Assessing the Progress towards Achieving "VISION 2020: The Right to Sight" Initiative in Ghana

Low Vision Practice and Service Provision Among Optometrists in Ghana: A Nationwide Survey

PURPOSE

To characterize practice patterns of low vision services among Optometrists in Ghana.

METHODS

The nationwide cross-sectional survey identified entities through the Ghana Optometrists Association (GOA) registry and utilized a semi-structured questionnaire to consolidate survey information that comprises practitioners' demographics, available services, diagnostic equipment, barriers to service provision and utilization, and interventions.

RESULTS

300 Optometrists were identified, with 213 surveyed (71% response rate). About fifty percent (52.6%) were in private practice, and more than two-thirds (77%) did not provide low vision services. Most (≥70%) reported lack of assistive devices, and basic eye care examination kits as the main barriers to low vision service provision. Similarly, practitioners reported unawareness of the presence of low vision centres (76.1%), and high cost of low vision aids (75.1%) as the prime perceived barriers for patients to utilize low vision services. Continuous professional development and public education (89-90%) were suggested as interventions to improve the uptake of low vision services. After statistical adjustment, private facility type (Adjusted odds ratio [AOR] = 0.35, p = 0.010) and lack of basic eye examination kits (AOR = 0.32, p = 0.002) were significantly associated with reduced odds of low vision service provision. Conversely, ≥15 years of work experience (AOR = 6.37, p = 0.011) was significantly associated with increased odds of low vision service provision.

CONCLUSIONS

Overall, the results indicate inadequate low vision coverage and service delivery. Government policies must be directed towards equipping practitioners with equipment and subsidize patient cost of treatment to optimize low vision care.

[Global ophthalmology : Update]

The aim of global ophthalmology is to maximize vision, ocular health and functional ability, thereby contributing to overall health and well-being, social inclusion and quality of life of every individual worldwide. Currently, an estimated 1.1 billion people live with visual impairment, 90% of which can be prevented or cured through largely cost-effective interventions. At the same time, 90% of people affected live in regions with insufficient eye health coverage. This challenge drove the World Health Organization (WHO) and a group of nongovernmental organizations to launch "VISION 2020: the Right to Sight", a global campaign which recently concluded after 20 years. The achievements, challenges and lessons learned were identified and incorporated into the current campaign "2030 IN SIGHT".

Assessment of optical quality of ready-made reading spectacles for presbyopic correction

PURPOSE

Many presbyopic patients in both developed and developing countries use ready-made reading spectacles for their near vision correction even though the quality of these spectacles cannot always be assured. This study assessed the optical quality of ready-made reading spectacles for presbyopic correction in comparison with relevant international standards.

METHODS

A total of 105 ready-made reading spectacles with powers ranging from +1.50 to +3.50 dioptres (D) in +0.50 D steps were randomly procured from open markets in Ghana and assessed for their optical quality, including induced prisms and safety markings. These assessments were done in line with the International Organization for Standardization (ISO 16034:2002 [BS EN 14139:2010]) as well as the standards used in low-resource countries.

RESULTS

All lenses (100%) had significant induced horizontal prism that exceeded the tolerance levels stipulated by the ISO standards, while 30% had vertical prism greater than the specified tolerances. The highest prevalence of induced vertical prism was seen in the +2.50 and +3.50 D lenses (48% and 43%, respectively). When compared with less conservative standards, as suggested for use in low-resource countries, the prevalence of induced horizontal and vertical prism reduced to 88% and 14%, respectively. While only 15% of spectacles had a labelled centration distance, none had any safety markings per the ISO standards.

CONCLUSION

The high prevalence of ready-made reading spectacles in Ghana that fail to meet optical quality standards indicates the need for more robust, rigorous and standardised protocols for assessing their optical quality before they are sold on the market. This will alleviate unwanted side effects including asthenopia associated with their use. There is also the need to intensify public health awareness on the use of ready-made reading spectacles, especially by patients with significant refractive errors and ocular pathologies.

