Analysis of an international collaboration for capacity building of human resources for eye care: case study of the college-college VISION 2020 LINK.

BACKGROUND: There is an extreme health workforce shortage in Eastern, Central, and Southern Africa. Shortage of eye care workers impedes effective implementation of prevention of blindness programs. The World Health Organization has identified education, partnership, leadership, financing, and policy as intertwined interventions that are critical to resolving this crisis on the long term. CASE PRESENTATION: The VISION 2020 LINK between the College of Ophthalmology of Eastern, Central, and Southern Africa and the Royal College of Ophthalmologists in the United Kingdom aims to increase the quantity and quality of eye care training in East, Central, and Southern Africa through a focus on five strategic areas: fellowship examination for ophthalmologists, training the trainers, curriculum development for residents in ophthalmology and ophthalmic clinical officers, continuous professional development (CPD), and mentoring program for young ophthalmologists. This study examined how education and partnership can be linked to improve eye care, through an evaluation of this north-south link based on its own targets and established frameworks to guide north-south links. METHODS: An exploratory qualitative case study design was used. Twenty-nine link representatives were recruited through purposive sampling and snowballing. Face-to-face interviews were conducted using a semi-structured interview schedule that incorporated the components of a successful link from an existing framework. Documents pertaining to the link were also examined. Thematic analysis was used for data analysis. RESULTS: The findings revealed that the perception to the contribution of the link to eye care in the region is generally positive. Process indicators showed that the targets in three strategic objectives of the link have been achieved. Framework-based evaluation also showed that the link is successful. Mutual learning and development of friendships were the most commonly identified success factors. Inadequate awareness of the link by college members is a key challenge. CONCLUSION: The study concludes that the link is active and evolving and has achieved most of its targets. Further developments should be directed to influence health system strengthening in Eastern, Central, and Southern Africa more strategically. The study recommends expansion of the scope of collaboration to involve multiple health system building blocks

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

Epidemiological and Genetic Considerations in Retinoblastoma

Retinoblastoma (Rb) is the most common primary intraocular malignancy of childhood. The incidence of Rb is stable worldwide at one case per 16,000–18,000 live births. It is estimated that 7800–8800 Rb cases were newly diagnosed globally in 2017. Over 80% of these are in low- and middle-income countries (LMICs) in Asia and Africa. So far, there is no validated evidence that retinoblastoma incidence is associated with gender, ethnicity or geographical factors. A link between human papillomavirus (HPV) and Rb is being investigated to establish its role in the pathophysiology of the sporadic form of the disease. Survival rates for Rb vary greatly between countries: while almost all Rb cases from high-income countries survive, cases in LMICs have a mortality rate of up to 70%

Patient satisfaction with trichiasis surgeryin Jigawa State, Nigeria

Purpose: Following the implementation of the SAFE (Surgery, Antibiotics, Facial Cleanliness, Environmental improvements) strategy for the control of trachoma in Jigawa state, ophthalmic nurses trained as lid surgeons perform trichiasis surgery in the state. This study aims to assess patient satisfaction with surgical results and trichiasis surgery services in the state.Methods: A retrospective cohort study of patients operated on for the first time between December 2012 and April 2013. Patients were examined for presence of recurrent trichiasis, eyelid contour abnormality and eyelid closure defects. Aspecially designed and pretested questionnaire was administered to each participant with questions about satisfaction with services, results, their opinion and recommendation.Results: Seventy-seven patients were examined. Fifty-six (73%) participants were female. The mean age of the participants was 54.9 years (±17.8 years) with a range of 8 to 90 years; females tended to be older but not statistically significantly so. We found that 97% were satisfied with the timing of operation and 97% were satisfied with staff conduct; subjective vision was better in 66%, post operative appearance was good in 82%; while expectation was met in 95%. Overall, 96% were of the opinion that surgery was helpful, while 97% of patients were willing to recommend the surgery to their family and friends.Conclusion: Patient satisfaction with results of trichiasis surgery and services in Jigawa state is high.Keywords: patient, satisfaction, trichiasis surgery, Jigawa State, Nigeri

Barriers to using assistive technology among students with visual disability in schools for the blind in Delhi, India.

