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Long-term visual acuity outcome of pediatric uveitis patients presenting with severe visual impairment. Sci Rep 2023; 13:2919. [PMID: 36807333 PMCID: PMC9941571 DOI: 10.1038/s41598-023-29159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
This study investigated the long-term visual acuity (VA) outcome in the eyes of children with uveitis and severe visual impairment (SVI; VA ≤ 20/200) at presentation. Fifty-one children [57 eyes; median age, 11 years; 51% female; median follow-up period, 36 months (interquartile range 14.9-64.4)] aged ≤ 16 years with uveitis managed at our tertiary center from January 2010 to July 2020 were reviewed. Uveitis mainly manifested as unilateral (74.5%), chronic course (82.4%), and panuveitis (43.1%). Ocular toxoplasmosis and toxocariasis were the most common diagnoses (9.8% each). At least one ocular complication at presentation was observed in 93% of the eyes. Overall, the mean logMAR VA improved from 1.8 at presentation to 1.2 at 5 years (P < 0.001). Common causes of poor vision included retinal detachment, atrophic bulbi, and optic atrophy. Predictive factors associated with less VA improvement over the follow-up period included preschool age of uveitis onset (P < 0.001), ocular symptoms duration before uveitis diagnosis ≥ 1 month (P = 0.004), and non-anterior uveitis (P = 0.047). The long-term VA outcome in uveitis-affected eyes with SVI at presentation was unfavorable. Younger age at uveitis onset, delayed presentation, and uveitis involving the posterior segment were associated with poorer VA outcome.
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Rajaa S, Sahu SK, Thulasingam M. Assessment of Community Health Volunteers contribution and factors affecting their health care service delivery in selected urban wards of Puducherry – A mixed-methods operational research study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rasoloniaina JR, Raberosoa R, Rakotondrajoa P, Randrianaivo JB, Razafinimpanana N, Randrianarisoa H, Demers L, Bassett K. Pediatric Case Finding in Madagascar: A Controlled, Prospective Population-based Assessment of Key Informant Productivity and Cost. Ophthalmic Epidemiol 2019; 26:408-415. [PMID: 31272270 DOI: 10.1080/09286586.2019.1639199] [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: 10/26/2022]
Abstract
Purpose: The Key Informant (KI) case finding method, which trains community members to screen children for eye problems and refer them to eye services, is a common strategy to identify and refer children with blindness and visual impairment. However, studies to date have not determined the benefit and cost of adding KIs to routine outreach activities.Methods: Four eye programs in Madagascar with established outreach camps added KIs to a portion of their camps distributed equally throughout their service region over a one year period. KIs recorded children screened and their attendance at an outreach camp. Outreach personnel used standardized registration forms to gather age, sex, visual acuity, diagnosis and treatment data. Costs were gathered for the KI program and outreach camps.Results: In one year, the 4 eye programs held 138 outreach camps, 43 with KIs. The KI camps were more productive than regular camps seeing an average of 61 and 24 children and 50 and 19 children with an eye problem, for KI and regular camps, respectively. The KI camps also saw more children with moderate or severe visual impairment or blindness with 21 and 8 children (per 10 camps) for KI and regular camps, respectively. A KI camp cost $463 ($642 vs. $179) more than a regular camp and $3 ($8 vs. $11) more per child seen.Conclusion: The KI method significantly increased the number of children attending outreach camps, at all levels of visual impairment and blindness, at a modest increase in costs.
