Self-reported cataracts in older adults in Ghana: sociodemographic and health related factors

Utilisation pattern of ophthalmic services in Ashanti Region, Ghana

BACKGROUND

 Best practice in optometry and ophthalmology recommends regular visits to eye care professionals, as routine eye examinations support early detection of ocular defects and associated systemic, sometimes potentially life-threatening, conditions.

AIM

 The study sought to determine the utilisation of ophthalmic services and its associated factors in the Ashanti region of Ghana.

SETTING

 Fifty electoral areas in 10 of the 43 districts in the Ashanti region of Ghana.

METHODS

 A total of 1615 participants, aged 18 years and above, were randomly selected in the Ashanti region of Ghana for this population-based, cross-sectional survey. The factors associated with having had an eye examination were guided by Andersen's Behavioural Model. The data were analysed using multiple logistic regression, employing the IBM SPSS software, version 25.

RESULTS

 After statistical adjustments, compared with the 18-29-year-old age group, older participants were found to be more likely to utilise eye care services: In addition, participants with higher formal education had higher odds for eye care utilisation compared with no former education: Being hypertensive, self-reported vision problems and feeling that regular eye examinations are important, were statistically associated with eye care utilisation.

CONCLUSION

 There is alarmingly poor utilisation of ophthalmic services in the Ashanti region of Ghana. Effective programmes to promote public health by addressing the socio-economic and individual barriers hindering the uptake of ophthalmic services in the Ashanti region of Ghana are thus necessary.Contribution: The study addresses a gap in the knowledge of factors associated with ophthalmic services utilisation in the Ashanti region of Ghana.

Risk factors for self-reported cataract symptoms, diagnosis, and surgery uptake among older adults in India: Findings from the WHO SAGE data

Visual impairments have a substantial impact on the well-being of older people, but their impact among older adults in low- and middle-income countries is under-researched. We examined risk factors for self-reported cataract symptoms, diagnosis, and surgery uptake in India.

Cross-sectional data from the nationally representative WHO SAGE data (2007-2008) for India were analysed. We focused on a sub-sample of 6558 adults aged 50+, applying descriptive statistics and logistic regression.

Nearly 1-in-5 respondents self-reported diagnosed cataracts, more than three-fifths (62%; n = 3879) reported cataract symptoms, and over half (51.8%) underwent surgery. Increasing age, self-reported diabetes, arthritis, low visual acuity, and moderate or severe vision problems were factors associated with self-reported diagnosed cataracts. Odds of cataract symptoms were higher with increasing age and among those with self-reported arthritis, depressive symptoms, low visual acuity, and with moderate or severe vision problems. Odds of cataract surgery were also higher with increasing age, self-reported diabetes, depressive symptoms, and among those with low visual acuity.

A public health approach of behavioural modification, well-structured national outreach eye care services, and inclusion of local basic eye care services are recommended.

Comparison of physical activity levels in Spanish people with diabetes with and without cataracts

Background

The objective was to compare levels of physical activity (PA) in a large sample of Spanish people with diabetes with and without cataracts. To our knowledge, this is the first study comparing PA levels in people with diabetes with and without cataracts in a large representative sample.

Methods

Cross-sectional data from the Spanish National Health Survey 2017 were analyzed (n = 1014 people with diabetes; 43.1% females; age range 15–69 years; mean age 58.4 ± 9.2 years). International Physical Activity Questionnaire (IPAQ) short form was used to measure PA. Total MET-min week−1 of PA were calculated and participants were divided into two categories according to American Diabetes Association PA guidelines: (i) <600 MET-min week−1. (ii) At least 600 MET-min week−1. Diabetes and cataracts were self-reported in response to the questions ‘Have you ever been diagnosed with diabetes/cataracts?’ Participants also reported other variables including age, gender, marital status, living as a couple, education, smoking, alcohol consumption and obesity. Statistical analysis was performed with SPSS 23.0.