Profiling and factors associated with glaucoma diagnostic practice in sub-Saharan Africa-a cross sectional study of Nigerian and Ghanaian optometrists

BACKGROUND

Ghana and Nigeria are the two countries in Africa that currently run the Doctor of Optometry (OD) program in sub-Saharan Africa (SSA). Optometrists in these countries are licensed to provide glaucoma care. Despite the clinically relevant practice guidelines for glaucoma, there is no data on the practice patterns for glaucoma eye care in SSA, a region with the highest prevalence of glaucoma. This study aimed to profile glaucoma diagnosis adherence to practice guidelines among optometrists in two neighbouring anglophone countries (Nigeria and Ghana).

METHODS

A web-based cross-sectional survey of practising optometrists was conducted in both countries. Each country data was weighted to reflect the total number of licensed and practising optometrists at the time of this survey. Descriptive analyses were performed against demography and practice factors using survey commands to adjust for sampling weights when estimating confidence intervals (CI) around prevalence estimates. Simple and multiple logistic regression analyses were performed to identify factors associated with glaucoma diagnosis.

RESULTS

A total of 493 optometrists (238, 48.3% and 255, 51.7%) from Ghana and Nigeria respectively, responded to the survey-the first to document and compare the glaucoma diagnostic criteria between optometrists in Ghana and Nigeria. More Ghanaian than Nigerian optometrists diagnosed glaucoma and over 90% in both countries reported that they frequently performed either tonometry, visual field testing, or fundus examination during glaucoma diagnosis. Ghanaian optometrists were significantly more likely to diagnose glaucoma than Nigerian optometrists (adjusted odd ratio, AOR = 6.15, 95%CI:1.63-23.15, P = .007). Optometrists who have practiced for more than 10 years (AOR = 7.04; 95%CI:1.74-28.47, P = .006) and private practice optometrists (AOR = 3.33; 95%CI:1.13-9.83, P = .03) were more likely to diagnose glaucoma.

CONCLUSIONS

The study provides information for evaluating glaucoma assessment for optometrists in both countries. Optometrists in both countries are reasonably well-equipped to diagnose glaucoma and are practicing at an adequate level, but with room for improvement.

The Aqueous Stem Bark Extract of Alstonia boonei Exhibits Anticataract Activity in Sprague Dawley Rat

In Africa, Alstonia boonei is used folklorically for the management of the multitude of conditions including cataract, which accounts for 50% of cases of blindness in the region. The current study set out to probe the traditional use of the aqueous extract of Alstonia boonei stem bark (ABE) as an anticataract remedy using Sprague Dawley rat models. We investigated the probable phytochemical constituents in the extract, in vitro antioxidant potential, and its in vitro aldose reductase inhibition. For the anticataract investigations, diabetic cataract was induced using galactose in 3-week-old Sprague Dawley rats, and age-related cataract was induced by the administration of sodium selenite to 10-day-old rat pups. Cataract scores in both models were determined after treatment with 30, 100, and 300 mgkg-1 doses of ABE and 10 mlkg-1 of distilled water. Lens glutathione, total lens protein, soluble lens proteins (alpha-A) crystallin, and aquaporin 0 levels in the enucleated lens homogenates were determined. Changes in lens to body weight were also determined with histopathological analysis done on the lenses in the selenite-induced cataract model. The presence of alkaloids, tannins, flavonoids, glycosides, and triterpenoids was identified in the extract. The extract inhibited aldose reductase activity with IC50 of 92.30 μgml-1. The 30, 100, and 300 mgkg-1ABE-treated rats recorded significantly (p < 0.05) reduced cataract scores indicating a delay in cataractogenesis in galactose-induced cataract and in selenite-induced cataractogenesis as well. Markers of lens transparency such as AQP0, alpha-A crystallin, and total lens proteins and lens glutathione levels were significantly (p < 0.05) preserved. In conclusion, this study establishes the anticataract potential of the aqueous stem bark extract of Alstonia boonei in Sprague Dawley rat models.

Assessment of the distribution of human and material resources for eye health in the public sector in Nampula, Mozambique

BACKGROUND

The unavailability of human and material resources can affect access to eye health services, constituting an obstacle in the fight against avoidable visual impairment. This study aimed to assess the availability and distribution of human and material resources for eye health in the public sector in Nampula province.

