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Padhy D, Pyda G, Marmamula S, Khanna RC. Barriers to uptake of referral services from secondary eye care to tertiary eye care and its associated determinants in L V Prasad Eye Institute network in Southern India: A cross-sectional study-Report II. PLoS One 2024; 19:e0303401. [PMID: 38743737 PMCID: PMC11093387 DOI: 10.1371/journal.pone.0303401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/07/2024] [Indexed: 05/16/2024] Open
Abstract
AIM To investigate the barriers to the uptake of referral services from secondary care centers (SC) to a higher-level tertiary care center (TC) in Southern India. METHODS A cross-sectional study was conducted in the Mahabubnagar district of Telangana, India, between February 1, 2018 to January 31, 2019 and all those referred from SC to TC between January 1, 2013 to December 30, 2016 were identified for interview. Based on inclusion criteria, of the 960 participants identified, 681 (70.9%) participated in the study. A validated study questionnaire was administered to all participants. Information collected were the demographic details, details related to their referral and barriers to referral. The participants that presented at TC were considered compliant and who did not, were non-compliant. Reasons for non-compliance was also collected. RESULTS The mean age those interviewed was 46.1 years (SD: 17.3 years) and 429 (63%) were males and 252 (37%) were females. Overall, 516 (75.8%) were compliant, and 165 (24.2%) were non-compliant. The major factors for non-compliance were economic (16.4%) and attitudinal (44.2%) barriers. Within the attitudinal barrier category, the most prevalent individual attitudinal barriers were 'too busy to go to the eye center for treatment (16.4%)'and 'able to manage routine daily activities with current vision (12.1%)'. The multivariable analysis showed that the non-compliant participants had only visited the SC once prior to the referral (odds ratio: 2.82; 95% CI: 1.43-5.57) (p = 0.003). CONCLUSIONS Participants with only one SC visit, were less likely to comply with referrals and the major barriers to compliance were economical and attitudinal. It is important to address these specific barriers to provide proper counseling to participants during referrals.
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Affiliation(s)
- Debananda Padhy
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Giridhar Pyda
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C. Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States of America
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Khan AA, Talpur KI, Awan Z, Arteaga SL, Bolster NM, Katibeh M, Watts E, Bastawrous A. Improving equity, efficiency and adherence to referral in Pakistan's eye health programmes: Pre- and post-pandemic onset. Front Public Health 2022; 10:873192. [PMID: 35937227 PMCID: PMC9354236 DOI: 10.3389/fpubh.2022.873192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Over one billion people worldwide live with avoidable blindness or vision impairment. Eye Health Programmes tackle this by providing screening, primary eye care, refractive correction, and referral to hospital eye services. One point where patients can be lost in the treatment journey is adherence to hospital referral. Context Peek Vision's software solutions have been used in Pakistan with the goal of increasing eye health programme coverage and effectiveness. This involved collaboration between health system stakeholders, international partners, local community leaders, social organizers and “Lady Health Workers”. Results From the beginning of the programmes in November 2018, to the end of December 2021, 393,759 people have been screened, 26% of whom (n = 101,236) needed refractive services or secondary eye care, and so were referred onwards to the triage centers or hospital services. Except for a short period affected heavily by COVID-19 pandemic, the programmes reached an increasing number of people over time: screening coverage improved from 774 people per month to over 28,300 people per month. Gathering and discussing data regularly with stakeholders and implementers has enabled continuous improvement to service delivery. The quality of screening and adherence to hospital visits, gender balance differences and waiting time to hospital visits were also improved. Overall attendance to hospital appointments improved in 2020 compared to 2019 from 45% (95% CI: 42–48%) to 78% (95% CI: 76–80%) in women, and from 48% (95% CI: 45–52%) to 70% (95% CI: 68–73%) in men. These patients also accessed treatment more quickly: 30-day hospital referral adherence improved from 12% in 2019 to 66% in 2020. This approach helped to utilize refractive services more efficiently, reducing false positive referrals to triage from 10.6 to 5.9%. Hospital-based services were also utilized more efficiently, as primary eye care services and refractive services were mainly delivered at the primary healthcare level. Discussion Despite various challenges, we demonstrate how data-driven decisions can lead to health programme systems changes, including patient counseling and appointment reminders, which can effectively improve adherence to referral, allowing programmes to better meet their community's needs.
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Affiliation(s)
- Asad Aslam Khan
- College of Ophthalmology and Allied Visual Sciences (COAVS), Mayo Hospital, King Edward Medical University, Lahore, Pakistan
- National Committee for Eye Health, Government of Pakistan, Islamabad, Pakistan
| | - Khalid Iqbal Talpur
- Sindh Institute of Ophthalmology and Visual Sciences (SIOVS), Liaquat University, Jamshoro, Pakistan
| | - Zahid Awan
- Head of Inclusive Eye Health Projects, CBM Pakistan Country Office, CBM International, Islamabad, Pakistan
| | - Sergio Latorre Arteaga
- Peek Vision, London, United Kingdom
- Department of Optometry, Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
| | - Nigel M. Bolster
- Peek Vision, London, United Kingdom
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Elanor Watts
- Peek Vision, London, United Kingdom
- Tennent Institute of Ophthalmology, Glasgow, United Kingdom
- *Correspondence: Elanor Watts
| | - Andrew Bastawrous
- Peek Vision, London, United Kingdom
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Banks LM, Liu J, Kielland A, Tahirou AB, Harouna AKS, Mactaggart I, Dybdahl R, Mounkaila DF, Grønningsæter A. Childhood disability in rural Niger: a population-based assessment using the Key Informant Method. BMC Pediatr 2022; 22:170. [PMID: 35361177 PMCID: PMC8969242 DOI: 10.1186/s12887-022-03226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Data on childhood disability is essential for planning health, education and other services. However, information is lacking in many low- and middle-income countries, including Niger. This study uses the Key Informant Method, an innovative and cost-effective strategy for generating population-based estimates of childhood disability, to estimate the prevalence and causes of moderate/severe impairments and disabling health conditions in children of school-going age (7–16 years) in the Kollo department of western Niger. Methods Community-based key informants were trained to identify children who were suspected of having the impairment types/health conditions included in this study. Children identified by key informants were visited by paediatricians and underwent an assessment for moderate/severe vision, hearing, physical and intellectual impairments, as well as epilepsy, albinism and emotional distress. Results Two thousand, five hundred sixty-one children were identified by key informants, of whom 2191 were visited by paediatricians (response rate = 85.6%). Overall, 597 children were determined to have an impairment/health condition, giving a prevalence of disability of 11.4 per 1000 children (10.6- 12.2). Intellectual impairment was most common (6.5 per 1000), followed by physical (4.9 per 1000) and hearing impairments (4.7 per 1000). Many children had never sought medical attention for their impairment/health condition, with health seeking ranging from 40.0% of children with visual impairment to 67.2% for children with physical impairments. Conclusion The Key Informant Method enabled the identification of a large number of children with disabling impairments and health conditions in rural Niger, many of whom have unmet needs for health and other services. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03226-0.
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Affiliation(s)
- Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Ali Bako Tahirou
- Laboratoire d'Études Et de Recherche Sur Les Dynamiques Sociales Et Le Développement Local (LASDEL), Niamey, Niger
| | - Abdoul Karim Seydou Harouna
- Laboratoire d'Études Et de Recherche Sur Les Dynamiques Sociales Et Le Développement Local (LASDEL), Niamey, Niger
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Hickman MS, Dean WH, Puri L, Singh S, Siegel R, Patel D. Ophthalmic Telesurgery with a Low-Cost Smartphone Video System for Surgeon Self-Reflection and Remote Synchronous Consultation: A Qualitative and Quantitative Study. TELEMEDICINE REPORTS 2022; 3:30-37. [PMID: 35720448 PMCID: PMC9049828 DOI: 10.1089/tmr.2021.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 06/15/2023]
Abstract
SUMMARY More than a third of the global burden of blindness is due to cataracts, yet cataract surgery is one of the most cost-effective surgical treatments in medicine. Poor surgical outcomes in many settings remain a major challenge, raising concerns about the quality and efficacy of surgical training. Reflective learning from video recordings of a trainees' surgical performance has a high educational impact and is available routinely for surgical training within high-resource institutions. However, the prohibitive cost and limited portability of current surgical video recording systems make its use problematic in low-resource settings and outreach environments. OBJECTIVE The study's aim was to evaluate the potential of smartphone-captured surgical videos for surgeon learning via self-recording and self-review as well as the potential to support live telesurgical consultation. METHODOLOGY A quantitative and qualitative methodology was used to explore and describe the utility and acceptance of smartphone videos in two training facilities in Nepal. Twenty surgeries were recorded on the smartphone for surgeon self-review, to assess image quality, and its application to measure performance against the International Council of Ophthalmology (ICO) Ophthalmology Surgical Competency Assessment Rubrics (OSCAR) SICS Rubric. The same system was used to transmit 15 different surgeries live via Skype from Nepal to an ophthalmologist surgical trainer in South Africa to evaluate the feasibility of live consultation. FINDINGS Overall video quality was described as high in 65% and moderate in 35% for the videos recorded for self-review. In the surgeries streamed via Skype, quality was described as high in 92.9% and moderate in 7.1%. There were no instances where the video quality was described as poor. The video quality was good enough that the surgeons could measure against ICO-OSCAR rubric in all cases. DISCUSSION The video quality of smartphone-captured surgical videos was found to be high and gained acceptance for reflective teaching and learning purposes. The extended telesurgical potential and portability of the smartphone enables use across many settings. More studies over a longer period are needed to determine how they can support training and learning in cataract surgery.