Results

The overall prevalence of cataract was 14.0% and the overall prevalence of people doing <600 MET-min week−1 of PA was 35.4%. The prevalence of cataract was significantly lower in those doing more PA (12.1% vs. 17.5%; P = 0.016). Those without cataracts were significantly more active than those with cataracts (1846.8 vs. 1289.4 MET-min week−1; P = 0.001). The adherence to American Diabetes Association PA guidelines was significantly higher in those without cataracts (66.1% vs. 55.6%; P = 0.016).

Conclusions

Interventions to promote PA targeting people with both diabetes and cataracts are warranted.

Self-reported hypertension as a predictor of chronic health conditions among older adults in Ghana: analysis of the WHO Study on global Ageing and adult health (SAGE) Wave 2

Introduction

Hypertension has been identified as a significant predictor of many chronic health conditions. Body Mass Index (BMI) and Quality of Life (QoL) are key determinants of hypertension especially among elderly populations. In this study, we examined the effect of self-reported hypertension (SRH) on chronic health conditions and quality of life among older adults in Ghana.

Methods

The WHO Study on Global Ageing and Adult Health Wave 2 data for Ghana, collected from 2014 to 2015 was applied in this study. Data for older adults aged 50 years and above were analyzed. Weighted descriptive and inferential analyses were performed using Stata 14. We predicted any potential associations between SRH and chronic health conditions using a corrected chi-square and Coarsened Exact Matching with adjusted odds ratios.

Results

The prevalence of SRH among older adults in Ghana was 15.8%. This was significantly associated with sex, marital status, religion, place of residence, working status, location/region, health status BMI, and QoL. In all, older adults with poor health status, obese state and high QoL had 3.15, 2.17 and 2.76 odds of SRH respectively [AOR(95%CI)p-value=3.15(1.65-6.02)0.001, 2.17(1.31-3.59)0.003 and 2.76(1.04-7.31)0.041)]. In addition, older adults with SRH were at increased risk of reporting chronic conditions such as stroke, angina, diabetes and cataract.

Conclusion

Overall, a key observation from this analysis is that SRH (and not only clinically diagnosed hypertension) is significantly associated with co-morbidities. In Ghana, older adults with SRH have increased risk of co-morbidities including diabetes, stroke, angina, and cataract. Interventions to improve the awareness and early detection of hypertension at the population level is key. Controlling hypertension at the population level will reduce prevalence of chronic conditions and increased protection.

Associations between cataract and multimorbidity: a cross-sectional study of 23,089 adults from Spain

BACKGROUND

Little is known about the association between cataract and multimorbidity. Therefore, the aim of the present study was to examine the relationship between cataract and chronic conditions and multimorbidity in a large representative sample of Spanish adults.

METHODS

This study used data from the Spanish National Health Survey 2017, a cross-sectional sample of 23,089 adults aged ≥15 years from Spain [54.1% female; mean (standard deviation) age 53.4 (18.9) years]. Cataract and 30 other physical and mental chronic conditions were self-reported. Multimorbidity was defined as the presence of at least two physical and/or mental chronic conditions (excluding cataract). Control variables included sex, age, marital status, education, smoking, and alcohol consumption. Multivariable logistic and negative binomial regression analyzes were conducted to assess associations.

RESULTS

The prevalence of cataract and multimorbidity was 12.5% and 56.5%, respectively. All chronic conditions were significantly more frequent in individuals with than in those without cataract. Overall, there was a positive relationship between cataract and multimorbidity [odds ratio (OR) = 2.77; 95% confidence interval (CI): 2.39-3.21]. In addition, cataract was significantly associated with the number of chronic conditions in the whole population [incidence rate ratio (IRR) = 1.34; 95% CI: 1.29-1.38].

CONCLUSIONS

Cataract is positively associated with chronic conditions and multimorbidity in adults. Interventions specifically designed for those with cataract to reduce or manage co-occurring chronic conditions and multimorbidity are urgently required.

