Building consensus for the development of child eye care services in South Darfur State of Sudan using the Delphi technique

Childhood visual impairment causes and barriers to accessing eye care: A suggested approach for Africa

BACKGROUND

 Childhood vision impairment (VI) has a significantly harmful effect on both health and social outcomes.

AIM

 To assess the causes of childhood VI, to determine obstacles to accessing eye care services and to develop a strategy for the childhood eye care system in African nations.

METHOD

 This systematic review was conducted by searching several online databases, including; Scopus, PubMed, ProQuest, Web of Science, Google Scholar, Ebsco and Medline. They focussed on articles available between 2003 and 2023. These studies were conducted to evaluate the causes of childhood VI and to assess obstacles to accessing eye care services in African countries.

RESULTS

 The main causes of childhood VI in African nations can be avoided with timely diagnosis and an appropriate management strategy. The leading obstacles to accessing childhood eye care services were a lack of availability, accessibility and affordability. In addition to these barriers, we found that there are concerns with quality of services, primary health care system, geographic barriers, incorrect health beliefs, inappropriate parental perception, a lack of knowledge, attitudes and inadequate practices related to paediatric eye care.

CONCLUSION

 The main causes of childhood VI were uncorrected refractive error (RE), amblyopia, cataract and corneal opacities that can be avoided with timely diagnosis and an appropriate management strategy. While the main obstacles to accessing childhood eye care services were a lack of availability, accessibility, affordability and healthcare system.Contribution: The recommended strategy for childhood eye-care services includes models for delivery and training.

Status of Childhood Eye Care Services in the Kingdom of Saudi Arabia: Eye Care Professionals’ Perspectives

Background:

The World Health Organization (WHO) reported that there are approximately 19 million visually impaired children worldwide, and most of the conditions are treatable by early intervention at the primary, secondary, and tertiary levels.

Objective:

To assess the status of paediatric eye care services in the Kingdom of Saudi Arabia

Methods:

A cross-sectional study was conducted among eye care professionals (optometrists and ophthalmologists) in public sector hospitals in various regions of Saudi Arabia. Data were collected through an online self-administered paediatric eye care service questionnaire based on a validated questionnaire.

Results:

A total of 137 completed questionnaires were obtained, with a response rate of 83%. The highest percentage of trained paediatric teams at hospitals was recorded at 95% in the eastern region (p= 0.024), while the lowest percentage was 44% in the southern region. Trained paediatric nurses were available in 88% of the eastern region hospitals, followed by 56% of the central region hospitals (p= 0.001). Services such as separate paediatric optometry clinics, dedicated ophthalmology outpatient clinics, and advanced diagnostic equipment were significantly higher in number in the eastern region than in the other regions (p˂0.001). The general status of human resources of eye professionals reveals that 73% of the facilities had both trained optometrists and ophthalmologists, approximately 70.8% had anaesthesiologists available, and almost 73.7% had easy access to available paediatricians.

Conclusion:

The overall quality of paediatric eye-related health care is satisfactory in most Saudi regions. However, there are some discrepancies among the regions in paediatric eye care services and facility types, which may need to be addressed by decision-makers in the Ministry of Health.

Outcomes of a Short Course in Improving Eye Healthcare Knowledge and Skills Among Final-Year Medical Students

BACKGROUND

Globally, at least, more than 2 billion people are either blind or visually impaired, the majority of whom live in low-income settings. Visually impaired people experience limitations in their daily activities in addition to the negative psychological impact. Ophthalmology is not a major focus in medical curricula, including in Sudan. The purpose of this study was to evaluate the effects of a short course in improving eye healthcare knowledge and skills among final-year medical students in a public university in Khartoum State, Sudan.

METHODS

A mixed-methods interventional study was conducted among 25 final-year medical students in Sudan. A short ophthalmology course was designed and conducted aiming to strengthen the knowledge and ability of the medical students to deal with common eye disorders, eye emergencies, prevention of blindness, and promotion for eye health. Data were collected using a closed-ended questionnaire at the start and 1 month after completion of the course. The quantitative data were analyzed using Excel, and the Fisher exact test was performed using Statistical Package for the Social Sciences (version 21.0) to examine any association between variables of interest. A p value of less than 0.05 was considered statistically significant. The quantitative data was supplemented by one focus group discussion that was conducted at the end of the course.

RESULTS

The average ophthalmology knowledge of participants improved from 52.6 to 86.6% (p < 0.001). Diagnostic skills improved from 57.3 to 93.6% (p < 0.001), and knowledge regarding the needed interventional actions improved from 58.6% to 94% (p < 0.001). Participants both enjoyed and learnt from this short course. Participants felt more confident and able to distinguish between simple, complicated, and urgent conditions. The majority of course content was new to them, but they suggested replacing some content with actual clinical work.

CONCLUSION

A well-designed short ophthalmology course significantly improves the levels of medical students' knowledge and skills towards eye health. Implementing such a course as a standard component in the national medical curriculum has the potential to contribute towards the reduction of blindness in the long term.

