathy in India. Indian J Ophthalmol 2016; 64:50-4. [PMID: 26953024 PMCID: PMC4821122 DOI: 10.4103/0301-4738.178152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
It is estimated that 65 million (17%) of 382 million persons with diabetes mellitus (DM) globally reside in India. While globally 35% persons with DM have diabetic retinopathy (DR), this proportion is reportedly lower in India, other countries in South Asia and China. We reviewed published data from 2008 onwards from PubMed, which ascertained DR in population-based representative samples. We also reviewed the risk factors for DR, on awareness regarding eye complications and on accessing an eye examination. Thirteen research studies have reported on the prevalence of DR among persons with DM; this prevalence was lower than the global level in China, India, and Nepal. Eleven studies reported DR risk factors association. The duration of diabetes and level of glycemic control were universally acknowledged DR risk factors. We identified 7 studies in the Asia region that researched the level of awareness about diabetes eye complications and the practice of accessing an eye examination. Excepting 1 study in China, others reported a significant proportion being aware that diabetes leads to eye complications. But the awareness was not translated into a positive practice-most studies reported only 20-50% of the persons with diabetes actually having had their eyes examined. The present review highlights the observation that the risk factors for DR need an integrated diabetic care pathway where the eye care team has to work in close collaboration and partnership with a diabetic care team has to reduce the risk of blindness from DR.
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Affiliation(s)
- G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India; Department of Clinical Research, Public Health Eye Care and Disability, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK,
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Gyawali B, Ferrario A, van Teijlingen E, Kallestrup P. Challenges in diabetes mellitus type 2 management in Nepal: a literature review. Glob Health Action 2016; 9:31704. [PMID: 27760677 PMCID: PMC5071649 DOI: 10.3402/gha.v9.31704] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/05/2016] [Accepted: 06/07/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Diabetes has become an increasingly prevalent and severe public health problem in Nepal. The Nepalese health system is struggling to deliver comprehensive, quality treatment and services for diabetes at all levels of health care. This study aims to review evidence on the prevalence, cost and treatment of diabetes mellitus type 2 and its complications in Nepal and to critically assess the challenges to be addressed to contain the epidemic and its negative economic impact. DESIGN A comprehensive review of available evidence and data sources on prevalence, risk factors, cost, complications, treatment, and management of diabetes mellitus type 2 in Nepal was conducted through an online database search for articles published in English between January 2000 and November 2015. Additionally, we performed a manual search of articles and reference lists of published articles for additional references. RESULTS Diabetes mellitus type 2 is emerging as a major health care problem in Nepal, with rising prevalence and its complications especially in urban populations. Several challenges in diabetes management were identified, including high cost of treatment, limited health care facilities, and lack of disease awareness among patients. No specific guideline was identified for the prevention and treatment of diabetes in Nepal. CONCLUSIONS We conclude that a comprehensive national effort is needed to stem the tide of the growing burden of diabetes mellitus type 2 and its complications in Nepal. The government should develop a comprehensive plan to tackle diabetes and other non-communicable diseases supported by appropriate health infrastructure and funding.
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Affiliation(s)
- Bishal Gyawali
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
- Nepal Development Society (NEDS), Bharatpur, Nepal; @hotmail.com
| | - Alessandra Ferrario
- LSE Health, London School of Economics and Political Science, London, United Kingdom
| | - Edwin van Teijlingen
- Faculty of Health & Social Sciences, Bournemouth University, Dorset, United Kingdom
| | - Per Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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Thapa R, Bajimaya S, Bouman R, Paudyal G, Khanal S, Tan S, Thapa SS, van Rens G. Intra- and inter-rater agreement between an ophthalmologist and mid-level ophthalmic personnel to diagnose retinal diseases based on fundus photographs at a primary eye center in Nepal: the Bhaktapur Retina Study. BMC Ophthalmol 2016; 16:112. [PMID: 27430579 PMCID: PMC4950770 DOI: 10.1186/s12886-016-0295-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 07/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early detection can reduce irreversible blindness from retinal diseases. This study aims to assess the intra- and inter-rater agreement of retinal pathologies observed on fundus photographs between an ophthalmologist and two-mid level ophthalmic personnel (MLOPs). METHOD A population-based, cross-sectional study was conducted among subjects 60 years and above in the Bhaktapur district of Nepal. Fundus photographs of 500 eyes of 500 subjects were assessed. The macula-centered 45-degree photographs were graded twice by one ophthalmologist and two MLOPs. Intra-rater and inter-rater agreements were assessed for the ophthalmologist and the MLOPs. RESULT Mean age was 70.22 years ± 6.94 (SD). Retinal pathologies were observed in 55.6 % of photographs (age-related macular degeneration: 34.2 %; diabetic retinopathy: 4.2 %; retinal vein occlusion: 3.8 %). Twelve (2.4 %) fundus pictures were non-gradable. The intra-rater agreement for overall retinal pathologies, retinal hemorrhage, and maculopathy were substantial both for the ophthalmologist as well as for the MLOPs. There was moderate inter-rater agreement between the ophthalmologist and the first MLOP on second rating for overall retinal pathologies, [kappa (k); 95 % CI = 0.59 (0.51-0.66)], retinal hemorrhage [k; 95 % CI = 0.60 (0.41-0.78)], and maculopathy [k; 95 % CI = 0.52 (0.43-0.60)]. Inter-rater agreement between the ophthalmologist and the second MLOP for second rating was moderate for overall retinal pathologies [k; 95 % CI = 0.52 (0.44-0.60)], substantial agreement for retinal hemorrhage [k; 95 % CI = 0. 68 (0.52-0.84)], moderate agreement for maculopathy [k; 95 % CI = 0.59 (0.50-0.67)]. CONCLUSION There is moderate agreement between the MLOPs and the ophthalmologist in grading fundus photographs for retinal hemorrhages and maculopathy.