The Association between Difficulty Seeing and Physical Activity among 17,777 Adults Residing in Spain

This is the first representative population-based study exploring the association between difficulty seeing (i.e., low vision) and physical activity in Spain. Cross-sectional data from the Spanish National Health Survey 2017 were analysed (n = 17,777, ≥15 years; 52% females). Difficulty seeing was self-reported in response to the question ‘‘Do you have difficulty seeing?” The international physical activity questionnaire (IPAQ) short form was used to measure level of physical activity. Multivariable logistic regression was used to assess associations overall and by age group (15–49, 50–64, ≥65 years). Covariates included in the analysis were sex, age, education, marital status, use of glasses or contact lenses, cataracts, diabetes, obesity, hypertension, smoking and alcohol consumption. The overall prevalence of difficulty seeing was 11%, and the overall prevalence of participating in less than 600 metabolic equivalent (MET)-min/week of physical activity was 30.2%. After adjustment for covariates, difficulty seeing was associated with significantly higher odds of performing less than 600 MET-min/week of physical activity with the odds ratio (OR) = 1.222 (95% confidence interval = 1.099–1.357). Considering the impact on health and quality of life due to reduced physical activity in people with difficulty seeing, at least 600 MET-min/week of physical activity should be promoted to this population.

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

Purpose

The aim of this study was to analyse eye health delivery in Ghana and examine the progress towards achieving VISION 2020 indicator targets.

Methods

This descriptive cross-sectional study was conducted between October 2017 and May 2018. It used a mixed method approach including desk-based reviews, a questionnaire-based survey of eye facilities in Ghana, and interviews with eye health system stakeholders to collect information on eye health delivery in facilities owned by the Ghana Health Service (GHS), quasigovernmental bodies (security agencies), and Christian Association of Ghana (CHAG). The information was benchmarked against the World Health Organization (WHO) targets for achieving the goals of VISION 2020.

Results

The magnitude of blindness and moderate to severe visual impairment (without pinhole) was 0.9% and 3.0%, respectively. The number of ophthalmologists available at the country level was 80.6% of the VISION 2020 target with optometrists and ophthalmic nurses exceeding targets for VISION 2020. The distribution of human resources was heavily skewed towards two out of the 10 regions in Ghana. Cataract surgical rate was low and met 25% of the WHO target. Basic equipment for refraction was available in the majority of facilities; however, there was a general lack of specialised eye care equipment across the country. Comparatively, CHAG facilities were better equipped than GHS facilities at the same level.

Conclusion

The Government of Ghana should revitalize the goals of VISION 2020 beyond the year 2020 and spearhead a concerted effort to ensure equitable distribution of human and infrastructural resources across the country.

Crude and standardized prevalences of cataract and related factors in the elderly people in Northern Iran

Purpose:

This study aims to estimate the crude and standardized prevalences of cataract and its related factors among old people in northern parts of Iran.

Methods:

This cross-sectional study was carried out among 397 people aged 60 and older in northern Iran. Required information about treated and nontreated cataract was collected using a standard checklist. The World Standard Population was applied for direct standardization.

Results:

The standardized prevalence (95% confidence interval) of cataract among men, women, and all people were 27.5% (21.2–33.8), 30.9% (24.5–37.4), and 29.1% (24.6–33.6), respectively. Based on multivariate logistic regression models, age over 75 years (OR = 3.03, 95% CI: 1.21–7.59), living alone (OR = 4.89, 95% CI: 1.86‒12.86), diabetes mellitus (odds ratio = 19.10, 95% confidence interval: 8.13–44.89), rheumatoid arthritis (OR = 7.76, 95% CI: 2.32–25.99), history of infectious diseases (OR = 4.02, 95% CI: 1.35‒11.98), hypertension (OR = 3.19, 95% CI: 1.59–6.42), history of ophthalmic surgery (OR = 2.83, 95% CI: 1.29–6.16), history of sedative drug use (OR = 2.71, 95% CI: 1.35–5.47), history of vitamin supplementation use (OR = 0.21, 95% CI: 0.08–0.55), and familial history of cataract (OR = 2.81, 95% confidence interval: 1.38–5.72) increased the odds of cataract. Our multiple logistic regression model explained 53% of the variation in developing cataract.