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Affiliation(s)
- M. Scott Hickman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Ad Astra Eye, Lawrence, Kansas, USA
| | - William H. Dean
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Lila Puri
- Dhangadhi Netralaya Hospital, Dhangadhi, Nepal
| | - Sanjay Singh
- Nepal Eastern Regional Eye Care Programme (EREC-P), Biratnagar, Nepal
| | - Rachel Siegel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daksha Patel
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Choi HG, Lee MJ, Baek SU. A longitudinal study of the association between visual impairment and income change using a national health screening cohort. Sci Rep 2022; 12:958. [PMID: 35046464 PMCID: PMC8770619 DOI: 10.1038/s41598-022-05003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 01/05/2022] [Indexed: 11/09/2022] Open
Abstract
We evaluated the influence of visual impairment (VI) on income change using the longitudinal database of a Korean National Health Insurance Service cohort. A total of 5292 participants ≥ 40 years old and registered as visually impaired persons were selected at a 1:4 ratio with 45,081 non-VI participants matched for age, sex, and income level. The income level of both the VI and non-VI groups increased over time. In the VI group, the income levels 3, 4 and 5 years were higher than the initial value, while the income levels from 1 through 5 years were increased each year in the non-VI group. The rate of change in income between time and VI were significant. In the subgroup analysis considering age, sex, and severity of VI, the rate of change in income were significant in < 65 years old subgroups. Regarding the severity of VI, a significant interaction was found for the mild-to-moderate VI subgroup. Although both the VI and non-VI groups showed increased income levels over 5 years, the degree of income increase in the VI group was relatively lower than that in the non-VI group. This finding was prominent in the middle-age subgroup. These results strongly suggested that VI induced an income inequality.
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Affiliation(s)
- Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, South Korea.,Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South Korea.
| | - Sung Uk Baek
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South Korea.
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Briesen S, Ng EY, Roberts H. Validity of first post‐operative day automated refraction following dense cataract extraction. Clin Exp Optom 2021; 94:187-92. [DOI: 10.1111/j.1444-0938.2010.00567.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sebastian Briesen
- Dardenne Eye Clinic, Bonn, Germany
- Kwale District Eye Centre, Mombasa, Kenya
| | - Eugene Yj Ng
- Royal Victoria Eye and Ear Hospital, Dublin, Ireland E‐mail:
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Poddar AK, Khan TA, Sweta K, Tiwary MK, Borah RR, Ali R, Sil AK, Sheeladevi S. Prevalence and causes of avoidable blindness and visual impairment, including the prevalence of diabetic retinopathy in Siwan district of Bihar, India: A population-based survey. Indian J Ophthalmol 2020; 68:375-380. [PMID: 31957732 PMCID: PMC7003600 DOI: 10.4103/ijo.ijo_1709_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: The aim of this study was to estimate the prevalence and causes of visual impairment (VI) and blindness and diabetic retinopathy (DR) in Siwan district, Bihar. Methods: A population-based cross-sectional study was done from January to March 2016 using the Rapid Assessment of Avoidable Blindness 6 (RAAB 6, incorporating DR module) methodology. All individuals aged ≥50 years were examined in 57 randomly selected clusters within the district. Results: A total of 3476 individuals were enumerated and 3189 (92%) completed examination. The overall prevalence of blindness and severe VI was 2.2% (95% confidence interval (CI): 1.6–2.8) and 3.4% (95% CI: 2.6–4.3), respectively. Untreated cataract was the leading cause of blindness (73%) and severe VI (93%). The cataract surgical coverage (CSC) at <3/60 was 71.5% for eyes and 89.3% for persons in this sample and the CSC was similar between the genders. Refractive error (71%) was the primary cause of early VI. The overall prevalence of known and newly diagnosed diabetes was 6.3% (95% CI, 5.4–7.2%). Prevalence of any DR, maculopathy, and sight-threatening DR was 15, 12.4, and 6%, respectively. Conclusion: To conclude, as compared to previous reports, the prevalence of blindness and DR in Siwan district of Bihar was found to be lower and the CSC was higher. However, the problem of avoidable blindness remains a major problem in this region.
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Affiliation(s)
- Ajit Kumar Poddar
- Department of Ophthalmology, Akhand Jyoti Eye Hospitals, Bihar, India
| | - Tanwir Ahmed Khan
- Department of Ophthalmology, Akhand Jyoti Eye Hospitals, Bihar, India
| | - Kumari Sweta
- Department of Ophthalmology, Akhand Jyoti Eye Hospitals, Bihar, India
| | | | - Rishi R Borah
- Orbis India Country Office, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| | - Rahul Ali
- Orbis India Country Office, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| | - Asim Kumar Sil
- Department of Ophthalmology, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| | - Sethu Sheeladevi
- Orbis India Country Office, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
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Zhang XJ, Leung CK, Li EY, Musch DC, Zheng CR, He MG, Chang DF, Lam DS. Diagnostic Accuracy of Rapid Assessment of Avoidable Blindness: A Population-based Assessment. Am J Ophthalmol 2020; 213:235-243. [PMID: 31846622 DOI: 10.1016/j.ajo.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of rapid assessment of avoidable blindness (RAAB). DESIGN Population-based diagnostic accuracy study. METHODS A total of 2145 (95.3%, 2145/2250) subjects aged 50 years and older who participated in the RAAB survey were included. All the recruited participants underwent ophthalmic examination according to the RAAB protocol and then were reexamined with instruments in a mobile eye clinic set up in a village center on the same day. Examination in the mobile clinic included standardized visual acuity (VA) tests using logMAR charts, refraction, slit-lamp biomicroscopy, and dilated fundal examination with a binocular indirect ophthalmoscope. Blindness and economic blindness were defined as VA in the better-seeing eye <3/60 and <6/60, respectively. Visual impairment (VI) was defined as VA <6/18 in the better eye. The primary cause of blindness and VI was defined according to the cause of VI in the participant's better eye. MAIN OUTCOME MEASURES The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) of receiver operating characteristics of RAAB for detection of blindness and the principal causes of VI. RESULTS A total of 1816 subjects (84.7%), including 686 men (37.8%) and 1130 women (62.2%), underwent ophthalmic examination in the mobile eye clinic. The mean (±standard deviation) age was 64.4 ± 9.6 years. The sensitivities, specificities, AUC, PLR, and NLR of RAAB were 90.3%, 99.3%, 0.948, 124.0, and 0.10, respectively, for detection of blindness (presenting visual acuity, PVA <3/60); 89.5%, 98.7%, 0.940, 69.2, and 0.11, respectively, for detection of economic blindness (PVA <6/60); and 90.3%, 97.7%, 0.940, 38.7, and 0.10, respectively, for detection of VI (PVA <6/18). The sensitivities, specificities, AUC, PLR, and NLR were 90.5%, 98.1%, 0.943, 48.1, and 0.10; and 60.4%, 98.7%, 0.796, 46.4, and 0.40 for detection of VI (PVA <6/18) owing to cataract and refractive error, respectively. CONCLUSION The diagnostic performances of RAAB were high for detecting the prevalence of blindness, VI, and VI owing to cataract.
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Sándor GL, Tóth G, Szabó D, Szalai I, Lukács R, Pék A, Tóth GZ, Papp A, Nagy ZZ, Limburg H, Németh J. Cataract blindness in Hungary. Int J Ophthalmol 2020; 13:438-444. [PMID: 32309181 DOI: 10.18240/ijo.2020.03.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/21/2019] [Indexed: 01/09/2023] Open
Abstract
AIM To estimate the prevalence of blindness and visual impairment resulting from cataract in the population aged ≥50y in Hungary, and to assess the cataract surgical services. METHODS A rapid assessment of avoidable blindness (RAAB) was conducted. A total of 3523 eligible people were randomly selected and examined. Each participant underwent surgery for cataract was interviewed with regard to the year, place, and costs of the surgery. Participants with obvious cataract were asked why they had not yet undergone surgery (barriers to surgery). RESULTS An estimated 12 514 people were bilaterally blind; the visual acuity (VA) in 19 293 people was <6/60, and the VA in 73 962 people was <6/18 in the better eye due to cataract. An estimated 77 933 eyes are blind; 98 067 eyes had a VA of <6/60, and an estimated 277 493 eyes had a VA of <6/18 due to cataract. Almost all cataract surgeries were conducted in government hospitals. The age- and sex-adjusted cataract surgical coverage with VA<3/60 in eyes was 90.0%. The rate of good visual outcome after surgery was 79.5%. Ocular comorbidity was the main cause of poor outcome (78.1%), followed by late complications (such as posterior capsule opacification) (17.2%), inadequate optical correction (3.1%), and surgical complications (1.6%). The main barrier to surgery in people with bilateral cataract and VA of <6/60 was 'need not felt'. CONCLUSION The prevalence of visual impairment resulting from cataract is slightly higher than expected. The quality of the cataract surgical service seems adequate in Hungary. However, the number of cataract operations per year should continue to increase due to the increasing patient demands and the aging population.
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Affiliation(s)
- Gábor L Sándor
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - Gábor Tóth
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - Dorottya Szabó
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - Irén Szalai
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - Regina Lukács
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary.,Department of Ophthalmology, Flór Ferenc Hospital, Kistarcsa 2143, Hungary
| | - Anita Pék
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary.,Department of Ophthalmology, Petz Aladár Hospital, Győr 9024, Hungary
| | - Georgina Z Tóth
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - András Papp
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
| | - Zoltán Z Nagy
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary.,Faculty of Health Sciences, Semmelweis University, Budapest 1088, Hungary
| | - Hans Limburg
- Health Information Services, Grootebroek 1613, The Netherlands
| | - János Németh
- Department of Ophthalmology, Semmelweis University, Budapest 1085, Hungary
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Mueller B, Ibraimova S, Mamutalieva E, Limburg H, Ibraimova A, Paduca A. Findings from a Rapid Assessment of Avoidable Blindness (RAAB) in the Southwest Region of Kyrgyzstan. Ophthalmic Epidemiol 2019; 27:141-147. [PMID: 31813309 DOI: 10.1080/09286586.2019.1701040] [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: 10/25/2022]
Abstract
Purpose: Reliable data on eye care needs in Kyrgyzstan are not readily available. The purpose of this study was to determine the prevalence and causes of blindness and visual impairment in persons aged 50 and above in the southwest of Kyrgyzstan and to support the Ministry of Health (MoH) in the planning of eye care in the region.Methods: A population-based survey was conducted in three states (Oblast) in the southwest region of Kyrgyzstan. Sixty clusters of 50 people aged 50 years and older were selected by probability proportionate to size sampling. Ethical approval was obtained from the MoH, consent was obtained from each participant.Results: A total number of 3,000 persons aged 50 and older were sampled. Among these 2,897 (95.9%) were examined. The prevalence of bilateral blindness was 1.7% [95%CI: 1.1-2.4]. Cataract (43.3%) was the main cause of blindness, followed by glaucoma (30%), age-related macular degeneration (ARMD) (8.3%), other posterior segment diseases (6.7%) and non-trachomatous corneal opacities (5%). The prevalence of blindness and visual impairment increased strongly with age. The cataract surgical coverage in blind persons was 59%.Conclusion: Cataract and glaucoma were the major causes of blindness and visual impairment in persons 50 and above. The majority of the causes (85%) were avoidable, with 45% (cataract and uncorrected aphakia) treatable, 6.7% (corneal opacity and phthisis) preventable by primary health care/eye care services and 33.3% (cataract surgical complications, glaucoma) preventable by specialized ophthalmic services. The data suggest that an expansion of eye care services to reduce avoidable blindness is needed, as ageing will lead to an increase in older people at risk and a higher demand for eye care in the future.
