Oculocutaneous albinism: identifying and overcoming barriers to vision care in a Nigerian population

Low-Cost Telerehabilitation in Low- and Middle-Income Countries (LMICs): Overcoming Barriers to Access and Improving Healthcare Delivery

BackgroundTelerehabilitation (TR) holds promise for addressing healthcare disparities in low- and middle-income countries (LMICs), where access to rehabilitation services is often limited due to economic, geographical, and infrastructure barriers. Despite its potential, TR faces unique challenges in LMICs, including inadequate digital infrastructure, limited access to affordable devices, and variable internet connectivity.ObjectiveThis study investigates the feasibility, barriers, and outcomes of implementing low-cost TR interventions in LMICs.MethodA narrative review was conducted where studies were analyzed for outcomes including cost-effectiveness, patient adherence, and clinical efficacy.ResultsFindings indicate that low-cost TR can significantly improve accessibility to rehabilitation in LMICs, with positive clinical outcomes for patients with stroke, musculoskeletal disorders, and chronic pain. TR led to a 40-60% reduction in travel-related costs for patients, with adherence rates comparable to in-person sessions. However, limited access to reliable internet and devices were major barriers, particularly in rural areas, highlighting a digital divide within LMIC populations. Innovative solutions, such as asynchronous video-based therapy, were found effective in overcoming connectivity challenges.ConclusionLow-cost TR is a viable approach to enhancing rehabilitation accessibility in LMICs, offering substantial reductions in cost and travel barriers. Addressing infrastructure challenges through scalable, offline-enabled platforms could enhance TR's reach and efficacy. Further research is necessary to develop sustainable TR models tailored to the specific needs of LMICs.

Mapping a research-advocacy-policy agenda on human rights and albinism: a mixed methods project

BACKGROUND

Persons with albinism face challenges to their wellbeing, safety, and security, ranging from vision impairment and skin cancer to stigma and discrimination. In some regions, they also face human rights atrocities including mutilation and murder. Research on human rights and albinism is a relatively new field that has gained momentum since the United Nations appointment of an Independent Expert on the enjoyment of human rights by persons with albinism. In this paper, we present the results of a mixed methods study undertaken to identify priorities for research, advocacy, and policy on albinism and human rights.

METHODS

The first component was a synthesis of peer-reviewed and grey literatures at the nexus of albinism, spiritual/cultural beliefs and practices, and human rights. We then conducted a priority-setting survey, informed by Delphi methods, on extant knowledge-practice gaps and research, advocacy, and policy priorities. Inclusion criteria included demonstrated expertise in the field (e.g., peer-reviewed publications, funded research), membership on national or international associations, or advocacy (civil society organizations) of more than 2 years in albinism and human rights. Thereafter, we gathered leading researchers, policy-makers, and civil society stakeholders for a Roundtable to gain consensus on these priorities.

RESULTS

Access to skin and vision care, and education were not deemed high priority for research, likely because the evidence supporting the need for these is well established. However, they were priorities for advocacy and policy: what is needed is mobilization of this evidence through advocacy and implementation of such services (policy). Other social determinants of health (rurality, poverty, and gender equality) are present as subtext in the findings, more so than priorities for research, advocacy, or policy, despite their preponderance in the lives of persons with albinism. Research was prioritized on stigma and discrimination; advocacy; and witchcraft, but with some differentiation between Global North and Global South priorities. Priorities for research, advocacy, and policy vary in keeping with the explanatory frameworks at play, including how harmful practices and witchcraft are viewed.

CONCLUSIONS

The lived experience of albinism is profoundly shaped by the social determinants of health (SDOH). Threats to the security and well-being of persons with albinism should be viewed through a human rights lens that encompasses the explanatory frameworks at play.

Understanding Barriers to the Access to Healthcare and Rehabilitation Services: A Qualitative Study with Mothers or Female Caregivers of Children with a Disability in Indonesia

Accessibility to healthcare and rehabilitation services for children with a disability (CWD) is essential to improving their health and wellbeing. However, access to the services, especially in many settings in developing countries with scarcity of resources, is still limited. As part of a qualitative study exploring impacts of caring for CWD on mothers or female caregivers and their coping strategies, this paper describes barriers for access to healthcare and rehabilitation services for CWD in Belu district, Indonesia. One-on-one, in-depth interviews were conducted with 22 mothers or female caregivers of CWD. Participants were recruited using a combination of purposive and snowball sampling techniques. These were supplemented with interviews with two staff of disability rehabilitation centers in Belu to understand any additional barriers. Data analysis was guided by a qualitative data analysis framework. Our analysis identified that lack of affordability of healthcare services (high costs and low financial capacity of mothers) was the key barrier for access to healthcare and rehabilitation services CWD. Religious or faith-based factors, such as being a non-Catholic (Belu is predominantly Catholic), converting from Catholic to other religions, and the belief in children’s disability condition as “God’s will”, were also influencing factors for lack of access to the services. Shortage of staff, distrust in the therapy skills of staff at rehabilitation centers, and unavailability of appropriately trained healthcare professionals were structural or system-related barriers. The findings indicate the need for government-owned and run disability rehabilitation centers (not faith-based), the provision of fully subsidised health insurance to provide free services, and the provision of qualified therapists and healthcare professionals (to build trust) in Belu and other similar settings in Indonesia.