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Affiliation(s)
- Raba Thapa
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Sanyam Bajimaya
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal
| | - Renske Bouman
- Vrije University Medical Center, Amsterdam, The Netherlands
| | - Govinda Paudyal
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Stevie Tan
- Vrije University Medical Center, Amsterdam, The Netherlands
| | - Suman S Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Ger van Rens
- Vrije University Medical Center, Amsterdam, The Netherlands
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Shukla R, Gudlavalleti MVS, Bandyopadhyay S, Anchala R, Gudlavalleti ASV, Jotheeswaran AT, Ramachandra SS, Singh V, Vashist P, Allagh K, Ballabh HP, Gilbert CE. Perception of care and barriers to treatment in individuals with diabetic retinopathy in India: 11-city 9-state study. Indian J Endocrinol Metab 2016; 20:S33-S41. [PMID: 27144135 PMCID: PMC4847448 DOI: 10.4103/2230-8210.179772] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is a leading cause of visual impairment. Low awareness about the disease and inequitable distribution of care are major challenges in India. OBJECTIVES Assess perception of care and challenges faced in availing care among diabetics. MATERIALS AND METHODS The cross-sectional, hospital based survey was conducted in eleven cities. In each city, public and private providers of eye-care were identified. Both multispecialty and standalone facilities were included. Specially designed semi-open ended questionnaires were administered to the clients. RESULTS 376 diabetics were interviewed in the eye clinics, of whom 62.8% (236) were selected from facilities in cities with a population of 7 million or more. The mean duration of known diabetes was 11.1 (±7.7) years. Half the respondents understood the meaning of adequate glycemic control and 45% reported that they had visual loss when they first presented to an eye facility. Facilities in smaller cities and those with higher educational status were found to be statistically significant predictors of self-reported good/adequate control of diabetes. The correct awareness of glycemic control was significantly high among attending privately-funded facilities and higher educational status. Self-monitoring of glycemic status at home was significantly associated with respondents from larger cities, privately-funded facilities, those who were better educated and reported longer duration of diabetes. Duration of diabetes (41%), poor glycemic control (39.4%) and age (20.7%) were identified as the leading causes of DR. The commonest challenges faced were lifestyle/behavior related. CONCLUSIONS The findings have significant implications for the organization of diabetes services in India.
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Affiliation(s)
- Rajan Shukla
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Murthy V. S. Gudlavalleti
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
- Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Souvik Bandyopadhyay
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Raghupathy Anchala
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Aashrai Sai Venkat Gudlavalleti
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - A. T. Jotheeswaran
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Srikrishna S. Ramachandra
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Vivek Singh
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Praveen Vashist
- Department of Community Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Komal Allagh
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Hira Pant Ballabh
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Clare E. Gilbert
- Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Thapa R, Bajimaya S, Paudyal G, Khanal S, Tan S, Thapa SS, van Rens G. Population awareness of diabetic eye disease and age related macular degeneration in Nepal: the Bhaktapur Retina Study. BMC Ophthalmol 2015; 15:188. [PMID: 26714483 PMCID: PMC4696239 DOI: 10.1186/s12886-015-0175-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/16/2015] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) and age-related macular degeneration (AMD) are among the leading causes of visual impairment and blindness in developing countries. This study aims to explore the awareness of these retinal diseases in Nepal. METHOD A population based cross-sectional study conducted among individuals 60 years and older from the Bhaktapur district of Nepal. One thousand consecutive subjects were enrolled and subjected to a structured questionnaire. RESULT Subject age ranged from 60 to 93 years with a meanof 69.5 years ± 7.1(S.D.). Males and females comprised 45.1 and 55.9 % of the population, respectively. The majority was illiterate (78.2 %), and agriculture was the predominant occupation (79.8 %). 12.1 % were aware of the effect of diabetes on the eye, and among them, 99 % were aware that diabetes was a blinding disease caused by DR.11.5 % of the subjects were aware of DR, and 10.1 % were aware that subjects with diabetes should undergo periodic eye examinations. Only 7.6 % of subjects were aware of AMD.7.5 and 7.4 % were aware about its aggravation with smoking and sunlight exposure, respectively. Younger age group, males, literates, service holders, best corrected visual acuity >0.3 LogMAR, were each significantly associated with an increase in awareness of diabetic retinopathy. Smokers and those with agricultural occupations were less aware regarding AMD. Those with diabetes,with or without DRwere significantly more aware than those not having the disease. CONCLUSION Among the Bhaktapur population, awareness of DR and AMD was only 11.5 and7.6 % respectively. Older age groups, females, illiterates, farmers, and those with poor visual acuity were less aware of these blinding diseases. We recommend community-based eye health education programs targeted at raising awareness of these diseases and preventive measures.
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Affiliation(s)
- Raba Thapa
- Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Sanyam Bajimaya
- Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Govinda Paudyal
- Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal.
| | - Stevie Tan
- Vrije University Medical Center, Amsterdam, The Netherlands.
| | - Suman S Thapa
- Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Ger van Rens
- Vrije University Medical Center, Amsterdam, The Netherlands.
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Liu L, Chen L. Awareness of diabetic retinopathy is the key step for early prevention, diagnosis and treatment of this disease in China. PATIENT EDUCATION AND COUNSELING 2014; 94:284-285. [PMID: 24286732 DOI: 10.1016/j.pec.2013.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/26/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Lei Liu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China; Key Laboratory of Endocrine Diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China; Department of Epidemiology, School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Lei Chen
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China; Key Laboratory of Endocrine Diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China.
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