BACKGROUND: Students with visual loss may benefit from assistive technology (AT) for their educational activities. AIM: To understand the barriers faced in using ATs by students who have heard of ATs and reported needing them, but were not using (acquainted students), at schools for the blind in Delhi. METHODS: Two hundred and fifty students were selected randomly from ten schools for the blind in Delhi and screened for presenting and pinhole binocular distance vision using a modified 'E' chart and multiple pinhole occluder. Students were divided into two groups; 1/60 or better vision (likely to benefit from vision-based AT) and <1/60 vision, (likely to benefit from tactile/sound-based AT). Awareness of, and need for, ATs was investigated for each student with a questionnaire. Then information on barriers to using AT was obtained from students who knew about AT, felt they needed AT, but were not using them. This information was collected for a total of 42 ATs. RESULTS: The three most requested tactile/sound-based ATs for the 250 students were talking watch, Braille typewriter and audio format. The three most requested vision-based ATs in 69 (27.6%) students who had presenting or pinhole visual acuity less than 6/18 to 1/60 were near optical magnifiers, electronic magnifiers and large keyboard for computer. Non-availability of ATs in schools was the most common perceived barrier (43% of overall responses), followed by economic constraints (20% of responses). CONCLUSION: Non-availability or limited possession of ATs and financial constraints were the major barriers to use of ATs among students.IMPLICATION FOR REHABILITATIONStudents with visual disability face many challenges in accessing assistive technology for their education learning, especially in low middle-income countries.Non-availability and limited possession of assistive technology by schools for the blind are main barriers in the study.School authorities must recognize their responsibility to ensure assistive technology (academic and non-academic related, visual and non-visual based) are made accessible for their students with adequate quantity.Future studies should focus on all school age children in the community rather than focusing on school going children

Assistive technology for visual impairment and trainers at schools for the blind in Delhi.

The aim of the study was to assess the availability of assistive technology (AT) for visual impairment and trainers in schools for the blind in Delhi. A cross-sectional study was conducted in 22 of the 24 schools in Delhi. The headteacher of each school was asked about availability of 52 ATs divided into writing, reading, math, sciences, sports, mobility, and daily living, using a questionnaire. Information on availability of trainers was also collected. Of the 52 ATs, the most frequently available were Braille slate with stylus and abacus (>90% of schools), followed by Taylor frame, long cane and talking watch (80% to 90% of schools). Only 11 of 52 AT devices were available in 60% or more of the schools. Tactile-based ATs were more available than vision-based ATs. In the 22 schools, 63 trainers for reading & writing were available (80% of posts), 18 for sciences (59%), 25 for math (70%), and 11 for mobility (50% of posts). Except Braille slate and stylus, there is a huge shortage of AT in these schools. The educational needs and performance of students could be helped by developing and using a list of priority Assistive Products for example, the WHO AP list

Assistive technology for students with visual disability in schools for the blind in Delhi.

