Need for optical intervention in children attending a school for the blind in Eritrea

Rehabilitation needs screening to identify potential beneficiaries: a scoping review

Objectives

The aim is to identify and compare the content of screening tools and needs assessments used to select rehabilitation beneficiaries and to describe the context of their use.

Design

Scoping review.

Data sources

We systematically searched five indexed databases for studies published from 1 January 2010 to 3 February 2023.

Eligibility criteria

We searched for papers published in English only. Papers describe a screening tool or needs assessment aiming to prospectively select potential beneficiaries of rehabilitation services based on a cut-off score or classification system.

Data extraction and synthesis

We charted the evidence according to the characteristics of the paper, rehabilitation needs screening context, screening tool and content of the screening tool. A descriptive synthesis is provided for screening methodology, settings, target populations, rehabilitation need types and phases of care. The WHO International Classification of Functioning, Disability and Health is used to categorise screening items.

Results

We identified 24 tools that use a range of screening methodologies, but mostly questionnaires that are used by health workers. Most tools have been proposed for the identification of a rehabilitation beneficiary among people with selected health conditions assessing the need to access a specific rehabilitation intervention, programme or occupational group. The majority of tools screen for current functioning limitations, and this is often the only screening component. When mapping screening items with the WHO International Classification of Functioning, Disability and Health (ICF), almost all ICF chapters for body functions and activities and participation have been included across screening tools, with the following most frequently included ICF categories: emotional functions (b152), acquiring, keeping and terminating a job (d845), sensation of pain (b280) and carrying out daily routine (d230).

Conclusions

Rehabilitation need screening tools commonly include the screening for current functioning limitations among people with selected health conditions. A screening tool that is applicable across health conditions and settings is not available.

Practice scope and job confidence of two-year trained optometry technicians in Eritrea

BACKGROUND

A two-year optometry technician (OT) training was started in Eritrea in 2009 to fulfill the immediate human resource needs in providing refractive, dispensing and primary eye care services in vision centers. This study aimed to assess the current practice pattern and confidence level among the OTs.

METHODS

A self-administered questionnaire was developed and administered to all available OTs in January 2017. The OTs were identified through the Ministry of Health's database. The questionnaire included questions on demographics, scope of practice and confidence level in the clinical practice areas.

RESULTS

A total of 94 OTs had graduated by the end of 2016 and 71 (75.5%) of them were involved in the country's eye care services. All the 70 OTs who completed the survey were working under the Ministry of Health in various regions of the country. The mean age of the OTs was 25.6 ± 4.7 years (range: 20 to 48 years) and 43 (61.4%) of them were male. Four out of six regions in the country lacked the required number of OTs for the recommended ratio of one refractionist to 50,000 population. All the OTs provided refraction services; however, they lacked experience in dispensing (62.9%), clinical examination of patients (35.7%) and low vision care (4.3%). While the OTs expressed confidence in refractive procedures, low levels of confidence were expressed for dispensing and primary eye care services.

CONCLUSION

OTs contributed to the primary eye care sector in Eritrea. However, high attrition rate, imbalanced distribution, a limited practice in core areas and low clinical confidence were the key challenges for this profession in this country. With better facilities, improved infrastructure and extended education and career opportunities, the two-year trained OTs could potentially serve further in the Eritrean eye care system. Further studies to evaluate the competency, job satisfaction and effectiveness OTs are recommended.

Retrospective data on causes of childhood vision impairment in Eritrea

BACKGROUND

Proper information on causes of childhood vision loss is essential in developing appropriate strategies and programs to address such causes. This study aimed at identifying the causes of vision loss in children attending the national referral eye hospital with the only pediatric ophthalmology service in Eritrea.

METHODS

A retrospective data review was conducted for all the children (< 16 years of age) who attended Berhan Aiyni National Referral Eye Hospital in five years period from January 2011 to December 2015. Causes of vision loss for children with vision impairment (recorded visual acuity less than 6/18 for distance in the better eye) was classified by the anatomical site affected and by underlying etiology based on the timing of the insult and causal factor.

RESULTS

The medical record cards of 22,509 children were reviewed, of whom 249 (1.1%) were visually impaired. The mean age of the participants was 7.82 ± 5.43 years (range: one month to 16 years) and male to female ratio was 1:0.65. The leading causes of vision loss were cataract (19.7%), corneal scars (15.7%), refractive error and amblyopia (12.1%), optic atrophy (6.4%), phthisis bulbi (6.4%), aphakia (5.6%) and glaucoma (5.2%). Childhood factors including trauma were the leading causes identified (34.5%) whereas other causes included hereditary factors (4%), intrauterine factors (2.0%) and perinatal factors (4.4%). In 55.0% of the children, the underlying etiology could not be attributed. Over two-thirds (69.9%) of vision loss was potentially avoidable in nature.

CONCLUSION

This study explored the causes of vision loss in Eritrean children using hospital based data. Cataract corneal opacities, refractive error and amblyopia, globe damage due to trauma, infection and nutritional deficiency, retinal disorders, and other congenital abnormalities were the leading causes of childhood vision impairment in children attending the tertiary eye hospital in Eritrea. As majority of the causes of vision loss was due to avoidable causes, we recommended primary level public health strategies to prevent ocular injuries, vitamin A deficiency, perinatal infections and retinopathy of prematurity as well as specialist pediatric eye care facilities for cataract, refractive errors, glaucoma and rehabilitative services to address childhood vision loss in Eritrea.