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Affiliation(s)
- Brigitte Mueller
- International Cooperation Department, Swiss Red Cross, International Cooperation, Wabern, Switzerland
| | | | - Elzat Mamutalieva
- International Cooperation Department, Swiss Red Cross, International Cooperation, Wabern, Switzerland
| | - Hans Limburg
- Health Information Services, Grootebroek, Netherlands
| | - Aigul Ibraimova
- Bishkek Scientific Research Centre of Traumatology and Orthopedics, Bishkek, Kyrgyzstan
| | - Ala Paduca
- Ophthalmology Department, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova
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Taryam MO, Rabiu MM, Muhammad N, Oladigbolu K, Abdurrahman H. Prevalence and causes of blindness and visual impairment; and cataract surgical services in Katsina state of Nigeria. Br J Ophthalmol 2019; 104:752-756. [PMID: 31488429 PMCID: PMC7286039 DOI: 10.1136/bjophthalmol-2019-314572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/24/2019] [Accepted: 08/20/2019] [Indexed: 11/20/2022]
Abstract
Aim To generate data on blindness and visual impairment for planning and monitoring a comprehensive eye care programme in Katsina state of Nigeria. Method A rapid assessment of avoidable blindness (RAAB) survey methodology was used to select 3120 persons aged 50 years and over. The sample was selected using a multistage cluster randomised sampling. Each participant had visual acuity and lens assessment. Persons with vision less than 6/12 in any eye were assessed for the cause of visual impairment. Persons with cataract were asked why they had not had surgery. Data were captured electronically with the mRAAB Android-based software and analysed with STATA V.14 software. Results A response rate of 90.1% was achieved. The age-sex adjusted blindness prevalence was 5.3% (95% CI 5.2% to 5.3%). Women were 30% more likely to be blind (OR 1.3, 95% CI 1.2 to 1.3). The principal causes of blindness were cataract (70%), other posterior segment (12%) and glaucoma (7%); 86.7% of blindness was avoidable. The prevalence of cataract blindness is 2.6% (95% CI 2.5% to 2.6%) with higher odds in women (OR 1.2, 95% CI 1.2 to 1.3, p<0.005). The cataract surgical coverage <6/60 for persons was 28.2% and women were 45% less likely to have had cataract surgery (OR 0.55, 95% CI 0.34 to 0.78, p<0.005). The major barriers to cataract surgery are lack of felt need and the cost of services. Conclusion Katsina state of Nigeria has high burden of avoidable blindness affecting more women. The state eye care programme should have cataract services that are more accessible, affordable and gender sensitive.
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Affiliation(s)
- Manal Omran Taryam
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | - Muhammad M Rabiu
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | - Nasiru Muhammad
- Ophthalmology Unit, Surgery Department, Usmanu Danfodiyo University, Sokoto, Nigeria.,Ophthalmology Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Kehinde Oladigbolu
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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Muhammad N, Adamu MD, Mpyet C, Bounce C, Maishanu NM, Jabo AM, Rabiu MM, Bascaran C, Isiyaku S, Foster A. Impact of a 10-Year Eye Care Program in Sokoto, Nigeria: Changing Pattern of Prevalence and Causes of Blindness and Visual Impairment. Middle East Afr J Ophthalmol 2019; 26:101-106. [PMID: 31543668 PMCID: PMC6737780 DOI: 10.4103/meajo.meajo_113_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: This study was undertaken to ascertain the current magnitude and causes of blindness and visual impairment in persons aged 50 years and over and to assess the impact of a 10-year eye care program in Sokoto State, Nigeria. METHODS: A rapid assessment of avoidable blindness (RAAB) survey (in persons 50 years and over) was conducted in 2016. Participants were selected in Wurno health zone using a two-stage cluster randomized sampling with probability proportional to size. Operational definitions were based on RAAB and World Health Organization eye examination record definitions. Eye care program documents were reviewed and data from a baseline survey undertaken in 2005 were reanalyzed. RESULTS: A response of 89.1% (2405 of 2700 participants) was obtained in the 2016 survey. With available correction, the unadjusted prevalence of blindness was 7.7% (95% confidence interval [CI]: 6.4, 8.9). The odds of blindness were 1.8 times higher in females than males (95% CI: 1.3, 2.4; P < 0.001). Major causes of blindness were cataract (48.9%) corneal disease (20.1%), glaucoma (10.3%), and uncorrected refractive error/aphakia (8.7%). The age- and sex-adjusted prevalence of blindness has declined from 11.6% (95% CI: 7.4, 17.0) in 2005 to 6.8% (95% CI: 5.6, 8.0%) in 2016. CONCLUSION: The blindness prevalence is high, and the major causes are avoidable in the health zone. The findings suggest that investments in the program over the last 10 years might have led to almost a halving in the prevalence of blindness in th e population. However, the small sample size of persons 50+ years from Wurno zone in the 2005 survey necessitate caution when comparing the 2005 and the 2016 surveys.
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Affiliation(s)
- Nasiru Muhammad
- Department of Ophthalmology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Mohammed D Adamu
- Department of Ophthalmology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria.,Sightsavers Nigeria Office, Kaduna, Nigeria.,Division of Ophthalmology, Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa
| | - Catey Bounce
- Department of Primary Care and Public Health Sciences, King's College, London, United Kingdom
| | - Nuhu M Maishanu
- Sokoto State Eye Health Programme, Ministry of Health, Sokoto, Nigeria
| | | | | | - Covadonga Bascaran
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Allen Foster
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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13
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Kulkarni S, Kondalkar S, Mactaggart I, Shamanna BR, Lodhi A, Mendke R, Kharat J, Kapse R, Dole K, Deshpande M. Generating evidence for planning eye care service delivery in an urban underprivileged population setting in Pune, Western India. BMJ Open Ophthalmol 2019; 4:e000202. [PMID: 31414051 PMCID: PMC6668608 DOI: 10.1136/bmjophth-2018-000202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To estimate prevalence of blindness, diabetic retinopathy and causes of blindness through rapid assessment of avoidable blindness (RAAB) survey in Pune, India to develop an evidence base for planning urban eye care services. Methods ‘Rapid assessment of avoidable blindness and diabetic retinopathy’ methodology was used. Compact segment sampling was used in each of the 60 selected electoral wards identified through cluster selection module of the RAAB software using probability proportionate to size method. Persons >50 years of age were enumerated from selected segments to achieve cumulative target of 60/day by two teams. Participants underwent presenting and pinhole visual acuity (VA) testing in each eye. A torch light examination and direct ophthalmoscopy established cause of visual impairment/blindness if present. Data were entered into and analysed using RAAB software. Results The response rate was 89.5% (3221/3600), and 55.3% were women. Results of only RAAB module are presented in this paper. Age-standardised and sex-standardised prevalence of blindness was 1.3% (95% CI 0.9 to 1.8). Cataract was the most common cause of blindness (45.7%) followed by overall posterior segment disorders (39.1%). Cataract surgical outcome was good (VA>6/18) or very good (VA>6/12) in 805/1190 (67.6%) cases. Cataract surgical coverage was 96.7%. ‘Need not felt’ (36.6%) and ‘cost’ (31.7%) were the most common barriers for cataract surgery. Conclusion Prevalence of blindness is showing declining trend in urban India. Cataract remains a major cause of blindness followed by posterior segment disorders. Social marketing, and referral linkages between community and service providers were planned after this survey.
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Affiliation(s)
- Sucheta Kulkarni
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Shridevi Kondalkar
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Islay Mactaggart
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - B R Shamanna
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Azher Lodhi
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Rohit Mendke
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Jitesh Kharat
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Rajesh Kapse
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Kuldeep Dole
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Madan Deshpande
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
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Rono H, Bastawrous A, Macleod D, Wanjala E, Gichuhi S, Burton M. Peek Community Eye Health - mHealth system to increase access and efficiency of eye health services in Trans Nzoia County, Kenya: study protocol for a cluster randomised controlled trial. Trials 2019; 20:502. [PMID: 31412937 PMCID: PMC6694474 DOI: 10.1186/s13063-019-3615-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/26/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Globally, eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services; in addition, specialist services are over-utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smartphone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteers (CV) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualising service delivery. We hypothesise that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. STUDY DESIGN A single masked, cluster randomised controlled trial design will be used. The unit of randomisation will be the 'community unit', defined as a dispensary or health centre with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitisation, where attendance will be ascertained. During triage, participants will be assessed and treated and, if necessary, referred onwards to Kitale Eye Unit. DISCUSSION We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. TRIAL REGISTRATION The Pan African Clinical Trials Registry (PACTR), 201807329096632 . Registered on 8 June 2018.