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Affiliation(s)
| | | | | | | | | | - Hoby Randrianarisoa
- Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo
| | | | - Ken Bassett
- Department of Ophthalmology, University of British Columbia, Vancouver, Canada
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Bronsard A, Geneau R, Duke R, Kandeke L, Nsibirwa SG, Ulaikere M, Courtright P. Cataract in children in sub-Saharan Africa: an overview. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1555037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Annie Bronsard
- Kilimanjaro Centre for Community Ophthalmology (KCCO), Moshi, Tanzania
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Robert Geneau
- Kilimanjaro Centre for Community Ophthalmology (KCCO), Moshi, Tanzania
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Roseline Duke
- Calabar Children Eye Centre, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Lévi Kandeke
- Department of Ophthalmology, University of Burundi, Bujumbura, Burundi
| | | | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology (KCCO), Moshi, Tanzania
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
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Woldie M, Feyissa GT, Admasu B, Hassen K, Mitchell K, Mayhew S, McKee M, Balabanova D. Community health volunteers could help improve access to and use of essential health services by communities in LMICs: an umbrella review. Health Policy Plan 2018; 33:1128-1143. [PMID: 30590543 PMCID: PMC6415721 DOI: 10.1093/heapol/czy094] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2018] [Indexed: 12/21/2022] Open
Abstract
A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low- and middle-income countries (LMICs). We report an umbrella review of systematic reviews, searching PubMed, the Cochrane library, the database of abstracts of reviews of effects (DARE), EMBASE, ProQuest dissertation and theses, the Campbell library and DOPHER. We considered a review as 'systematic' if it had an explicit search strategy with qualitative or quantitative summaries of data. We used the Joanna Briggs Institute (JBI) critical appraisal assessment checklist to assess methodological quality. A data extraction format prepared a priori was used to extract data. Findings were synthesized narratively. Of 422 records initially found by the search strategy, we identified 39 systematic reviews eligible for inclusion. Most concluded that services provided by CHVs were not inferior to those provided by other health workers, and sometimes better. However, CHVs performed less well in more complex tasks such as diagnosis and counselling. Their performance could be strengthened by regular supportive supervision, in-service training and adequate logistical support, as well as a high level of community ownership. The use of CHVs in the delivery of selected health services for population groups with limited access, particularly in LMICs, appears promising. However, success requires careful implementation, strong policy backing and continual support by their managers.
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Affiliation(s)
- Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, U.S.A
| | | | - Bitiya Admasu
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | | | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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Ganesh SC, Narendran K, Nirmal J, Valaguru V, Shanmugam S, Patel N, Narayanaswamy P, Musch DC, Ehrlich JR. The key informant strategy to determine the prevalence and causes of functional low vision among children in South India. Ophthalmic Epidemiol 2018; 25:358-364. [PMID: 29969337 DOI: 10.1080/09286586.2018.1489969] [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: 10/28/2022]
Abstract
PURPOSE To report the prevalence and causes of functional low vision (FLV) in school-age children in Coimbatore District, Tamil Nadu, India and to report our experience using the key informant (KI) method in this setting. METHODS Children suspected of having low vision were identified by KIs or Aravind Eye Hospital personnel in Coimbatore District. All identified children underwent a cycloplegic refraction and full eye exam. A primary cause of decreased vision was determined for each child. The prevalence of FLV was calculated for children 6-14 years old. Spectacles and low vision devices were provided free of charge. RESULTS 345 children aged 6-14 years were referred and 231 had FLV. The positive-predictive value of KI referrals was 64.5%. The prevalence of FLV was 0.071% (7.1 per 10,000; 95% CI 0.062-0.080%) and ranged from 0.026% to 0.141% across the district's blocks. Older children (age 11-14 years; OR 1.41; 95% CI 1.09-1.82) and males (OR 1.52; 95% CI 1.16-1.98) had greater odds of being diagnosed with FLV. The most common causes of FLV were retinal disorders (30.0%) and amblyopia (25.5%). Low vision devices were provided to 169 children who had a mean near and distance visual acuity improvement of 0.31 and 0.63 logMAR, respectively (p < 0.001). CONCLUSIONS This study reports a moderate prevalence of FLV and demonstrates the ability of KIs to identify school-age children with FLV in South India. The provision of basic low vision services can improve visual outcomes in this population.
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Affiliation(s)
| | | | | | - Vijayakumar Valaguru
- b Lions Aravind Institute of Community Ophthalmology , Madurai , Tamil Nadu , India
| | | | - Nish Patel
- c Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences , University of Michigan , Ann Arbor , MI , USA
| | - Prabha Narayanaswamy
- c Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences , University of Michigan , Ann Arbor , MI , USA
| | - David C Musch
- c Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences , University of Michigan , Ann Arbor , MI , USA.,d Institute for Healthcare Policy and Innovation, University of Michigan , Ann Arbor , MI , USA.,e Department of Epidemiology , University of Michigan , Ann Arbor , MI , USA
| | - Joshua R Ehrlich
- c Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences , University of Michigan , Ann Arbor , MI , USA.,d Institute for Healthcare Policy and Innovation, University of Michigan , Ann Arbor , MI , USA
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