Visual function and visual ability in adolescents with oculocutaneous albinism

Individuals with ocular and oculocutaneous albinism (OCA) have significantly reduced visual acuity (VA) resulting in visual impairment (VI). The aim is to report on the visual function of adolescents with OCA and their quality of life (QoL) in terms of their visual ability. A total of 28 adolescents with OCA participated in this study. Tests of visual function included distance VA, refractive error, contrast sensitivity (CS), and colour vision. The Cardiff Visual Ability Questionnaire for Children (CVAQC) was used to assess visual ability. All participants presented with cutaneous hypopigmentation and nystagmus, while only two had strabismus. A mean myopic refractive error was found, and with-the-rule (WTR) astigmatism was most common. The mean best-corrected VA was 0.81 ± 0.17 logMAR and 0.81 ± 0.18 logMAR in the right and left eyes, respectively. The mean CS with the best refractive correction was 1.23 ± 0.33 log CS in the right eye and 1.29 ± 0.33 log CS in the left eye. The mean Cardiff visual ability score was −0.37 ± 0.79 log units. The variation of refractive errors and the magnitude thereof underscores the need for regular eye examinations in individuals with OCA. The majority of participants had moderate VI, and these participants had a better mean Cardiff visual ability score than those with severe VI. Similarly, participants with normal binocular CS had a better Cardiff visual ability score than those with a loss of CS.

Utilisation of eye and skin care, and social services among persons with albinism in Ulundi, KwaZulu-Natal, South Africa

Background: Knowledge of the utilisation of eye and skin care, and social services among persons with albinism is essential for planning intervention strategies for this group.Aim: The aim of this study was to determine the utilisation of eye and skin care, and social services among persons with albinism in the Ulundi Municipality of KwaZulu-Natal Province, South Africa.Setting: The Ulundi Municipality of KwaZulu-Natal, South Africa.Methods: The cross-sectional survey used a questionnaire to collect data from 21 participants living with albinism. Semi-structured face-to-face interviews were conducted in small peer groups.Results: The participants (n = 21; males 8 and females 13) were aged 4 to 60 years (mean = 24.5 ± 17.9 years). All participants reported that they had their eyes tested within the last two years by an optometrist and none by an ophthalmologist. Almost half (42.9%) had never used a low vision device, this being because of their non-availability (44.4%), financial constraints (33.3%) and lack of or poor awareness (22.2%). Participants reported wearing a wide-brimmed hat (47.6%), a combination of wide-brimmed-hats and sunglasses (33.3%) for eye protection and 19% reported using neither. All the participants reported that they used sunscreen with sun protection factor and 90.5% reported using long-sleeved shirts for skin protection. The majority (81%) of participants reported receiving the South African Social Security Agency (SASSA) social (visual disability) grant, with 85.7% knowing where the SASSA offices were located.Conclusion: Despite the poor use of low vision aids, the level of utilisation of eye and skin care, and other social services among participants was good.

A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries

Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services—diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to services for any disability. A diverse range of measures of disability and access were used across studies making comparability difficult. However, there was some evidence that access to rehabilitation is low among people with disabilities. No clear patterns were seen in access by equity measures such as age, locality, socioeconomic status, or country income group due to the limited number of studies measuring these indicators, and the range of measures used. Access to rehabilitation services was highly variable and poorly measured within the studies in the review, but generally shown to be low. Far better metrics are needed, including through clinical assessment, before we have a true appreciation of the population level need for and coverage of these services.

Prevalence and profile of ophthalmic disorders in oculocutaneous albinism: a field report from South-Eastern Nigeria

To assess the burden and spectrum of refractive and non-refractive ophthalmic disorders in south-eastern Nigerians with oculocutaneous albinism. In a population-based survey in Enugu state, between August, 2011 and January, 2012, albinos were identified using the database of the Enugu state's Albino Foundation, and mass media-based mobilisation. The participants were enrolled at the Eye Clinics of the University of Nigeria Teaching Hospital and Enugu State University of Science and Technology Teaching Hospital using a defined protocol. Relevant socio-demographic and clinical data were obtained from each participant. Descriptive and comparative statistics were performed. Statistical significance was indicated by p < 0.05. The participants (n = 153; males, 70) were aged 23.5 + 10.4 SD years (range 6-60 years). Both refractive and non-refractive disorders were present in all participants. Non-refractive disorders comprised nystagmus, foveal hypoplasia, hypopigmented fundi and prominent choroidal vessels in 100.0% participants; and strabismus in 16.3% participants. Refractive disorders comprised astigmatism -73.2% eyes, myopia -23.9% and hypermetropia 2.9%. Spherical refractive errors ranged from -14.00 DS to +8.00 DS while astigmatic errors ranged from -6.00 DC to +6 DC. Mixed refractive and non-refractive disorder i.e. presenting visual impairment was present in 100.0% participants. Overall, refractive error was associated with non-possession of tertiary education (OR 0.61; 95% CI 0.38-0.96; p = 0.0374). There is high prevalence of refractive, non-refractive and mixed ophthalmic disorders among albinos in south-eastern Nigeria. This underscores the need for tailored provision of resources to address their eye care needs, and creation of needs awareness amongst them.