Background: To understand the awareness and utilization of assistive technology in students at schools for the blind in Delhi.Methods: A cross sectional study was conducted among 250 students selected randomly from 10 blind schools in Delhi. Binocular distance presenting and pinhole vision acuity were assessed using Snellen "E" chart and a multiple pinhole occluder. Students were also interviewed using a questionnaire about 42 assistive devices to understand their awareness and use.Results: Male participants were 72.8%. Of the total, 27.6% students had best corrected visual acuity <6/18 to 1/60, and the rest had <1/60 vision. The awareness about tactile and sound-based technology was good among students: Braille books (98%), Braille slate and stylus (99.2%), handheld audio recorders (77.6%) and screen readers (77.2%). Good awareness was reported for abacus (88.8%), walking long canes (94.4%) and smart cane (89.6%), audible balls (96%), Braille chess (82.8%) and talking watch (98%). Among the students with <6/18 to 1/60 vision, the awareness of visual based technology ranged from 0.8% (typoscope) to 43.6% (video magnifiers). Braille technology was used for reading by 96.4% (books) and for writing by 96.8% (Braille slate and stylus) irrespective of visual status. Other devices were poorly used ranging from nil (typoscope) to 55% (screen readers). The use of math and science learning devices was poor (<20%). Walking canes were used by 59% of students whereas 87.2% students used audible ball for games.Conclusion: The results showed that majority of students used tactile based technology irrespective of visual status.Implications for rehabilitationStudents with visual disability need assistive technology for a wide range of activities including academic learning.Students in schools for the blind who have binocular best corrected vision acuity of 1/60 or better should be encouraged to use visual based assistive technology instead of tactile based.Students with binocular best corrected vision acuity less than1/60 should be encouraged to use other available tactile and sound-based assistive technologies as well as Braille books and Braille slate and stylus for their academic activities including maths and sciences.Teachers should be trained in the use of various assistive technologies for reading, writing, maths, sciences, sports, mobility and activities of daily living

Trends in cataract surgical rate and resource utilisation in Egypt.

PURPOSE: To describe cataract services in Egypt and explore resources and practices in public and private sectors. METHODS: The study was conducted between June and August 2015. All facilities in the country providing cataract services were contacted to obtain information on surgeries performed in 2014. Hospitals performing eye surgery in Quena, Sharkia, and Fayoum regions were visited and a questionnaire on resources for cataract surgery was completed. RESULTS: Cataract surgery was offered in the public sector by 64 government and 16 university teaching hospitals and in the private sector by 101 hospitals. Over 90% of all facilities in the country contacted participated in the study. In 2014, the national cataract surgical rate (CSR) was 3674 varying in governorates from 7579 in Ismailia to 402 in Suez. The private sector performed 70% of cataract surgeries. Analysis of three regions showed an 11.7% increase in cataract output between 2010 and 2014. The average number of cataract surgeries per unit in 2014 was 2272 in private, 1633 in university, and 824 in government hospitals. Private hospitals had 60% of human resources for eye care. Phacoemulsification was the surgical technique in 85.6% of private, 72.1% of university, and 41% of government hospitals. Reasons explaining the differences in output between public and private sectors were the lack of trainers, supervisors, and incentives. CONCLUSION: The private sector provides most of the cataract services in Egypt, resulting in inadequate services for the poor. There is a 15-fold variation in CSR between the best and least served regions. The public sector could increase cataract output by improving training, supervision, and incentives

Predictors of uptake of eye examination in people living with diabetes mellitus in three counties of Kenya.

BACKGROUND: Diabetic retinopathy (DR) is a significant public health concern that is potentially blinding. Clinical practice guidelines recommend annual eye examination of patients with diabetes for early detection of DR. Our aim was to identify the demand-side factors that influence uptake of eye examination among patients already utilizing diabetes services in three counties of Kenya. METHODS: We designed a clinic based cross-sectional study and used three-stage sampling to select three counties, nine diabetes clinics in these counties and 270 patients with diabetes attending these clinics. We interviewed the participants using a structured questionnaire. The two outcomes of interest were 'eye examination in the last 12 months' and 'eye examination ever'. The exposure variables were the characteristics of participants living with diabetes. RESULTS: The participants had a mean age of 53.3 years (SD 14.1) and an average interval of 4 months between visits to the diabetes clinic. Only 25.6% of participants had ever had an eye examination in their lifetime, while 13.3% had it in the preceding year. The independent predictors of uptake were referral by diabetes services, patient knowledge of diabetes eye complications, comorbid hypertension and urban or semi-urban residence. CONCLUSIONS: We conclude that access to retinal examination for DR is low in all three counties. An intervention that increases the knowledge of patients with diabetes about eye complications and promotes referral of patients with diabetes for eye examination may improve access to annual eye examination for DR

Authors’ Response to Peer Reviews of “Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention”

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