Awareness regarding eye donation among stakeholders in Srikakulam district in South India

Background There is a huge need for the availability of transplantable donor corneas worldwide to reduce the burden of corneal blindness due to corneal opacity. Voluntary eye donation depends on the awareness levels of various stakeholders in the community. This study aimed to assess the awareness level regarding eye donation among various stakeholders in Srikakulam district in the state of Andhra Pradesh, India. Methods 355 subjects were selected from the district using multi stage random sampling. A pre tested semi structured questionnaire was used to collect information regarding each individual’s awareness, knowledge, and perception regarding eye donation. Each response was scored individually and a total score was calculated. Univariate and multivariate regression analysis was used to determine the factors associated with willingness towards eye donation and increased awareness levels. Results Of the 355 subjects interviewed, 192 (54%) were male and 163 (46%) were female. The mean age of the stakeholders was 35.9 years (SD ±16.1) and all the study subjects were literate. Ninety-three percent of subjects were aware of the concept of eye donation. Knowledge levels were similar among the teaching community and persons engaged in social service, but lower among students (p < 0.05). Among the stakeholders, there was considerable ambiguity regarding whether persons currently wearing spectacles or suffering from a chronic illnesses could donate their eyes. Older age group (p < 0.001), female gender (p < 0.001) and education (p < 0.001) were associated with increased knowledge levels. 82% of the subjects were willing to donate their eyes and this was unaffected by gender or geographical location (rural vs urban). Conclusions Awareness levels and willingness to donate eyes are high among the stakeholders in Srikakulam district in India. The services of stakeholders could be utilized, in conjunction with other community based eye donation counselors, to promote awareness regarding eye donation among the general population

Blindness in Childhood in Developing Countries: Time for a Reassessment?

Paul Courtright and colleagues argue that the changing patterns of global childhood blindness suggest a need to reassess research, training, and programmatic requirements

Evaluating the relationship between ciprofloxacin prescription and non-susceptibility in Salmonella Typhi in Blantyre, Malawi: an observational study

Background: Ciprofloxacin is the first-line drug for treating typhoid fever in many countries in Africa with a high disease burden, but the emergence of non-susceptibility poses a challenge to public health programmes. Through enhanced surveillance as part of vaccine evaluation, we investigated the occurrence and potential determinants of ciprofloxacin non-susceptibility in Blantyre, Malawi. Methods: We conducted systematic surveillance of typhoid fever cases and antibiotic prescription in two health centres in Blantyre, Malawi, between Oct 1, 2016, and Oct 31, 2019, as part of the STRATAA and TyVAC studies. In addition, blood cultures were taken from eligible patients presenting at Queen Elizabeth Central Hospital, Blantyre, as part of routine diagnosis. Inclusion criteria were measured or reported fever, or clinical suspicion of sepsis. Microbiologically, we identified Salmonella enterica serotype Typhi (S Typhi) isolates with a ciprofloxacin non-susceptible phenotype from blood cultures, and used whole-genome sequencing to identify drug-resistance mutations and phylogenetic relationships. We constructed generalised linear regression models to investigate associations between the number of ciprofloxacin prescriptions given per month to study participants and the proportion of S Typhi isolates with quinolone resistance-determining region (QRDR) mutations in the following month. Findings: From 46 989 blood cultures from Queen Elizabeth Central Hospital, 502 S Typhi isolates were obtained, 30 (6%) of which had either decreased ciprofloxacin susceptibility, or ciprofloxacin resistance. From 11 295 blood cultures from STRATAA and TyVAC studies, 241 microbiologically confirmed cases of typhoid fever were identified, and 198 isolates from 195 participants sequenced (mean age 12·8 years [SD 10·2], 53% female, 47% male). Between Oct 1, 2016, and Aug 31, 2019, of 177 typhoid fever cases confirmed by whole-genome sequencing, four (2%) were caused by S Typhi with QRDR mutations, compared with six (33%) of 18 cases between Sept 1 and Oct 31, 2019. This increase was associated with a preceding spike in ciprofloxacin prescriptions. Every additional prescription of ciprofloxacin given to study participants in the preceding month was associated with a 4·2% increase (95% CI 1·8–7·0) in the relative risk of isolating S Typhi with a QRDR mutation (p=0·0008). Phylogenetic analysis showed that S Typhi isolates with QRDR mutations from September and October, 2019, belonged to two distinct subclades encoding two different QRDR mutations, and were closely related (4–10 single-nucleotide polymorphisms) to susceptible S Typhi endemic to Blantyre. Interpretation: We postulate a causal relationship between increased ciprofloxacin prescriptions and an increase in fluoroquinolone non-susceptibility in S Typhi. Decreasing ciprofloxacin use by improving typhoid diagnostics, and reducing typhoid fever cases through the use of an efficacious vaccine, could help to limit the emergence of resistance. Funding: Wellcome Trust, Bill & Melinda Gates Foundation, and National Institute for Health and Care Research (UK)

Trachoma grading: Observer trials conducted in southern Malawi

A variety of grading schemes have been proposed for the clinical classification of inflammatory trachoma. During a population based study of ocular disease conducted in southern Malawi we tested a simplified version of the current WHO grading scheme. Intraobserver agreement statistics were less than satisfactory for three of four graders. Interobserver agreement when compared against either a well experienced standard ophthalmologist or a consensus grade improved over time for two of the three graders. However, initial agreement for all three graders was only fair to moderate. Previous studies of trachoma grading schemes support these unsatisfactory results. A new system of classification is needed that is both accurate and reliable in a field setting

Blindness and visual impairment in southern Malawi

There is a paucity of reliable information on the prevalence and causes of blindness in sub-Saharan Africa, and this produces problems in designing and evaluating blindness prevention programmes. To address this problem and to provide baseline data for the evaluation of such programmes, the government of Malawi, in conjunction with a number of agencies, conducted a population-based prevalence survey of ocular disease in the Lower Shire River Valley in southern Malawi, an area where blindness is common. The prevalence of bilateral blindness found (1.27%) is similar to that in other developing countries and represents a significant public health problem. At least 60% of this blindness is preventable or easily reversible

Blindness and visual impairment in southern Malawi

There is a paucity of reliable information on the prevalence and causes of blindness in sub-Saharan Africa, and this produces problems in designing and evaluating blindness prevention programmes. To address this problem and to provide baseline data for the evaluation of such programmes, the government of Malawi, in conjunction with a number of agencies, conducted a population-based prevalence survey of ocular disease in the Lower Shire River Valley in southern Malawi, an area where blindness is common. The prevalence of bilateral blindness found (1.27%) is similar to that in other developing countries and represents a significant public health problem. At least 60% of this blindness is preventable or easily reversible

The epidemiology of trachoma in southern Malawi

A popululation-based prevalence survey of ocular disease was conducted in the Lower Shire River Valley of Malawi 1983. A total of 5,436 children \u3c6 years of age and 1,664 persons ≥6 years were examined. The prevalence of inflammatory trachoma peaked in the 1-2-year-old age group at 48.7% and declined rapidly with age to \u3c5% by age 15. The prevalence of cicatricial trachoma was low in young children and climbed gradually with age to \u3e40% among those ≥50 years. Risk factors for inflammatory disease in young children included low socioeconomic status of the family, long walking distance to the household\u27s primary source of water, absence of a latrine in the family compound, and presence of trachoma among siblings. Indices of crowding practices were not associted with inflammatory disease. An apparent inverse association of facewashing and inflammatory trachoma in children did not hold up when adjusted for other risk factors