A Rapid Assessment of Avoidable Blindness in Southern Zambia

INTRODUCTION: A rapid assessment of avoidable blindness (RAAB) was conducted in Southern Zambia to establish the prevalence and causes of blindness in order to plan effective services and advocate for support for eye care to achieve the goals of VISION 2020: the right to sight. METHODS: Cluster randomisation was used to select villages in the survey area. These were further subdivided into segments. One segment was selected randomly and a survey team moved from house to house examining everyone over the age of 50 years. Each individual received a visual acuity assessment and simple ocular examination. Data was recorded on a standard proforma and entered into an established software programme for analysis. RESULTS: 2.29% of people over the age of 50 were found to be blind (VA <3/60 in the better eye with available correction). The major cause of blindness was cataract (47.2%) with posterior segment disease being the next main cause (18.8%). 113 eyes had received cataract surgery with 30.1% having a poor outcome (VA <6/60) following surgery. Cataract surgical coverage showed that men (72%) received more surgery than women (65%). DISCUSSION: The results from the RAAB survey in Zambia were very similar to the results from a similar survey in Malawi, where the main cause of blindness was cataract but posterior segment disease was also a significant contributor. Blindness in this part of Zambia is mainly avoidable and there is a need for comprehensive eye care services that can address both cataract and posterior segment disease in the population if the aim of VISION 2020 is to be achieved. Services should focus on quality and gender equity of cataract surgery

Mortality from non-communicable diseases and associated risk factors in Zambia; analysis of the sample vital registration with verbal autopsy 2015/2016

Abstract Background Non-communicable diseases (NCDs) are the world’s growing cause of preventable illness, disability, morbidity, and mortality which account for 71% of deaths. The aim of this study was to determine the factors associated with mortality from NCDs among persons aged 15 years and above in Zambia. Methodology The study used data from Sample Vital Registration with Verbal Autopsy (SAVVY) 2015/16 (Zambia). A total of 3529 Verbal Autopsy were completed in the study, with only 2599 of death where among people aged 15 years and above. Three-level data analysis was applied; univariate analysis, bivariate analysis, and multivariate analysis (binary logistic regression). Findings The overall number of deaths from NCDs was 28.81%. Stratified analysis by gender showed that deaths from NCDs were higher among women (32.60%) as compared to men (26.25%). Among all persons, dying from NCDs was associated with tobacco use, age, and education. Tobacco use was negatively associated with mortality from NCDs (adjusted odds ratio [aOR] = 0.68; 95% confidence interval [CI]: 0.48–0.98). Age was positively associated with the odds of dying from NCDs among persons aged 45–59 years (aOR = 3.87, 95% CI: 2.13–7.01), 60–74 years (aOR = 12.05, 95% CI: 6.44–22.55), and 75 + years (aOR = 15.16, 95% CI: 7.93–28.97). The likelihood of dying from NCDs was higher among persons with secondary education as compared to those with no education (aOR = 1.93, 95% CI: 1.11–3.33). Conclusion The findings from this study suggest that public health interventions targeting NCDs need to consider behavioural factors, especially tobacco use which exposes people to second-hand smoke. We also recommend large-scale national-level studies to further examine the contribution of each factor leading to mortality from NCDs

Costs of eye care services: prospective study from a faith-based hospital in Zambia.

PURPOSE: To estimate the mean costs of cataract surgery and refractive error correction at a faith-based eye hospital in Zambia. METHODS: Out-of-pocket expenses for user fees, drugs and transport were collected from 90 patient interviews; 47 received cataract surgery and 43 refractive error correction. Overhead and diagnosis-specific costs were determined from micro-costing of the hospital. Costs per patient were calculated as the sum of out-of-pocket expenses and hospital costs, excluding user fees to avoid double counting. RESULTS: From the perspective of the hospital, overhead costs amounted to US$31 per consultation and diagnosis-specific costs were US$57 for cataract surgery and US$36 for refractive error correction. When including out-of-pocket expenses, mean total costs amounted to US$128 (95% confidence interval [CI] US$96--168) per cataract surgery and US$86 (95% CI US$67--118) per refractive error correction. Costs of providing services corresponded well with the user fee levels established by the hospital. CONCLUSION: This is the first paper to report on the costs of eye care services in an African setting. The methods used could be replicated in other countries and for other types of visual impairments. These estimates are crucial for determining resources needed to meet global goals for elimination of avoidable blindness

Additional file 1 of Mortality from non-communicable diseases and associated risk factors in Zambia; analysis of the sample vital registration with verbal autopsy 2015/2016

Supplementary Material

Percentage of poor outcomes with and without IOL insertion following cataract surgery in Southern Zambia compared to the WHO recommendations.

<p>Percentage of poor outcomes with and without IOL insertion following cataract surgery in Southern Zambia compared to the WHO recommendations.</p

Reasons given for not having cataract surgery.

<p>Reasons given for not having cataract surgery.</p

Prevalence of Visual Loss by Gender.

<p>Prevalence of Visual Loss by Gender.</p

Juvenile-onset Open-Angle Glaucoma at the University Teaching Hospitals - Eye Hospital, Lusaka Zambia

Purpose: To demonstrate the socioeconomic, demographic and clinical characteristics associated with patients of juvenile-onset open- angle glaucoma (JOAG) at the University Teaching Hospitals Eye Hospital (UTHs - EH).Methods: This was a cross-sectional survey for Juvenile Open Angle Glaucoma (JOAG) conducted at the UTHs - EH in, Lusaka, Zambia from January to December 2013. All participants aged between 18 and 39 years had a full ocular examination after capturing&nbsp; demographic and socioeconomic information. The ocular examination included visual acuity, intraocular pressure (IOP) and cup disc ratio (CDR) and tests performed were central corneal thickness (CCT) and visual fields. Severity was graded based visual field (VF) in the worse eye using the advanced glaucoma intervention study score. Univariate and multivariate logistic regression, stratified by age group and gender, was used to determine the association between demographic factors and JOAG and between clinical factors and JOAG.Results: Of the 1625 patients recruited for the study, 309 were POAG patients. Of the 309 POAG patients, 140 aged 20 to 39 years old had bilateral JOAG. The distribution of the 140 participants was 98 (70.9%) females and 42 (29.4%) males. Thirteen (9.3 %) were aged 20 – 24 years, 29 (20.7%) 25 – 29 years, 44 (31.4%) 30 – 34 years, and 54 (38.6%) 35 – 39 years. The mean age of the patients was 25.1 ± SD 8.7 years. The prevalence of JOAG was 8.6% Keywords: Juvenile-onset open-angle glaucoma (JOAG), cup disc ratio (CDR), primary open-angle glaucoma (POAG), visual field (VF),&nbsp; intraocular pressure (IOP), family histor

Editorial essay: Covid-19 and protected and conserved areas

The COVID-19 pandemic is having a dramatic impact on the global community; on people’s lives and health, livelihoods, economies, and behaviours. Most zoonotic disease pandemics, including COVID-19, arise from the unsustainable exploitation of nature. This special editorial provides a snapshot of how protected and conserved areas around the world are being impacted by COVID-19. For many protected and conserved areas, negative impacts on management capacity, budgets and effectiveness are significant, as are impacts on the livelihoods of communities living in and around these areas. We provide a commentary on how effectively and equitably managed systems of protected and conserved areas can be part of a response to the pandemic that both lessens the chance of a recurrence of similar events and builds a more sustainable future for people and nature. We conclude the editorial with a Call for Action for the rescue, recovery, rebuilding and expansion of the global network of protected and conserved areas