METHODS

A mixed method approach was used, which included document reviews (to extract information regarding the number of professionals and inhabitants in each district) and application of a questionnaire to heads of the ophthalmology department in each health facility (to obtain the list of available equipment). The ratios of eye health professionals per population in Nampula province and each of its districts were calculated and evaluated taking into account the recommendations of the World Health Organization (WHO). Based on the level of care of each health facility, the availability of equipment was evaluated.

RESULTS

Nampula Province has not reached the recommended ratio of eye health professionals per population in the different categories (ophthalmic technicians with 0.8 per 100 thousand inhabitants; optometrists and ophthalmologists with 0.4 and 0.2 per 250 thousand inhabitants, respectively). Most districts of Nampula did not reach the recommended ratio in the three categories of professionals, except Nampula City (provincial capital). However, there was a greater concentration of professionals and facilities with eye health services in the provincial capital. Primary and secondary level health facilities lacked some equipment to provide eye health services within their scope.

CONCLUSIONS

There is an unequal distribution of the workforce in Nampula and the centralization of surgical services at the Central Hospital of Nampula level. Therefore, there is a need to review resource distribution strategies and decentralization policy of eye health services in Nampula.

Anticataract Effect of the Aqueous Extract of the Flowers of Aspilia africana in Murine Model of Diabetic and Age-Related Cataracts

Background

The use of Aspilia africana in traditional medicine for the management of ocular diseases has been reported in India and some indigenous communities of Africa. The aim of this study was to investigate the aqueous extract of the flowers of A. africana (AAE) as an anticataract remedy using murine models of diabetic and senile cataracts.

Methods

Preliminary phytochemical screening of the extract, in vitro antioxidant assays, and in vitro aldose reductase inhibitory activity were performed. For anticataract investigations of the extracts, diabetic cataract was induced by galactose administration in 3-week-old Sprague Dawley rats. The evaluation of experimentally induced age-related cataract was performed by administering sodium selenite to 10-day-old rat pups.

Results

The phytochemical analysis revealed the presence of alkaloids, tannins, flavonoids, glycosides, and saponins. In vitro aldose reductase inhibitory property of the extract on rat lenses revealed that the AAE inhibited the enzyme activity with IC₅₀ of 12.12 µg/ml. For the anticataract investigations, 30, 100, and 300 mg·kg^-1AAE-treated rats recorded significantly low (p ≤ 0.0001) cataract scores compared to the negative control rats, indicating a delay in cataractogenesis from the second week of treatment in the galactose-induced cataractogenesis. Similarly, the treatment with AAE caused a significant reduction (p ≤ 0.0001) in cataract scores compared to the negative control rats in the selenite-induced cataractogenesis. Markers of lens transparency, such as aquaporin 0, alpha-A crystallin, and total lens proteins and lens glutathione levels, were significantly preserved (p ≤ 0.05-0.0001) in each cataract model after AAE treatment.

Conclusion

The study established the anticataract potential of the aqueous extract of flowers of A. africana in murine models, hence giving scientific credence to its folkloric use in the management of cataract.

A situational analysis of clinical refraction services in the capital city of the Maldives

Background

Uncorrected refractive error is a leading cause of visual impairment globally. This study aimed to determine the current state of clinical refraction services and barriers to service provision in the capital city of the Maldives.

Methods

This cross-sectional, descriptive-analytical study used a purposive sampling technique. The list of facilities providing refraction services in the city of Malé was compiled through a desk review and finalized after verification by personnel from the Ministry of Health. The availability of human resources and infrastructure was measured using a pre-coded questionnaire that also listed barriers to service provision, followed by on-site observations and subsequent data analysis.

Results

Three clinical ophthalmology departments within hospitals, two ophthalmology hospitals, and nine primary eye care centers were selected for this study. The private sector (n = 12, 85.7%) was the primary provider of refractive error services. All facilities possessed the essential equipment required for refraction. Only optometrists and ophthalmologists conducted refraction. Contact lens assessment and low vision services were not available at any facility. The number of refractions conducted in Malé annually was 145,392. Human resources and management-related factors were the major barriers to the provision of clinical refraction services (n = 21, 44.7%).

Conclusions

Accessibility to refractive error management and low vision services is needed in Malé to meet current population needs. Existing resources, including humans and equipment, require augmentation regarding service provision and enhancement. Knowledge of these barriers could lead to the upscaling of refraction services in Malé, Maldives by health policy makers.