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Affiliation(s)
- Hillary Rono
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Kitale County referral and teaching Hospital, Ravine Road, P.O. Box 98, Kitale, 30200 Kenya
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- The Peek Vision Foundation, 1 Fore Street, London, EC2Y 9DT UK
| | - David Macleod
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Emmanuel Wanjala
- Kitale County referral and teaching Hospital, Ravine Road, P.O. Box 98, Kitale, 30200 Kenya
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, P.O. Box 19676, Nairobi, 00202 Kenya
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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15
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Bastawrous A, Mathenge W, Nkurikiye J, Wing K, Rono H, Gichangi M, Weiss HA, Macleod D, Foster A, Burton M, Kuper H. Incidence of Visually Impairing Cataracts Among Older Adults in Kenya. JAMA Netw Open 2019; 2:e196354. [PMID: 31251374 PMCID: PMC6604086 DOI: 10.1001/jamanetworkopen.2019.6354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/11/2019] [Indexed: 01/10/2023] Open
Abstract
Importance Half of all the cases of blindness worldwide are associated with cataract. Cataract disproportionately affects people living in low- and middle-income countries and persons of African descent. Objective To estimate the 6-year cumulative incidence of visually impairing cataract in adult participants in the Nakuru Eye Disease Cohort Study in Kenya. Design, Setting, and Participants This secondary analysis of the Nakuru Eye Disease Cohort Study was conducted from February 2016 to April 2016. This cohort comprised citizens of Nakuru, Kenya, aged 50 years or older who consented to participate in the initial or baseline survey from January 2007 to November 2008, as well as the follow-up conducted from January 2013 to March 2014. All participants at baseline (n = 4364) and follow-up (n = 2159) underwent ophthalmic examination. Main Outcomes and Measures Six-year cumulative incidence of visually impairing cataract, risk factors of incidence, population estimates, and required cataract surgical rates to manage incident visually impairing cataract. Results In total, 4364 individuals (with a mean [SD] age of 63.4 [10.5] years and with 2275 women [52.1%]) had complete eye examinations at baseline, and 2159 participants (with a mean [SD] age of 62.5 [9.3] years and with 1140 men [52.8%]) were followed up 6 years later. The 6-year cumulative incidence of visually significant cataract in either eye was 251.9 per 1000 (95% CI, 228.5-276.8), with an increase with age from 128.9 (95% CI, 107.9-153.2) per 1000 for the group aged 50 to 59 years to 624.5 (95% CI, 493.1-739.9) per 1000 for the group aged 80 years or older. This equated to an annual incidence of visually significant cataract of 45.0 per 1000 people aged 50 years or older. Multivariable analysis showed alcohol consumption (risk ratio [RR], 1.4; 95% CI, 1.1-1.8), diabetes (RR, 1.7; 95% CI, 1.3-2.3), educational level, and increasing age (RR, 3.8; 95% CI, 2.6-5.5 for those aged ≥80 years) were associated with incident visually impairing cataract. Extrapolations to all people aged 50 years or older in Kenya indicated that 148 280 (95% CI, 134 510-162 950) individuals might develop new visually impairing cataract in either eye (visual acuity <6/18 in the worse-seeing eye) and that 9540 (95% CI, 6610-13 750) might become cataract blind in both eyes (visual acuity <3/60 in better-seeing eye). Conclusions and Relevance Adults in Kenya appeared to have a high incidence of visually impairing cataract, making cataract a priority for blindness prevention programs in the region; surgical interventions and awareness of these services are also required.
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Affiliation(s)
- Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr Agarwal’s Eye Hospital, Kigali, Rwanda
| | - John Nkurikiye
- Rwanda International Institute of Ophthalmology and Dr Agarwal’s Eye Hospital, Kigali, Rwanda
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hillary Rono
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Kitale Eye Unit and Trans Nzoia County, Kitale, Kenya
- Ministry of Health, Nairobi, Kenya
| | - Michael Gichangi
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Allen Foster
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
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16
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Livelihood opportunities amongst adults with and without disabilities in Cameroon and India: A case control study. PLoS One 2018; 13:e0194105. [PMID: 29630606 PMCID: PMC5890974 DOI: 10.1371/journal.pone.0194105] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/23/2018] [Indexed: 11/19/2022] Open
Abstract
Proven links between disability and poverty suggest that development programmes and policies that are not disability-inclusive will leave persons with disabilities behind. Despite this, there is limited quantitative evidence on livelihood opportunities amongst adults with disabilities in Low and Middle Income Countries. This study adds to the limited evidence base, contributing data from one African and one Asian Setting. We undertook a population-based case–control study of adults (18+) with and without disabilities in North-West Cameroon and in Telangana State, India. We found that adults with disabilities were five times less likely to be working compared to age-sex matched controls in both settings. Amongst adults with disabilities, current age, marital status and disability type were key predictors of working. Inclusive programmes are therefore needed to provide adequate opportunities to participate in livelihood prospects for adults with disabilities in Cameroon and India, on an equal basis as others. These findings are of crucial importance at this stage of the Sustainable Development Agenda, to ensure that the mandate of inclusive development is achieved.
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Tataryn M, Polack S, Chokotho L, Mulwafu W, Kayange P, Banks LM, Noe C, Lavy C, Kuper H. Childhood disability in Malawi: a population based assessment using the key informant method. BMC Pediatr 2017; 17:198. [PMID: 29179740 PMCID: PMC5704595 DOI: 10.1186/s12887-017-0948-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Epidemiological data on childhood disability are lacking in Low and Middle Income countries (LMICs) such as Malawi, hampering effective service planning and advocacy. The Key Informant Method (KIM) is an innovative, cost-effective method for generating population data on the prevalence and causes of impairment in children. The aim of this study was to use the Key Informant Method to estimate the prevalence of moderate/severe, hearing, vision and physical impairments, intellectual impairments and epilepsy in children in two districts in Malawi and to estimate the associated need for rehabilitation and other services. Methods Five hundred key informants (KIs) were trained to identify children in their communities who may have the impairment types included in this study. Identified children were invited to attend a screening camp where they underwent assessment by medical professionals for moderate/severe hearing, vision and physical impairments, intellectual impairments and epilepsy. Results Approximately 15,000 children were identified by KIs as potentially having an impairment of whom 7220 (48%) attended a screening camp. The estimated prevalence of impairments/epilepsy was 17.3/1000 children (95% CI: 16.9–17.7). Physical impairment (39%) was the commonest impairment type followed by hearing impairment (27%), intellectual impairment (26%), epilepsy (22%) and vision impairment (4%). Approximately 2100 children per million population could benefit from physiotherapy and occupational therapy and 300 per million are in need of a wheelchair. An estimated 1800 children per million population have hearing impairment caused by conditions that could be prevented or treated through basic primary ear care. Corneal opacity was the leading cause of vision impairment. Only 50% of children with suspected epilepsy were receiving medication. The majority (73%) of children were attending school, but attendance varied by impairment type and was lowest among children with multiple impairments (38%). Conclusion Using the KIM this study identified more than 2500 children with impairments in two districts of Malawi. As well as providing data on child disability, rehabilitation and referral service needs which can be used to plan and advocate for appropriate services and interventions, this method study also has an important capacity building and disability awareness raising component.
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Affiliation(s)
- Myroslava Tataryn
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK.
| | | | - Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Petros Kayange
- Department of Surgery, Opthalmology Unit, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | | | - Chris Lavy
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
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Olokoba L, Mahmoud O, Adepoju F, Olokoba A, Durowade K. Evaluation of the Community Cataract Surgical Services of a University Teaching Hospital Using Cataract Surgical Coverage in Nigeria. Ethiop J Health Sci 2016; 26:109-16. [PMID: 27222623 PMCID: PMC4864339 DOI: 10.4314/ejhs.v26i2.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Cataract is the leading cause of blindness in the world. An efficient and effective cataract surgical service is necessary to reduce the backlog of cataract blindness in the community. This study aims to determine the cataract surgical coverage among individuals aged 50 years and above residing in Esie and Arandun communities. This will serve as a measure of the impact of the cataract intervention programme provided by the University of Ilorin Teaching Hospital, Nigeria. Methods The study was a population-based, cross sectional survey conducted from November to December, 2013. Cataract surgical services are provided by the University of Ilorin Teaching Hospital, Nigeria, at Esie and Arandun communities as out-reach centres. Seven hundred and fifty-five individuals aged 50 years and above residing in these communities had basic ocular examination done. Results Out of the 765 subjects registered, 755(98.7%) were examined. Out of these, 38.4% were males and 61.6% were females. The prevalence of bilateral cataract blindness was 1.6%. The Cataract Surgical Coverage (eyes) at visual acuity < 3/60 for males and females were 52.3% and 51.2% respectively (X2=19.30, p=0.001), while the Cataract Surgical Coverage (person) at visual acuity less < 3/60 for males and females were 80.6% and 68.4% respectively (X2=2.10, p=0.147). Conclusion The Cataract Surgical Coverage was high with a correspondingly low prevalence of cataract blindness in these communities. The availability of cataract surgical services via out-reach programmes bridges the gap between eye care-givers and the community.
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Affiliation(s)
- L Olokoba
- Department of Ophthalmology, General Hospital, Ilorin, Nigeria
| | - O Mahmoud
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - F Adepoju
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A Olokoba
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - K Durowade
- Department of Epidemology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Muhit M, Wadud Z, Islam J, Khair Z, Shamanna BR, Jung J, Khandaker G. Generating Evidence for Program Planning: Rapid Assessment of Avoidable Blindness in Bangladesh. Ophthalmic Epidemiol 2016; 23:176-84. [DOI: 10.3109/09286586.2016.1155716] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Mohammad Muhit
- Child Sight Foundation (CSF), Dhaka, Bangladesh
- Faculty of Public Health and Life Sciences, University of South Asia, Dhaka, Bangladesh
| | - Zakia Wadud
- Child Sight Foundation (CSF), Dhaka, Bangladesh
| | | | | | - BR Shamanna
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Jenny Jung
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Gulam Khandaker
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia
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The Correlation of Age and Postoperative Visual Acuity for Age-Related Cataract. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7147543. [PMID: 26881225 PMCID: PMC4736385 DOI: 10.1155/2016/7147543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/22/2015] [Accepted: 12/10/2015] [Indexed: 11/28/2022]
Abstract
Purpose. Clinically, what is the best time for age-related cataract (ARC) patients to receive surgeries and get the most benefits is important. We explored the relationship between age and presenting postoperative visual acuity (POVA) in patients from rural China. Methods. Three Lifeline Express Hospital Eye-Train missions of Peking University People's Hospital were chosen. At the first day after surgery, 3452 ARC eyes with the presenting POVA ≥ 6/60 were enrolled. The relationship between age and POVA was analyzed statistically. Results. In these three missions, there were more female patients than males; the ratio of females to males was 1.71. The average age of females was older than males. Overall, the percentages of patients with good visual outcomes (≥6/18) were significantly decreased with aging. Different regions had variations, but the trends were the same. There was weak linear correlation between age and POVA. The correlations of females were stronger than males in Yuncheng and Sanmenxia and weaker than males in Zhoukou. Conclusion. The good visual outcomes of presenting POVA were significantly decreased with aging and there were weak linear correlations between age and POVA in rural China. The linear correlation might be influenced by the difference of gender and region.
