Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings

In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.

Prevalence, predictors and reasons for home delivery amongst women of childbearing age in Dodoma Municipality in central Tanzania

Introduction

The objective was to determine the prevalence, predictors and reasons for home delivery amongst women of childbearing age in Dodoma, Tanzania.

Methods

A cross-sectional study was conducted amongst women living in Dodoma Municipality. Data were collected using adapted questionnaires and analysed using SPPS version 23. A multivariable logistic regression model was used to assess the independent predictors of home delivery.

Results

A total of 425 women of childbearing age were enrolled in this study. The mean (± SD) age of the participants was 28.7 (±7.1) years. The prevalence of home delivery was 35.5% (n=150, 95% CI 30.9 – 40.2). Women with secondary school and above had 93% less odds of home delivery than women who had no education (AOR=0.0795% CI: 0.03–0.18). Women who lived in rural areas (AOR=3.49, 95% CI: 2.12–5.75), and women living more than 5km from health facilities (AOR=2.67, 95% CI: 1.65–4.37) had higher odds of home delivery. The main reasons for home delivery were transportation cost, and long distance to the nearest health facilities.

Conclusion

In this population, the prevalence of home delivery remained to be high. To address this more collaborative multisectoral effort like strengthening health education and strengthening maternity waiting homes are needed.

The use of a newspaper insertion to promote DIY testing of vision in India

BACKGROUND

The mass media have the potential to motivate people to participate in self appraisal of their own health status. An innovative communication package was designed to help people to examine vision at home. The impact of publishing the "do it yourself" (DIY) kit in Indian newspapers was evaluated.

METHODS

A pretested bilingual vision testing kit was published in three newspapers. The kit comprised four tumbling Es corresponding to 6/12 line of Snellen's optotypes. Directions on using the kit were enclosed. 3 -7 days after publication of the kit, a telephone survey of newspaper readers was undertaken to evaluate the impact and cost effectiveness.

RESULTS

603 people were contacted over the telephone. 125 (20.73%) subscribed to the newspaper carrying the DIY insertion. 43.2% (54) noticed the insertion of which 88.89% (48) read the enclosed instructions carefully. 58.33% respondents felt sufficiently motivated to contact an ophthalmologist. Graduates had a 3.83 times higher probability of reading the communication insertion compared with others. Differences in relation to other demographic variables were not statistically significant.

CONCLUSIONS

Newspapers are an excellent medium for communicating self appraisal kits for vision testing. The medium is cost effective and has significant reach in the urban agglomerates of India.

Intralenticular foreign bodies: report of eight cases and review of management

PURPOSE

The management of intralenticular foreign bodies (ILFBs) with or without cataract has varied from time to time in the last century. We evaluated the surgical removal of the ILFBs with cataract extraction as a single-stage procedure.

METHODS

Eight consecutive cases with intralenticular foreign bodies presenting to the trauma centre at our institute, were included in the study. Planned ILFB removal with cataract extraction and IOL implantation as a single-stage procedure was done in all the patients. They were followed up from 2 months to 2 years after the surgery.

RESULTS

ILFBs were removed with Kelman-Mcpherson forceps in seven cases and in one it was expressed with the nucleus during extra capsular cataract extraction. Co-existent posterior capsular tears were seen in two eyes, of which only one needed a localized vitrectomy. Posterior chamber intraocular lens implantation was possible without any complication in all the cases. Postoperative uveitis seen in three cases was easily controlled with periocular steroids. Best corrected visual acuity at last examination was 6/9 or better in 7 cases and 6/12 in one case with posterior capsular opacification.

CONCLUSIONS

Timing and necessity of ILFB removal may be adjusted according to the foreign body characteristics and associated ocular trauma, choosing, as far as possible, the least traumatic procedure. Use of forceps rather than magnets is safer for the removal of the ILFB. Co-existent posterior capsular tears need to be anticipated and dealt with when encountered.

Scleral-fixated intraocular lens implantation in unilateral aphakic children

OBJECTIVE

To assess the feasibility of scleral-fixated intraocular lens (IOL) implantation as an alternative form of optical correction in aphakic children intolerant of contact lenses and whose anterior segments lack capsular support.

DESIGN

Prospective, noncomparative case series.

PARTICIPANTS

A total of 11 eyes of 11 unilateral aphakic children in the age group 4 to 9 years (mean, 6.45 years) were included in the study.

INTERVENTION

Secondary scleral-fixated IOL implantation was performed in all cases. The patients underwent anterior vitrectomy at the time of IOL implantation. Amblyopia therapy in the form of patching was given post-IOL surgery. The follow-up ranged from 4 to 18 months (mean, 10.90 months).

MAIN OUTCOME MEASURES

Postoperative best-corrected visual acuity (BCVA) in comparison to preoperative visual status and complications from the procedure were analyzed.

RESULTS

Postoperative BCVA remained within 1 Snellen line of the preoperative visual status in six eyes, or 54.5% of patients; it improved by more than 1 Snellen line in three eyes, or 27.2% of patients, and decreased by more than 1 Snellen line in two eyes, or 18.1% of patients. The complications encountered were suture erosion through the conjunctiva in two eyes (18.18%), marked postoperative anterior chamber reaction in two eyes (18.18%), IOL decentration in one eye (9.09%), glaucoma in one eye (9.09%), and cystoid macular edema in one eye (9.09%).

CONCLUSION

Secondary scleral-fixated IOL implantation was successful in achieving BCVA comparable to preoperative BCVA. However, a longer follow-up is required to document any further complications.

Mitomycin-C in congenital glaucoma

BACKGROUND AND OBJECTIVE

To evaluate the adjunctive use of mitomycin-C (MMC) during trabeculotomy and trabeculectomy for eyes with high-risk congenital glaucoma.

PATIENTS AND METHODS

A prospective, randomized, double-blind study was performed to compare the effect of a single, 4-minute intraoperative exposure to 0.2 mg/ml (group 1) or 0.4 mg/ml (group 2) of MMC on trabeculotomy with trabeculectomy in 16 high-risk cases (30 eyes) of congenital glaucoma.

RESULTS

The preoperative and final postoperative intraocular pressures (IOPs) of the two groups did not differ significantly. At the final follow-up, IOP control (< 21 mm Hg) without medications was achieved in 60% of the eyes in group 1 and in 86.67% of the eyes in group 2 (P = 21). With medication, IOP control was achieved in 86.7% of the eyes of each group. In both groups, the rate of surgical failure was 13.3%. Avascular, thin, sharply demarcated blebs were noted in 33.3% of the eyes from group 1 and in 66.67% of those from group 2 (P = .14). Intraoperative and postoperative hyphema and postoperative hypotony were the complications encountered in both groups, whereas serous choroidal detachment and wound leakage were seen only in group 2.

CONCLUSIONS

Intraoperative MMC applied at a concentration of 0.2 mg/ml controlled postoperative IOP as effectively as a 0.4-mg/ml concentration in high-risk cases of congenital glaucoma, but with a lower incidence of complications and thin-walled blebs.

Black corneal ulcer

PURPOSE

To discuss the etiology of an unusual finding of black color in a corneal ulcer.

METHODS

Smear examination and culture of the corneal scraping were undertaken.

RESULTS

The causative organism was found to be Aspergillus ruger.

CONCLUSION

Black color in the corneal ulcer is attributed to Aspergillus niger.