Conclusion:

Our study showed that the prevalence of cataract in the study population was relatively high. We also found that aging, living alone, diabetes mellitus, rheumatoid arthritis, hypertension, infectious diseases, ophthalmic surgery, sedative drugs and familial history of cataract were the risk factors of cataract and vitamin supplementations were its protective factors.

The association between diabetes and cataract among 42,469 community-dwelling adults in six low- and middle-income countries

BACKGROUND

Cataract is a major cause of visual impairment in people with diabetes, yet a paucity of data is available in low- and middle-income countries (LMICs) on this comorbidity. Thus we assessed the association between diabetes and cataract in 6 LMICs.

METHODS

Cross-sectional, community-based data from the Study on Global Ageing and Adult Health (SAGE) was analyzed (n = 42,469 aged ≥18 years). Five years information on self-reported diagnosis of cataract was collected. Three definitions for cataract were used: (a) Self-reported diagnosis and/or past 12-month symptoms; (b) Solely self-reported diagnosis; and (c) Surgical treatment for cataract in the past five years. Diabetes was based on self-reported diagnosis. Multivariable logistic regression was conducted to assess the associations.

RESULTS

Overall, the prevalence of diabetes was 3.1% (95%CI = 2.7-3.5%) and that of cataract based on the three different definitions was: (a) 13.3% (95%CI = 12.4-14.3%); (b) 4.4% (95%CI = 3.9-4.8%), (c) 1.7% (95%CI = 1.5-2.0%). After adjustment the association was significantly elevated: (a) OR = 2.10 (95%CI = 1.59-2.76); (b) OR = 2.62 (95%CI = 2.00-3.42); (c) OR = 2.80 (95%CI = 1.78-4.40). These associations were particularly pronounced among those aged <50 years.

CONCLUSIONS

A strong association between diabetes and cataract was observed in LMICs. Considering the impact on health and quality of life and the limited treatment options especially for cataract it is mandatory to promote the prevention through bi-directional screening and treatment.

A smartphone-assisted microfluidic chemistry analyzer using image-based colorimetric assays for multi-index monitoring of diabetes and hyperlipidemia

A smartphone-assisted microfluidic chemistry analyzer using an image-based colorimetric detection method was successfully developed for the simultaneous analysis of three diabetes- and hyperlipidemia-related indexes, glucose (GLU), triglyceride (TG), and total cholesterol (TC). A fan-shaped microfluidic chip was designed and optimized to reliably allocate a premixed serum sample into four reaction chambers by a simple pipetting. The color changes of the peroxidase-H₂O₂ enzymatic reactions in the chambers were captured and analyzed using a smartphone-controlled analyzer with a LED light source and a CCD camera. The highly quantitative relationships between the analyte concentrations and the color characteristic values of the green channel of the captured images were successfully established, enabling accurate and reproducible detections of GLU, TG, and TC simultaneously at a low cost. The parallel analyses of 111 serum samples using our system and a conventional chemistry analyzer were conducted, yielding an excellent correlation and consistency between these two systems. This study proved the feasibility of performing the multi-index monitoring of diabetes, hyperlipidemia, and other chronic diseases on a point-of-care platform at a high fidelity, but a low cost.