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Mohammadi SF, Hashemi H, Mazouri A, Rahman-A N, Ashrafi E, Mehrjardi HZ, Roohipour R, Fotouhi A. Outcomes of Cataract Surgery at a Referral Center. J Ophthalmic Vis Res 2016; 10:250-6. [PMID: 26730309 PMCID: PMC4687257 DOI: 10.4103/2008-322x.170358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To report the outcomes of cataract surgery at a large referral eye hospital and to identify factors associated with less than excellent visual outcomes. Methods: Hospital records of patients, who had undergone age-related cataract extraction (1,285 procedures) within a two-year period were sampled randomly for 353 patients (405 eyes) and baseline characteristics were recorded. Up to three causes of visual loss (contributory reasons) were considered and the principal cause of “less than excellent outcome,” i.e., best spectacle corrected visual acuity (BSCVA) <20/25 was defined as the primary reason. Results: Mean age of the participants was 68.6 years, and 50.7% of enrolled subjects were female. Phacoemulsification had been performed in 92.1% of cases. Out of 405 eyes, 54%, 78%, and 97% achieved BSCVA of ≥20/25, ≥20/40, and ≥20/200, respectively. Poor visual outcomes were significantly associated with older age (OR: 4.55 for age >70 years), female gender (OR: 4.64), ocular comorbidities (OR: 7.68), surgically challenging eyes (OR: 7.33), long and short eyes (versus eyes with normal axial length, OR: 3.24), and being operated on by a novice surgeon (OR: 2.41). The leading contributory reasons for unfavorable outcome, in descending order were maculopathy (17%), posterior capsule opacification (PCO, 11.8%), corneal opacity (5.7%), and degenerative myopia (5.4%). Conclusion: Maculopathy, PCO, corneal opacity, degenerative myopia and ARMD may contribute to unfavorable outcomes in cataract surgery.
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Affiliation(s)
- Seyed-Farzad Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Arash Mazouri
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Rahman-A
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ashrafi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Z Mehrjardi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramak Roohipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Lucas RM, Norval M, Wright CY. Solar ultraviolet radiation in Africa: a systematic review and critical evaluation of the health risks and use of photoprotection. Photochem Photobiol Sci 2016; 15:10-23. [DOI: 10.1039/c5pp00419e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The majority of the African continent experiences high solar UVB radiation throughout the year. The adverse consequences of this on the health of populations living in Africa are reviewed.
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Affiliation(s)
- Robyn M. Lucas
- National Centre for Epidemiology and Population Health
- The Australia National University
- Canberra
- Australia
| | - Mary Norval
- Biomedical Sciences
- University of Edinburgh
- Edinburgh
- UK
| | - Caradee Y. Wright
- South African Medical Research Council and University of Pretoria
- Pretoria
- South Africa
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Abstract
Cataract remains the leading cause of blindness in Africa. We performed a systematic literature search of articles reporting barriers to cataract surgery in Africa. PubMed and Google Scholar databases were searched with the terms "barriers, cataract, Africa, cataract surgery, cataract surgical coverage (CSC), and rapid assessment of avoidable blindness (RAAB)." The review covered from 1999 to 2014. In RAAB studies, barriers related to awareness and access were more commonly reported than acceptance. Other type of studies reported cost as the most common barrier. Some qualitative studies tended to report community and family dynamics as barriers to cataract surgery. CSC was lower in females in 88.2% of the studies. The variability in outcomes of studies of barriers to cataract surgery could be due to context and the type of data collection. It is likely that qualitative data will provide a deeper understanding of the complex social, family, community, financial and gender issues relating to barriers to uptake of cataract surgery in Africa.
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Affiliation(s)
- Shaheer Aboobaker
- Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Paul Courtright
- Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, South Africa
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, South Africa
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Mactaggart I, Kuper H, Murthy GVS, Sagar J, Oye J, Polack S. Assessing health and rehabilitation needs of people with disabilities in Cameroon and India. Disabil Rehabil 2015; 38:1757-64. [PMID: 26680511 DOI: 10.3109/09638288.2015.1107765] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess the association between disability and serious health problems, and the access and uptake of health and rehabilitation services in Cameroon and India. METHODS We undertook a population-based case-control study, nested within a survey in Fundong Health District, North West Cameroon (August-October 2013) and in Mahbubnagar District, Telangana State, India (February-April 2014). Disability was defined as the presence of self-reported difficulties in functioning or clinical impairments. One control without disability was selected per case, matched by age, gender and cluster. Information was collected using structured questionnaires on: socioeconomic status, health, access to health services and rehabilitation. RESULTS Cases with disability were significantly more likely to report a serious health problem in the last year compared to controls in both India (OR = 3.2, 95% CI 2.1-4.8) and Cameroon (OR = 1.9, 1.4-2.7). The vast majority of people sought care when seriously ill, and this did not vary between cases and controls. Awareness and use of rehabilitation services was extremely low in both Cameroon and India. CONCLUSIONS Further focus is needed to improve awareness of rehabilitation services among people with disabilities in India and Cameroon to ensure that their rights are fulfilled and to achieve the goal of Universal Health Coverage. Implications for Rehabilitation People with and without disabilities equally seek health care in India and Cameroon. However, people with disabilities experience more frequent serious health problems than people without. Extremely few people with disabilities were aware of rehabilitation services despite their existence in the study settings.
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Affiliation(s)
- Islay Mactaggart
- a International Centre for Evidence in Disability , London School of Hygiene & Tropical Medicine , London , UK
| | - Hannah Kuper
- a International Centre for Evidence in Disability , London School of Hygiene & Tropical Medicine , London , UK
| | - G V S Murthy
- b Indian Institute of Public Health , Hyderabad , India
| | | | - Joseph Oye
- c Sightsavers International , Yaounde , Cameroon
| | - Sarah Polack
- a International Centre for Evidence in Disability , London School of Hygiene & Tropical Medicine , London , UK
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Patil S, Gogate P, Vora S, Ainapure S, Hingane RN, Kulkarni AN, Shammanna BR. Prevalence, causes of blindness, visual impairment and cataract surgical services in Sindhudurg district on the western coastal strip of India. Indian J Ophthalmol 2015; 62:240-5. [PMID: 24618491 PMCID: PMC4005244 DOI: 10.4103/0301-4738.128633] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Konkan coast of India is geographically distinct and its pattern of blindness has never been mapped. Aim: To study the prevalence and causes of blindness and cataract surgical services in Sindhudurg district of West Coast. Subjects: Individual aged > 50 years. Materials and Methods: Rapid assessment of avoidable blindness used to map blindness pattern in the district. Statistical analysis: SPSS version 19. Results: Amongst those examined 1415 (51.7%) had visual acuity (VA) >20/60, 924 (33.8%, confidence interval (C.I) 30.5%-36.8%) had VA 20/200-<20/60(visual impairment), 266 (9.7%, C.I. 6.1%-13.3%) had VA < 20/200-20/400 (severe visual impairment) and 132 (4.8%, C. I. 1.1%-8.5%) had VA < 20/400 (blindness by WHO standards). There was no significant gender difference in prevalence of blindness, but blindness and visual impairment was more in older and rural residing individuals. Amongst those with presenting vision < 20/200 in better eye, 309 (82.4%) had cataract, 36 (9.7%) had corneal scars, 13 (3.5%) had diabetic retinopathyand 3 (0.8%) had glaucoma. Cataract surgical coverage for the district was only 30.5%; 32% for males and 28.4% for females. Unable to afford, lack of knowledge and lack of access to services were the commonest barriers responsible for cataract patients not seeking care. Amongst those who had undergone cataract surgery, only 50% had visual acuity ≥ 20/60.46.9% of the population had spectacles for near, but only 53.3% of the population had presenting near vision < N10. Conclusion: Cataract, refractive errors and diabetes were significant causes of visual impairment and blindness.
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Affiliation(s)
| | - Parikshit Gogate
- Lions NAB Eye Hospital, Miraj; Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
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Ahmad K, Zwi AB, Tarantola DJM, Azam SI. Eye Care Service Use and Its Determinants in Marginalized Communities in Pakistan: The Karachi Marine Fishing Communities Eye and General Health Survey. Ophthalmic Epidemiol 2015; 22:370-9. [PMID: 25835643 DOI: 10.3109/09286586.2015.1012592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine gender, ethnic, and socioeconomic differences in access to eye care services in marine fishing communities in Karachi, Pakistan. METHODS The Karachi Marine Fishing Communities Eye and General Health Survey was a door-to-door, cross-sectional survey conducted between March 2009 and April 2010 in fishing communities in Keamari, Karachi, located on the coast of the Arabian Sea. Adults aged ≥50 years living on three islands and in four coastal areas were enrolled. Participants underwent a detailed interview regarding sociodemographics, eye problems and eye care service use, testing of presenting and best-corrected visual acuity with a reduced logMAR chart, and detailed eye examination. RESULTS A total of 700 people were planned to be included in the study; 638 (91.1%) were interviewed and examined. Most participants were extremely poor and had no formal education. Only 45.3% (95% confidence interval, CI, 41.4-49.2%) of participants reported having had an eye examination in the past; 12.1% (95% CI 9.5-14.6%) and 30.9% (95% CI 27.3-34.5%) had seen an eye doctor within the last year or prior 5 years, respectively. In the multivariable analysis, ethnicity was the strongest independent predictor of eye care service use, followed by self-reported eye problems and diabetes. Ethnic Bengalis were 4.2 times less likely (adjusted odds ratio 0.24, 95% CI 0.15-0.38; p < 0.001) to have had an eye examination in the past than Kutchis. CONCLUSIONS Despite a high prevalence of visual impairment and blindness, levels of eye care examinations in fishing communities, especially among ethnic Bengalis, are disappointingly low. Such communities deserve particular attention in Vision 2020 and other national and international strategies and plans.