Practice patterns in the management of amblyopia among optometrists in Ghana

Despite internationally recognized guidelines, amblyopia management varies among eye care professionals worldwide. Hence, we sought to investigate the practice patterns of amblyopia management and the factors associated with the decision to treat amblyopia among optometrists in Ghana. A cross-sectional survey was conducted among registered optometrists in Ghana from January 2020 to October 2020. Data collection was done through the administration of online questionnaires via e-mail (google form). The structured questionnaires included demographic information, mode, and scope of practice, diagnostic criteria, examination procedures, treatment modalities, and prognosis. A p value of less than 0.05 was deemed statistically significant. The mean (±SD) age of all the 168 respondents was 32.6 (±6.1) years (range: 24-50 years). The majority of the optometrists (64.9%) treated amblyopia in their practice; with the most prevalent being refractive amblyopia (68.2%), followed by strabismic amblyopia (27.1%), then form-deprivation amblyopia (4.7%). Most (76.1%) amblyopic patients presented with symptomatic squinting. The most common ocular and medical history was anisometropia (90.0%), and the most common diagnostic procedures were patient history, visual acuity, and refraction. Optical correction (88.3%) was mainly prescribed for amblyopia treatment, followed by patching (58.5%). Nearly half of the respondent (45.0%) reported good prognosis after amblyopia treatment. After statistical adjustment, female optometrists were significantly associated with decreased odds of treating amblyopia (AOR = 0.36, p = .004). Refractive amblyopia is the main type of amblyopia managed by optometrists in Ghana. Hence, optical correction is the primary treatment regime. Current amblyopia management practice among optometrists adhere to recommended guidelines and our findings demonstrate uniformity in the standard of care.

Situational analysis of diabetic retinopathy treatment Services in Ghana

Background

Although the equitable distribution of diabetic retinopathy (DR) services across Ghana remains paramount, there is currently a poor understanding of nationwide DR treatment services. This study aims to conduct a situation analysis of DR treatment services in Ghana and provide evidence on the breadth, coverage, workload, and gaps in service delivery for DR treatment.

Methods

A cross-sectional study was designed to identify health facilities which treat DR in Ghana from June 2018 to August 2018. Data were obtained from the facilities using a semi-structured questionnaire which included questions identifying human resources involved in DR treatment, location of health facilities with laser, vitreoretinal surgery and Anti–vascular endothelial growth factor therapy (Anti-VEGF) for DR treatment, service utilisation and workload at these facilities, and the average price of DR treatment in these facilities.

Results

Fourteen facilities offer DR treatment in Ghana; four in the public sector, seven in the private sector and three in the Christian Health Association of Ghana (CHAG) centres. There was a huge disparity in the distribution of facilities offering DR services, the eye care cadre, workload, and DR treatment service (retinal laser, Anti-VEGF, and vitreoretinal surgery). The retinal laser treatment price was independent of all variables (facility type, settings, regions, and National Health Insurance Scheme coverage). However, settings (p = 0.028) and geographical regions (p = 0.010) were significantly associated with anti-VEGF treatment price per eye.

Conclusion

Our results suggest a disproportionate distribution of DR services in Ghana. Hence, there should be a strategic development and implementation of an eye care plan to ensure the widespread provision of DR services to the disadvantaged population as we aim towards a disadvantaged population as we aim towards a universal health coverage.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06608-9.

Job satisfaction and its associated factors among optometrists in Ghana: a cross-sectional study

Background

Job satisfaction describes an employee’s motivation and/or feeling of satisfaction towards his/her work. Globally, healthcare professionals’ turnover and retention play a critical role in the delivery of essential health services. In Ghana, however, little has been done to ascertain job satisfaction levels among human resources for eye-health. The objective of this study therefore was to assess job satisfaction and its associated factors among optometrists in Ghana.

Methods

A cross-sectional survey was conducted among 304 registered and licensed optometrists of the Ghana Optometric Association between September 2018 and June 2019. A validated, well-structured questionnaire was used to elicit information on socio-demographic characteristics of participants and measures on job satisfaction. Scores from a five-point Likert scale was employed to examine job satisfaction and its associated factors. Linear regression analyses were used to evaluate the association between overall job satisfaction and its associated factors using Rasch logit scores.