Demographic Characteristics and Causes of Visual Impairment in the White Nile State of Sudan: A Hospital-based Study

Abstract: BACKGROUND: The World Health Organization (WHO) states that visual impairment (VI) is a reduction of vision functions due to eye diseases, trauma, and congenital eye conditions. Current estimates indicate that more than 90% of people with vision impairment live in rural and developing countries. AIM: This study aimed to determine demographic characteristics and causes of visual impairment in the White Nile State of Sudan METHODS: A cross-sectional retrospective hospital-based study, including all patients attending Kosti and Rabak eye hospitals from January to December 2017, was conducted. A total of 1000 records were reviewed, 300 of them met the required criteria and then included in this study, with a mean age of 59.8 ± 18.5 (ranging from 10 to 95) years old. Visual impairment was classified according to the International Classification of Diseases, 11th revision, 2018 (ICD-11). RESULTS: The prevalence of VI was found at 28.5 %. Based on best-corrected visual acuity (BCVA), 6 participants (2.0%) were mild VI, 32 (10.7%) had moderate VI, 152 (50.7%) had severe VI, and 110 (36.7%) were blind. VI was associated with patients' age in children (3.6%) and reached (48.3) in older age (P=0.001). VI was more common among males 158 (52.7%) than females but was statistically not significant (P=0.35). The main causes of VI were cataract (52%), refractive errors (20.7%), glaucoma (16.3%), corneal disorders (5.3%), diabetic retinopathy (1.7 %), and other causes (4%). Conclusion Visual impairment was high in the community and more prevalent among older age. Cataract was the leading cause of VI, then refractive errors and glaucoma. Among children, uncorrected refractive errors and cataracts were the common leading causes of VI. In adults, the main causes were cataracts, uncorrected refractive errors, and glaucoma.

Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review

Background: Neurological impairments (NI) and disability are common among older children in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical and rehabilitative care by children and adolescents with NI in LMICs. Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all studies reporting on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches. Results: Our literature searches identified 3,258 reports of which 20 were included in the final analysis. Fifteen studies (75.0%) originated from diverse settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=17, 85.0%), geographical and physical inaccessibility (N=14, 70.0%), inadequate healthcare resources (N=14, 70.0%), prohibitive culture and beliefs (N=12, 60.0%), and inadequate education/awareness (N=11, 55.0%). Factors reported in <50% of the studies included competing domestic roles (N=4, 20%) and a lack of confidentiality for personal information (N=2, 10.0%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level. Conclusions: Financial constraints, geographic and physical inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs. PROSPERO registration: CRD42020165296 (28/04/2020).

A systemic review of barriers to accessing paediatric eye care services in African countries

Background

Global estimate reported that 1.4 million children are blind of which three-quarters live in developing countries. Childhood Visual Impairment is a major public health problem globally especially in rural areas of developing countries.

Objective

To review barriers to accessing paediatric eye care services in African countries.

Methods

The studies in this review were searched in online databases (PubMed, Web of Sciences, ProQuest, Scopus, Google Scholar, African Index Medicus and Medline) for studies published between January 2000 and April 2020. The articles included in this review, which was conducted in Africa to assess the barriers for accessing paediatric eye care services with regards availability, accessibility, affordability, socio cultural barriers of parents/caregivers and community.

Results

Of 22 705 articles screened, the study found 29 publications from 10 African countries which met the inclusion criteria. The main barriers were non-availability, non-accessibility, and non-affordability of paediatric eye care services. The studies reviewed revealed that there are other factors affecting the utilization of paediatric eye services which include the primary health system, geographic barriers, health beliefs, perception of parents; lack of knowledge, attitudes and practices about paediatric eye care. Furthermore, environmental, demographic barriers and socio-economic status has negative impact on accessing paediatric eye care services in African counties.

Conclusion

The main barriers to accessing paediatric eye care services in Africa were affordability, accessibility and availability. There is therefore a need for all relevant stakeholders to play a significant role in addressing barriers to child eye care in African countries.

Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review

Background: Neurological impairments (NI) and disability are common among survivors of childhood mortality in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical care by children and adolescents with NI in LMICs. Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all reports on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches, and we report a synthesized analysis of the barriers identified in the primary studies. Results: Our literature searches identified 3,074 reports of which 16 were included in the final analysis. Fourteen studies (87.5%) originated from rural settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=15, 93.8%), geographical inaccessibility (N=11, 68.8%), inadequate healthcare resources (N=11, 68.8%), inadequate education/awareness (N=9, 56.3%), and prohibitive culture/beliefs (N=9, 56.3%). Factors reported in <50% of the studies related to the attitude of the patient, health worker, or society (N=7, 43.8%), poor doctor-patient communication (N=5, 31.3%), physical inaccessibility (N=3, 18.8%), and a lack of confidentiality for personal information (N=2, 12.5%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level. Conclusions: Financial constraints, geographic inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs. PROSPERO registration: CRD42020165296 (28/04/2020).