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Affiliation(s)
- Khabir Ahmad
- a School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales , Sydney , New South Wales , Australia .,b Section of Ophthalmology and Office of Surgical Research, Department of Surgery, Aga Khan University , Karachi , Pakistan
| | - Anthony B Zwi
- a School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales , Sydney , New South Wales , Australia
| | - Daniel J M Tarantola
- c School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales , Sydney , New South Wales , Australia , and
| | - Syed Iqbal Azam
- d Department of Community Health Sciences , Aga Khan University , Karachi , Pakistan
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Isipradit S, Sirimaharaj M, Charukamnoetkanok P, Thonginnetra O, Wongsawad W, Sathornsumetee B, Somboonthanakij S, Soomsawasdi P, Jitawatanarat U, Taweebanjongsin W, Arayangkoon E, Arame P, Kobkoonthon C, Pangputhipong P. The first rapid assessment of avoidable blindness (RAAB) in Thailand. PLoS One 2014; 9:e114245. [PMID: 25502762 PMCID: PMC4263597 DOI: 10.1371/journal.pone.0114245] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/05/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The majority of vision loss is preventable or treatable. Population surveys are crucial for planning, implementation, and monitoring policies and interventions to eliminate avoidable blindness and visual impairments. This is the first rapid assessment of avoidable blindness (RAAB) study in Thailand. METHODS A cross-sectional study of a population in Thailand age 50 years old or over aimed to assess the prevalence and causes of blindness and visual impairments. Using the Thailand National Census 2010 as the sampling frame, a stratified four-stage cluster sampling based on a probability proportional to size was conducted in 176 enumeration areas from 11 provinces. Participants received comprehensive eye examination by ophthalmologists. RESULTS The age and sex adjusted prevalence of blindness (presenting visual acuity (VA) <20/400), severe visual impairment (VA <20/200 but ≥20/400), and moderate visual impairment (VA <20/70 but ≥20/200) were 0.6% (95% CI: 0.5-0.8), 1.3% (95% CI: 1.0-1.6), 12.6% (95% CI: 10.8-14.5). There was no significant difference among the four regions of Thailand. Cataract was the main cause of vision loss accounted for 69.7% of blindness. Cataract surgical coverage in persons was 95.1% for cut off VA of 20/400. Refractive errors, diabetic retinopathy, glaucoma, and corneal opacities were responsible for 6.0%, 5.1%, 4.0%, and 2.0% of blindness respectively. CONCLUSION Thailand is on track to achieve the goal of VISION 2020. However, there is still much room for improvement. Policy refinements and innovative interventions are recommended to alleviate blindness and visual impairments especially regarding the backlog of blinding cataract, management of non-communicative, chronic, age-related eye diseases such as glaucoma, age-related macular degeneration, and diabetic retinopathy, prevention of childhood blindness, and establishment of a robust eye health information system.
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Affiliation(s)
- Saichin Isipradit
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Maytinee Sirimaharaj
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Puwat Charukamnoetkanok
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Oraorn Thonginnetra
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Warapat Wongsawad
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Busaba Sathornsumetee
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | | | - Piriya Soomsawasdi
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Umapond Jitawatanarat
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Wongsiri Taweebanjongsin
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Eakkachai Arayangkoon
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Punyawee Arame
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Chinsuchee Kobkoonthon
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
| | - Pannet Pangputhipong
- Mettapracharak (Wat Rai Khing) Hospital, 52 Moo 2 Rai Khing, Sampran, Nakornprathom 73210, Thailand
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Essue BM, Li Q, Hackett ML, Keay L, Iezzi B, Tran KD, Tan Phuc H, Jan S. A Multicenter Prospective Cohort Study of Quality of Life and Economic Outcomes after Cataract Surgery in Vietnam. Ophthalmology 2014; 121:2138-46. [DOI: 10.1016/j.ophtha.2014.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/24/2014] [Accepted: 05/15/2014] [Indexed: 11/26/2022] Open
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Schaftenaar E, van Gorp ECM, Meenken C, Osterhaus ADME, Remeijer L, Struthers HE, McIntyre JA, Baarsma GS, Verjans GMGM, Peters RPH. Ocular infections in sub-Saharan Africa in the context of high HIV prevalence. Trop Med Int Health 2014; 19:1003-14. [PMID: 25039335 DOI: 10.1111/tmi.12350] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Healthy eyes and good vision are important determinants of populations' health across the globe. Sub-Saharan Africa is affected by simultaneous epidemics of ocular infections and human immunodeficiency virus (HIV). Ocular infection and its complications, along with cataract and ocular trauma, are common conditions in this region with great impact on daily life. In this review, we discuss the epidemiology, clinical manifestations and microbial aetiology of the most important infectious ocular conditions in sub-Saharan Africa: conjunctivitis, keratitis and uveitis. We focus specifically on the potential association of these infections with HIV infection, including immune recovery uveitis. Finally, challenges and opportunities for clinical management are discussed, and recommendations made to improve care in this neglected but very important clinical field.
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Affiliation(s)
- Erik Schaftenaar
- Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands; Anova Health Institute, Johannesburg, Tzaneen, South Africa; Rotterdam Eye Hospital, Rotterdam, The Netherlands
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Randrianaivo JB, Anholt RM, Tendrisoa DL, Margiano NJ, Courtright P, Lewallen S. Blindness and cataract surgical services in Atsinanana region, Madagascar. Middle East Afr J Ophthalmol 2014; 21:153-7. [PMID: 24791107 PMCID: PMC4005180 DOI: 10.4103/0974-9233.129767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To assess the prevalence and causes of avoidable blindness in Atsinanana Region, Madagascar, with the Rapid Assessment of Avoidable Blindness (RAAB) survey. We analyzed the hospital records to supplement the findings for public health care planning. Materials and Methods: Only villages within a two-hour walk from a road, about half of the population of Atsinanana was included. Seventy-two villages were selected by population-proportional-to-size sampling. In each village, compact segment sampling was used to select 50 people over age 50 for eye examination using standard RAAB methods. Records at the two hospitals providing cataract surgery in the region were analyzed for information on patients who underwent cataract surgery in 2010. Cataract incidence rate and target cataract surgery rate (CSR) was modeled from age-specific prevalence of cataract. Results: The participation rate was 87% and the sample prevalence of blindness was 1.96%. Cataract was responsible for 64% and 85.7% of blindness and severe visual impairment, respectively. Visual impairment was due to cataract (69.4%) and refractive error (14.1%). There was a strong positive correlation between cataract surgical rate by district and the proportion of people living within 2 hours of a road. There were marked differences in the profiles of the cataract patients at the two facilities. The estimated incidence of cataract at the 6/18 level was 2.4 eyes per 100 people over age 50 per year. Conclusions: Although the survey included only people with reasonable access, the main cause of visual impairment was still cataract. The incidence of cataract is such that it ought to be possible to eliminate it as a cause of visual impairment, but changes in service delivery at hospitals and strategies to improve access will be necessary for this change.
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Affiliation(s)
| | - R Michele Anholt
- Department of Ecosystem and Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology Tanzania, Moshi, Tanzania ; Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa
| | - Susan Lewallen
- Kilimanjaro Centre for Community Ophthalmology Tanzania, Moshi, Tanzania ; Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa
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Bastawrous A, Mathenge W, Peto T, Weiss HA, Rono H, Foster A, Burton M, Kuper H. The Nakuru eye disease cohort study: methodology & rationale. BMC Ophthalmol 2014; 14:60. [PMID: 24886366 PMCID: PMC4024270 DOI: 10.1186/1471-2415-14-60] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/03/2014] [Indexed: 11/22/2022] Open
Abstract
Background No longitudinal data from population-based studies of eye disease in sub-Saharan-Africa are available. A population-based survey was undertaken in 2007/08 to estimate the prevalence and determinants of blindness and low vision in Nakuru district, Kenya. This survey formed the baseline to a six-year prospective cohort study to estimate the incidence and progression of eye disease in this population. Methods/Design A nationally representative sample of persons aged 50 years and above were selected between January 2007 and November 2008 through probability proportionate to size sampling of clusters, with sampling of individuals within clusters through compact segment sampling. Selected participants underwent detailed ophthalmic examinations which included: visual acuity, autorefraction, visual fields, slit lamp assessment of the anterior and posterior segments, lens grading and fundus photography. In addition, anthropometric measures were taken and risk factors were assessed through structured interviews. Six years later (2013/2014) all subjects were invited for follow-up assessment, repeating the baseline examination methodology. Discussion The methodology will provide estimates of the progression of eye diseases and incidence of blindness, visual impairment, and eye diseases in an adult Kenyan population.
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Affiliation(s)
- Andrew Bastawrous
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, UK.