Prevalence of Self-Reported Diagnosed Cataract and Associated Risk Factors among Elderly South Africans

This paper estimates the prevalence of self-reported cataract and associated risk factors among individuals aged ≥50 years in South Africa. Data from a nationally-representative cross-sectional Study on Global AGEing and Adult Health (SAGE) (N = 3646) conducted in South Africa from 2007–2008 was analyzed. The primary outcome was self-reported cataract, and exposures included socio-demographics, self-reported co-morbidities, and behavioral factors. Linearized multivariate logistic regression models were used. The weighted prevalence of self-reported diagnosed cataract was 4.4% (95%CI: 3.4–5.8). Prevalence was greater among individuals with advancing age (10.2%), higher quality of life (QoL) (5.9%), education (5.2%), and wealth (5.8%) than their counterparts. Prevalence was also higher among individuals with depression (17.5%), diabetes (13.3%), hypertension (9.1%), and stroke (8.4%) compared to those without these conditions, with the exception of obesity (4.2%). In the final multivariate model, the odds of self-reported cataract were: 4.14 times higher among people ≥70 years than 50 to 59 year olds (95%CI: 2.28–7.50); 2.48 times higher in urban than rural residents (95%CI: 1.25–4.92); 5.16, 2.99, and 1.97 times higher for individuals with depression (95%CI: 1.92–13.86), hypertension (95%CI: 1.60–5.59), and diabetes (95%CI: 1.07–3.61), compared to those without these conditions.

"All I Need Is Help to Do Well": Herbs, Medicines, Faith, and Syncretism in the Negotiation of Elder Health Treatment in Rural Ghana

This qualitative research sought answers to questions about how elders in Agate, Ghana, coped with the challenges of illness in a rural village and in particular how they negotiated treatment for their illnesses within a flawed and limited healthcare system. In our study, 22 of 28 interviewees used all methods available to them (biomedical approaches [doctors and/or hospitals and/or doctor-prescribed medications], herbs, over-the-counter medicines [i.e., acetaminophen painkillers], and faith-based methods [praying/fasting/laying of hands/holy food and/or water]) in attempts to heal their illnesses. A syncretism existed in the negotiation of treatment options. All participants in our study used some form of what we term "Treatment Blending" (TBL), the use by a single participant of more than one of the aforementioned treatment methods for illness. Our research also revealed a widespread use of multiple spiritual systems (at the same time) and practitioner overlap (visiting a doctor, a traditional healer, and/or Christian pastor). Elders, in multiple cases, demonstrated the daily practice of one religion while seeking healing through another framework. TBL among our participants was a reflection of the lives elders lead in which illness and healing cannot be separated from the spiritual, the idea of an omnipresent God who is the ultimate "doctor," and ancient African traditions of herbs and rituals that possess deeper meaning for both physical and psychological healing and well-being. This ran parallel with the syncretism of religion itself in Ghana and suggests possible related paths through which to improve the healthcare system for elders in rural Ghana utilizing local faith-based groups and the elders themselves to assist.

Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives

The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Childbearing May Increase the Risk of Nondiabetic Cataract in Chinese Women's Old Age

Backgrounds. Ocular changes may arise during pregnancy and after childbirth, but very few studies have reported the association between childbearing and cataract among older adults. Methods. 14,292 individuals aged 60+ years were recruited in Xiamen, China, in 2013. Physician-diagnosed cataract and diabetes status were assessed by a self-reported questionnaire. Childbearing status was measured by number of children (NOC). Structural equation modeling (SEM) analysis was conducted to examine the relationships among NOC, diabetes, and cataract. Gender-specific logistic models regressing nondiabetic cataract on NOC were performed by adjusting some covariates. Results. 14,119 participants had complete data, of whom 5.01% suffered from cataract, with higher prevalence in women than men (6.41% versus 3.51%). Estimates of SEM models for women suggested that both NOC and diabetes were risk factors for cataract and that no correlation existed between NOC and diabetes. Women who had one or more children faced roughly 2–4 times higher risk of nondiabetic cataract than their childless counterparts (OR [95% CI] = 3.88 [1.24, 17.71], 3.21 [1.04, 14.52], 4.32 [1.42, 19.44], 4.41 [1.46, 19.74], and 3.98 [1.28, 18.10] for having 1, 2, 3, 4-5, and 6 or more children, resp.). Conclusions. Childbearing may increase the risk of nondiabetic cataract in Chinese women's older age.