Toward Universal Eye Health Coverage-Key Outcomes of the World Health Organization Package of Eye Care Interventions: A Systematic Review

Importance

Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed.

Objective

To describe the key outcomes of the PECI development.

Evidence Review

A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review.

Findings

Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI.

Conclusions and Relevance

This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.

Bacterial isolates involved in cases of septicaemia in a Nigerian hospital

Of the nine hundred and twenty patients clinically diagnosed of having septicaemia at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria between 1980-1987, 233 (25.3%) had blood samples positive by culture. Thirteen different bacterial species were identified from positive blood cultures of which six predominated: Staphylococcus aureus (30.5%), Coliforms (17.6%), Klebsiella spp. (14.2%), Pseudomonas aeruginosa (9.2%), Escherichia coli (7.9%) and Salmonella typhi (5.9%). The in vitro antibiotic, disc sensitivity pattern of the isolates showed they were relatively resistant to ampicillin and penicillin G but comparatively sensitive to antibiotics commonly used in the treatment of infections caused by these organisms. Septicaemia cases were recorded in all age groups but incidence in females was slightly but not significantly higher than in males (p less than 0.05). The study reveals the predominance of S. aureus strains in case of septicaemia in Nigeria.