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Danquah L, Kuper H, Eusebio C, Rashid MA, Bowen L, Foster A, Polack S. The long term impact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines. PLoS One 2014; 9:e94140. [PMID: 24747192 PMCID: PMC3991652 DOI: 10.1371/journal.pone.0094140] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/13/2014] [Indexed: 11/18/2022] Open
Abstract
Background Cataract surgery has been shown to improve quality of life and household economy in the short term. However, it is unclear whether these benefits are sustained over time. This study aims to assess the six year impact of cataract surgery on health related quality of life (HRQoL), daily activities and economic poverty in Bangladesh and The Philippines. Methods and Findings This was a longitudinal study. At baseline people aged ≥50 years with visual impairment due to cataract (‘cases’) and age-, sex-matched controls without visual impairment were interviewed about vision specific and generic HRQoL, daily activities and economic indicators (household per capita expenditure, assets and self-rated wealth). Cases were offered free or subsidised cataract surgery. Cases and controls were re-interviewed approximately one and six years later. At baseline across the two countries there were 455 cases and 443 controls. Fifty percent of cases attended for surgery. Response rates at six years were 47% for operated cases and 53% for controls. At baseline cases had poorer health and vision related QoL, were less likely to undertake productive activities, more likely to receive assistance with activities and were poorer compared to controls (p<0.05). One year after surgery there were significant increases in HRQoL, participation and time spent in productive activities and per capita expenditure and reduction in assistance with activities so that the operated cases were similar to controls. These increases were still evident after six years with the exception that time spent on productive activities decreased among both cases and controls. Conclusion Cataract causing visual loss is associated with reduced HRQoL and economic poverty among older adults in low-income countries. Cataract surgery improves the HRQoL of the individual and economy of the household. The findings of this study suggest these benefits are sustained in the long term.
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Affiliation(s)
- Lisa Danquah
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Liza Bowen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Allen Foster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Bastawrous A, Burgess PI, Mahdi AM, Kyari F, Burton MJ, Kuper H. Posterior segment eye disease in sub-Saharan Africa: review of recent population-based studies. Trop Med Int Health 2014; 19:600-9. [PMID: 24479434 PMCID: PMC4065367 DOI: 10.1111/tmi.12276] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective To assess the burden of posterior segment eye diseases (PSEDs) in sub-Saharan Africa (SSA). Methods We reviewed published population-based data from SSA and other relevant populations on the leading PSED, specifically glaucoma, diabetic retinopathy and age-related macular degeneration, as causes of blindness and visual impairment in adults. Data were extracted from population-based studies conducted in SSA and elsewhere where relevant. Results PSEDs, when grouped or as individual diseases, are a major contributor to blindness and visual impairment in SSA. PSED, grouped together, was usually the second leading cause of blindness after cataract, ranging as a proportion of blindness from 13 to 37%. Conclusions PSEDs are likely to grow in importance as causes of visual impairment and blindness in SSA in the coming years as populations grow, age and become more urban in lifestyle. African-based cohort studies are required to help estimate present and future needs and plan services to prevent avoidable blindness.
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Affiliation(s)
- Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Lewallen S, Courtright P, Etya'ale D, Mathenge W, Schmidt E, Oye J, Clark A, Williams T. Cataract incidence in sub-Saharan Africa: what does mathematical modeling tell us about geographic variations and surgical needs? Ophthalmic Epidemiol 2014; 20:260-6. [PMID: 24070099 DOI: 10.3109/09286586.2013.823215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To apply a previously described mathematical model, designed to estimate cataract incidence from age-specific prevalence, to Rapid Assess of Avoidable Blindness survey data from Sub-Saharan Africa in order to estimate the incidence of cataract and therefore surgical needs. METHODS All Rapid Assessment of Avoidable Blindness surveys from Sub-Saharan Africa were identified. A previously developed mathematical model, designed to estimate the incidence of operable cataract was applied to those (27/32) meeting the inclusion criteria. RESULTS Incidence varied significantly across the continent with the result that cataract surgery rate targets required to eliminate cataract vary too. When variation in age structure is also taken into account, the cataract surgery rate needed to eliminate cataract visual impairment at the level of 6/18 ranges from 1200-4500 surgeries per year per million population. CONCLUSIONS This is important evidence of significant variation in the incidence of cataract within Sub-Saharan Africa. The variation may be related to genetic or cultural variations on the continent and has important implications for planning services.
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Affiliation(s)
- Susan Lewallen
- Kilimanjaro Centre for Community Ophthalmology International, Groote Schuur Hospital , Observatory , South Africa
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Prevalence of Blindness and Outcomes of Cataract Surgery in Hainan Province in South China. Ophthalmology 2013; 120:2176-83. [DOI: 10.1016/j.ophtha.2013.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 11/20/2022] Open
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Kalua K, Lewallen S, Courtright P. Update on cataract and its management in Africa. EXPERT REVIEW OF OPHTHALMOLOGY 2013. [DOI: 10.1586/eop.13.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bastawrous A, Dean WH, Sherwin JC. Blindness and visual impairment due to age-related cataract in sub-Saharan Africa: a systematic review of recent population-based studies. Br J Ophthalmol 2013; 97:1237-43. [PMID: 23696652 DOI: 10.1136/bjophthalmol-2013-303135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM We aimed to evaluate age-related cataract as a contributor to blindness and visual impairment (VI) in sub-Saharan Africa (SSA). METHODS A systematic review of population-based studies published between 2000 and October 2012. Prevalence and proportions of blindness and VI due to cataract, cataract surgical coverage (CSC), per cent intraocular lens (IOL) implantation and visual outcomes of surgery in accordance with WHO criteria were ascertained. RESULTS Data from 17 surveys (subjects mostly aged ≥ 50-years-old) from 15 different countries in SSA were included, comprising 96 402 people. Prevalence of blindness (presenting visual acuity <3/60 in better eye) ranged from 0.1% in Uganda to 9.0% in Eritrea, and the proportion of total blindness due to cataract ranged between 21% and 67%. Cataract was the principal cause of blindness and VI in 15 and 14 studies, respectively. There was a strong positive correlation between good visual outcomes and IOL use (R=0.69, p=0.027). Considerable inter-study heterogeneity was evident in CSC and visual outcomes following surgery, and between 40% and 100% of operations had used IOL. CONCLUSIONS Cataract represents the principal cause of blindness and VI and should remain a priority objective for eye care in SSA. However, the prevalence of blindness and VI due to cataract was variable and may reflect differences in the availability of cataract surgical programmes and cataract incidence.
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Affiliation(s)
- Andrew Bastawrous
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, , London, UK
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Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal H. Epidemiology of glaucoma in sub-saharan Africa: prevalence, incidence and risk factors. Middle East Afr J Ophthalmol 2013; 20:111-25. [PMID: 23741130 PMCID: PMC3669488 DOI: 10.4103/0974-9233.110605] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of this study is to review the epidemiology of different types of glaucoma relevant to Sub-Saharan Africa (SSA) and to discuss the evidence regarding the risk factors for onset and progression of glaucoma, including risk factors for glaucoma blindness. METHODS Electronic databases (PubMed, MedLine, African Journals Online- AJOL) were searched using the full text, Medical Subject Headings (MeSH) terms, author(s) and title to identify publications since 1982 in the following areas: population-based glaucoma prevalence and incidence studies in SSA and in African-derived black populations outside Africa; population-based prevalence and incidence of blindness and visual impairment studies in SSA including rapid assessment methods, which elucidate the glaucoma-specific blindness prevalence; studies of risk factors for glaucoma; and publications that discussed public health approaches for the control of glaucoma in Africa. RESULTS Studies highlighted that glaucoma in SSA is a public health problem and predominantly open-angle glaucoma. It is the second-leading cause of blindness, has a high prevalence, an early onset and progresses more rapidly than in Caucasians. These factors are further compounded by poor awareness and low knowledge about glaucoma even by persons affected by the condition. CONCLUSION Glaucoma care needs to be given high priority in Vision 2020 programs in Africa. Many questions remain unanswered and there is a need for further research in glaucoma in SSA in all aspects especially epidemiology and clinical care and outcomes involving randomized controlled trials. Genetic and genome-wide association studies may aid identification of high-risk groups. Social sciences and qualitative studies, health economics and health systems research will also enhance public health approaches for the prevention of blindness due to glaucoma.
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Affiliation(s)
- Fatima Kyari
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mohammed M. Abdull
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Andrew Bastawrous
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare E. Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah Faal
- Africa Vision Research Institute, Durban, South Africa
- Calabar Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Nigeria
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Guruprasad BS, Krishnamurthy D, Narendra DP, Ranganath BG, Shamanna RB. Changing Scenario of Cataract Blindness in Kolar District, Karnataka, South India. The Utility of Rapid Assessment of Avoidable Blindness in Reviewing Programs. Ophthalmic Epidemiol 2013; 20:89-95. [DOI: 10.3109/09286586.2012.759597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Signes-Soler I, Piñero DP, Javaloy J. Prevalence of visual problems in a rural population of Kenya. Acta Ophthalmol 2013; 91:e165-6. [PMID: 22974434 DOI: 10.1111/j.1755-3768.2012.02507.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prevalence and predictors of refractive error and spectacle coverage in Nakuru, Kenya: a cross-sectional, population-based study. Int Ophthalmol 2013; 33:541-8. [DOI: 10.1007/s10792-013-9742-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/06/2013] [Indexed: 11/30/2022]
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Murthy GVS, John N, Shamanna BR, Pant HB. Elimination of avoidable blindness due to cataract: where do we prioritize and how should we monitor this decade? Indian J Ophthalmol 2013; 60:438-45. [PMID: 22944756 PMCID: PMC3491272 DOI: 10.4103/0301-4738.100545] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: In the final push toward the elimination of avoidable blindness, cataract occupies a position of eminence for the success of the Right to Sight initiative. Aims: Review existing situation and assess what monitoring indicators may be useful to chart progress towards attaining the goals of Vision 2020. Settings and Design: Review of published papers from low and middle income countries since 2000. Materials and Methods: Published population-based data on prevalence of cataract blindness/visual impairment were accessed and prevalence of cataract blindness/visual impairment computed, where not reported. Data on prevalence of cataract blindness, cataract surgical coverage at different visual acuity cut offs, surgical outcomes, and prevalence of cataract surgery were analyzed. Scatter plots were used to look at relationships of some variables, with Human Development Index (HDI) rank. Available data on Cataract Surgical Rate (CSR) was plotted against prevalence of cataract surgery reported from surveys. Results: Worse HDI Ranks were associated with higher prevalence of cataract blindness. Most studies showed that a significant proportion of the blind were covered by surgery, while a fifth showed that a significant proportion, were operated before they went blind. A good visual outcome after surgery was positively correlated with higher surgical coverage. CSR was positively correlated with cataract surgical coverage. Conclusions: Cataract surgical coverage is increasing in most countries at vision <3/60 and visual outcomes after cataract surgery are improving. Establishing population-based surveillance of cataract surgical need and performance is a strong monitoring tool and will help program planners immensely.