Results

A total of 214 optometrists gave valid responses to the questionnaires used for the final analysis. The mean (± SD) score of the overall perception of job satisfaction among optometrists was 3.36 (± 1.00), with 74.3% of them being satisfied with their jobs. After statistical adjustment, Good work-life balance (Unstandardized co-efficient (β) = 0.288, p = 0.001), Salary (β = 0.222, p < 0.0005), Supervision (β = 0.117, p = 0.044), and Continuing Education Opportunities (β = 0.138, p = 0.017) were all significantly associated with higher levels of overall job satisfaction.

Conclusions

Most optometrists were satisfied with their jobs. Effective strategic planning and management of human resources for eye-health in Ghana are essential in the development of quality eye-health systems and the provision of high-quality eyecare services.

Prevalence and pattern of amblyopia in a rural hospital in Ghana

Amblyopia is a developmental ocular disease of childhood-onset which may lead to persistent sequelae into adulthood. Early detection and management of amblyopia usually result in an improved visual outcome. The purpose of this study was to determine the prevalence and pattern of amblyopia in a rural hospital in Ghana. Clinical records of patients seen (from January 2014 to December 2018) at Westphalian Medical Center, Oyoko, Ashanti Region, Ghana, were reviewed retrospectively. Unilateral amblyopia was defined as a two-line interocular difference or more in visual acuity. Bilateral amblyopia was defined as best-corrected visual acuity (BCVA) of Snellen 6/12 or worse in both eyes, with evidence of bilateral ametropia or obstruction of the visual pathway. Following a review of 12,602 patient records, 258 cases of amblyopia were identified. The mean (±SD) presenting age of amblyopic patients was 24.3 ± 16.1 years, with a male-to-female ratio of 1:1.1. The period prevalence of amblyopia was 2.04%. The period prevalence of unilateral and bilateral amblyopia was 1.38% and 0.66%, respectively. The most prevalent form of amblyopia was refractive with a cumulative prevalence of 1.42%. Strabismic and stimulus deprivation amblyopia accounted for 0.36% and 0.21% of all amblyopic cases, respectively. A major cause of amblyopia in this population was refractive error, hence the use of spectacle correction for its initial management. Repeated assessment after an appropriate period of refractive adaptation would elucidate the proportion of amblyopias needing additional treatment modalities. Vision screening for early detection of amblyopia in childhood with accessible and effective management of amblyopia (including refractive correction and occlusion treatment) is necessary to reduce the impact of amblyopia in Ghana.

Visual impairment and social isolation, depression and life satisfaction among older adults in Ghana: analysis of the WHO's Study on global AGEing and adult health (SAGE) Wave 2

AIM

To estimate the prevalence of visual impairment (VI) and associated factors and further quantify its association with social isolation, depression and life satisfaction among older adults in Ghana.

METHODS

WHO Study on Global AGEing and Adult Health Ghana dataset for older adults 50 years and above was used for this study. Social isolation, depression and life satisfaction were our primary outcomes with VI being our secondary outcome. We employed negative binomial, Poisson and generalised negative binomial regression models individually modified with Coarsened Exact Matching method of analysis. All analysis was performed by adopting robust SE estimation using Stata V.15.

RESULTS

The prevalence of VI was 17.1% (95% CI14.3 to 20.2) and the factors associated include age groups, educational level, religion, region, where the participant was born, and difficulty in work/households activity (p<0.05). The inferential analysis shows that the significant log-likelihood score of social isolation and life satisfaction for older adults with VI was 0.25 more (95% CI 0.03 to 0.47) and 0.04 less (95% CI -0.08 to -0.01), respectively, compared with those without VI. The prevalence of depression among older adults with VI was significantly 90% higher compared with non-VI (adjusted prevalence ratio (95% CI) = 1.90 (1.17 to 3.09), p<0.001).

CONCLUSION

The prevalence of VI is associated with increasing age, educational level and self-rated health. VI was identified to be associated with social isolation, depression and diminishing life satisfaction. In order to achieve sustainable development goal #3, a national focus on geriatric care as part of the implementation of the National Ageing Policy will garner improvement in the quality of life of older adults with visual VI in Ghana. Eye health practitioners at all levels of the health systems should consider the psychosocial consequences of VI for the optimum care of the older adult client.