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Affiliation(s)
- Gudlavalleti V S Murthy
- Indian Institute of Public Health and South Asia Centre for Disability Inclusive Development and Research, Hyderabad, India
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Odugbo OP, Mpyet CD, Chiroma MR, Aboje AO. Cataract blindness, surgical coverage, outcome, and barriers to uptake of cataract services in Plateau State, Nigeria. Middle East Afr J Ophthalmol 2013; 19:282-8. [PMID: 22837620 PMCID: PMC3401796 DOI: 10.4103/0974-9233.97925] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
PURPOSE The purpose was to estimate the prevalence of blindness due to cataract, assess visual outcomes of cataract surgery, and determine the cataract surgical coverage rate and barriers to uptake of services among individuals aged 50 years or older in Plateau State, Nigeria. MATERIALS AND METHODS A population-based, cross-sectional survey of 4200 adults 50 years or older was performed. Multistage stratified random sampling, with probability proportional to size was used to select a representative sample. The Rapid Assessment of Cataract Surgical Services protocol was used. Statistical significance was indicated by (P < 0.05). RESULTS The cohort comprised 4115 subjects (coverage: 98%). The prevalence of bilateral blindness due to cataract was 2.1%, [95% confidence intervals (CI): 1.7-2.5%] in the entire cohort, 2.4% in females (95% CI: 1.8-3.8%); and 1.8% in males (95% CI: 1.2-2.4%) (χ(2) = 0.85, P > 0.05). The prevalence of monocular blindness due to cataract was 5.9% (95% CI: 5.2-6.6%). The cataract surgical coverage for subjects with visual acuity (VA) less 3/60 was 53.8% in the entire cohort; 60.5% for males and 48% for females (χ(2) = 2.49, P > 0.05). The couching coverage for subjects who were blind was 12%. A total of 180 eyes underwent surgical intervention (surgery or couching) for cataract, of which, 48 (26.7%) eyes underwent couching. The prevalence of bilateral (pseudo) aphakia was 1.5%, (95% CI: 1.2-1.9%) and 2.7% (95% CI: 2.2-3.2%) for unilateral (pseudo) aphakia. Visual outcomes of the 180 eyes that underwent surgical intervention were good (VA ≥ 6/18) in 46 (25.6%) eyes and poor (VA < 6/60) in 105 (58.3%) eyes. Uncorrected aphakia was the most common cause of poor outcome (65.1%). Most subjects who underwent cataract surgery were not using spectacles 74 (71.2%). Cost and lack of awareness were the main barriers to uptake of cataract surgery services. CONCLUSION Couching remains a significant challenge in Nigeria. The outcomes of cataract surgery are poor with the lack of aphakic correction being the main cause of the poor outcomes.
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Affiliation(s)
- Ojo P Odugbo
- Department of Ophthalmology, University of Jos, Jos, Nigeria
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Lindfield R, Vishwanath K, Ngounou F, Khanna RC. The challenges in improving outcome of cataract surgery in low and middle income countries. Indian J Ophthalmol 2013; 60:464-9. [PMID: 22944761 PMCID: PMC3491277 DOI: 10.4103/0301-4738.100552] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cataract is the leading cause of blindness globally and surgery is the only known measure to deal with it effectively. Providing high quality cataract surgical services is critical if patients with cataract are to have their sight restored. A key focus of surgery is the outcome of the procedure. In cataract surgery this is measured predominantly, using visual acuity. Population- and hospital-based studies have revealed that the visual outcome of cataract surgery in many low and middle income settings is frequently sub-optimal, often failing to reach the recommended standards set by the World Health Organization (WHO). Another way of measuring outcome of cataract surgery is to ask patients for their views on whether surgery has changed the functioning of their eyes and their quality of life. There are different tools available to capture patient views and now, these patient-reported outcomes are becoming more widely used. This paper discusses the visual outcome of cataract surgery and frames the outcome of surgery within the context of the surgical service, suggesting that the process and outcome of care cannot be separated. It also discusses the components of patient-reported outcome tools and describes some available tools in more detail. Finally, it describes a hierarchy of challenges that need to be addressed before a high quality cataract surgical service can be achieved.
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Affiliation(s)
- Robert Lindfield
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Syed A, Polack S, Eusebio C, Mathenge W, Wadud Z, Mamunur AKM, Foster A, Kuper H. Predictors of attendance and barriers to cataract surgery in Kenya, Bangladesh and the Philippines. Disabil Rehabil 2013; 35:1660-7. [DOI: 10.3109/09638288.2012.748843] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mathenge W, Bastawrous A, Peto T, Leung I, Foster A, Kuper H. Prevalence of age-related macular degeneration in Nakuru, Kenya: a cross-sectional population-based study. PLoS Med 2013; 10:e1001393. [PMID: 23431274 PMCID: PMC3576379 DOI: 10.1371/journal.pmed.1001393] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 01/09/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Diseases of the posterior segment of the eye, including age-related macular degeneration (AMD), have recently been recognised as the leading or second leading cause of blindness in several African countries. However, prevalence of AMD alone has not been assessed. We hypothesized that AMD is an important cause of visual impairment among elderly people in Nakuru, Kenya, and therefore sought to assess the prevalence and predictors of AMD in a diverse adult Kenyan population. METHODS AND FINDINGS In a population-based cross-sectional survey in the Nakuru District of Kenya, 100 clusters of 50 people 50 y of age or older were selected by probability-proportional-to-size sampling between 26 January 2007 and 11 November 2008. Households within clusters were selected through compact segment sampling. All participants underwent a standardised interview and comprehensive eye examination, including dilated slit lamp examination by an ophthalmologist and digital retinal photography. Images were graded for the presence and severity of AMD lesions following a modified version of the International Classification and Grading System for Age-Related Maculopathy. Comparison was made between slit lamp biomicroscopy (SLB) and photographic grading. Of 4,381 participants, fundus photographs were gradable for 3,304 persons (75.4%), and SLB was completed for 4,312 (98%). Early and late AMD prevalence were 11.2% and 1.2%, respectively, among participants graded on images. Prevalence of AMD by SLB was 6.7% and 0.7% for early and late AMD, respectively. SLB underdiagnosed AMD relative to photographic grading by a factor of 1.7. After controlling for age, women had a higher prevalence of early AMD than men (odds ratio 1.5; 95% CI, 1.2-1.9). Overall prevalence rose significantly with each decade of age. We estimate that, in Kenya, 283,900 to 362,800 people 50 y and older have early AMD and 25,200 to 50,500 have late AMD, based on population estimates in 2007. CONCLUSIONS AMD is an important cause of visual impairment and blindness in Kenya. Greater availability of low vision services and ophthalmologist training in diagnosis and treatment of AMD would be appropriate next steps. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Wanjiku Mathenge
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Ophthalmology, Kigali Health Institute, Kigali, Rwanda
- The Fred Hollows Foundation–Eastern Africa, Nairobi, Kenya
| | - Andrew Bastawrous
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Tunde Peto
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Irene Leung
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Allen Foster
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Bettadapura GS, Donthi K, Datti NP, Ranganath BG, Ramaswamy SB, Jayaram TS. Assessment of avoidable blindness using the rapid assessment of avoidable blindness methodology. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:389-93. [PMID: 23050247 PMCID: PMC3456477 DOI: 10.4103/1947-2714.100982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: More than 90% of visual impairment can either be treated or avoided. Rapid Assessment of Avoidable Blindness methodology provides valid estimates in short time to assess magnitude and causes of blindness. Aims: To estimate the prevalence and causes of blindness in persons above 50 years in Kolar, South India, using the above methodology. Materials and Methods: Sixty one clusters of 50 people aged above 50 years were selected by probability-proportionate to size sampling. Participants were evaluated using a standardized survey form. Persons with vision <20/60 were dilated and examined by an ophthalmologist. Results: Of the 3050 people listed 2907 were examined (95.3%). Prevalence of bilateral blindness in persons was 3.9%; severe visual impairment 3.5%, and visual impairment 10.4%. Untreated cataract was the leading cause of blindness (74.6%) and severe visual impairment (73.3%). Avoidable causes of blindness accounted for 91.2% of all blindness and 95.0% of severe visual impairment. ‘Waiting for maturity’ and ‘No one to accompany’ were the most common barriers to uptake of cataract surgery. Conclusion: Untreated cataract continues to be the leading cause of avoidable blindness. Modified strategies need to be implemented to tackle the burden of cataract blindness.
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Affiliation(s)
- Guruprasad S Bettadapura
- Department of Ophthalmology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
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Kandeke L, Mathenge W, Giramahoro C, Undendere FPA, Ruhagaze P, Habiyakare C, Courtright P, Lewallen S. Rapid assessment of avoidable blindness in two northern provinces of Burundi without eye services. Ophthalmic Epidemiol 2012; 19:211-5. [PMID: 22775276 DOI: 10.3109/09286586.2012.690493] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the prevalence and causes of blindness, severe visual impairment and visual impairment as well as cataract surgical coverage in two northern provinces of Burundi for the purpose of planning eye services. METHODS The population-based Rapid Assessment of Avoidable Blindness survey methodology was used. RESULTS Of 3800 people enrolled, 3684 (97%) were examined. The sample prevalences of blindness, severe visual impairment, and visual impairment were 1.1% (95% confidence interval, CI 0.8-1.4), 0.6% (95% CI 0.4-0.9), and 1.7% (95% CI 1.3-2.1), respectively. The leading causes of blindness were cataract (55%) and posterior segment causes (37%). Severe visual impairment was mainly due to cataract (43%) and refractive error (39%), and visual impairment was mainly due to refractive error (67%) and cataract (18%). Cataract surgical coverage by person at the level of <6/60 was 15%. CONCLUSIONS The low prevalence of vision loss in this area with no eye services and a low cataract surgical coverage rate is surprising and possibly due to the effects of the previous years of conflict in which those with decreased vision may have been most likely to perish. If this explanation is correct, then Burundi needs to plan to deal with a markedly increasing prevalence of cataract in future.
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