Barriers to Accessing Eye Health Services in Suburban Communities in Nampula, Mozambique

Globally, an estimated 2.2 billion people are visually impaired (VI) or blind, and a large proportion (90%) of those affected live in low- and middle-income countries (LMICs), where access to eye health services is limited. This study aimed to identify barriers to accessing eye health services and associated factors in suburban communities of Nampula. A cross-sectional community-based study was carried out on adults ≥18 years old. A total of 338 adults were randomly selected from three communities (Muthita, Piloto, and Nthotta). Individual interviews were carried out and socio-demographic data, eye symptoms, date of last eye examination, and barriers to access to eye health services were extracted. Among participants, 49.4% had eye symptoms and 41.7% did not have their eye examinations up to date. The most cited barriers were crowding in hospitals (40.7%), financial difficulties (30.0%), self-medication (20.5%), traditional treatment (17.8%), and buying eyeglasses on the street (11.6%). Barriers limited the service target to 33%. Lower levels of schooling and monthly family income and farmer occupation were statistically associated with the most barriers as risk factors. The use of eye health services was lower due to barriers to accessing eye services. More specific intervention plans and greater cooperation between sectors are needed to improve these indicators

Computer vision syndrome and associated factors in university students and teachers in Nampula, Mozambique

Background Computer Vision Syndrome (CVS) is a complex of eye and visual problems that arise while using a computer or other Video Display Terminal (DVT). With the advent of the COVID-19 pandemic, the use of these DVTs has become indispensable in the lives of students and teachers. This study aims to identify the prevalence of CVS and associated factors in students and teachers at Lúrio University, in Nampula, during the pandemic period. Methods This is a cross-sectional study, carried out between November 2020 and March 2021. The validated CVS questionnaire (CVS-Q) and another semi-structured questionnaire on ergonomic risk factors were applied. Odds ratios (OR) and adjusted odds ratios (aOR) were calculated to measure the association between CVS and computer use conditions. Results The prevalence of CVS was 76.6%, and the female gender, age ≤ 20 years, levels I, II, III of course, lack of knowledge about ergonomics, use the computer to study, use more than 6 hours daily, absence of anti-reflex treatment, use of other devices and sitting in an inappropriate chair were risk factors for the occurrence of CVS, while being a teacher was a protective factor. Conclusion The prevalence of CVS found in this study was high, due to several factors, especially not using ergonomic principles when using computers and other DVTs. There is a need to adopt intervention strategies focused on the most vulnerable groups such as women, age group ≤20 years and students, especially at the first year level, right after entering the University

The Prevalence of Visual Impairment and Refractive Errors among a Youth Population in Mozambique: Evidence of the Need for Intervention

Visual impairment (VI) can significantly interfere in the child’s daily activities and quality of life, having a negative effect on their development and learning. The aim of the study was to determine the prevalence of VI and associated demographic factors in students examined during the program “Moçambique te vejo melhor”. This study was cross-sectional and retrospective, based on the 2018/19 edition of the program. Eye examinations were performed in secondary school students, aged between 12 and 20 years, of five districts in Nampula province. The examination included visual acuity, non-cycloplegic refraction and assessment of the anterior and posterior segment and ocular adnexa. The prevalence of uncorrected, presenting and best-corrected VI found was 18.3%, 10.8%, and 5.0%, respectively. Refractive error (RE) had a prevalence of 24.7%, and the age groups between 15–17 years and 18–20 years were significantly associated with myopia (with OR: 4.9 and OR: 8.8, respectively), as well as the 11th and 12th grade (OR: 8.1 and OR: 10.7, respectively), and Malema district had association with myopia (ORa: 0.4) and hyperopia (ORa: 0.4 and OR: 0.3) as a protective factor. The prevalence of RE and VI was relatively high, showing the need for greater intervention at the school level.The “Moçambique te vejo melhor” program is fully funded by Lurio University

The Prevalence of Visual Impairment and Refractive Errors among a Youth Population in Mozambique: Evidence of the Need for Intervention

Visual impairment (VI) can significantly interfere in the child’s daily activities and quality of life, having a negative effect on their development and learning. The aim of the study was to determine the prevalence of VI and associated demographic factors in students examined during the program “Moçambique te vejo melhor”. This study was cross-sectional and retrospective, based on the 2018/19 edition of the program. Eye examinations were performed in secondary school students, aged between 12 and 20 years, of five districts in Nampula province. The examination included visual acuity, non-cycloplegic refraction and assessment of the anterior and posterior segment and ocular adnexa. The prevalence of uncorrected, presenting and best-corrected VI found was 18.3%, 10.8%, and 5.0%, respectively. Refractive error (RE) had a prevalence of 24.7%, and the age groups between 15–17 years and 18–20 years were significantly associated with myopia (with OR: 4.9 and OR: 8.8, respectively), as well as the 11th and 12th grade (OR: 8.1 and OR: 10.7, respectively), and Malema district had association with myopia (ORa: 0.4) and hyperopia (ORa: 0.4 and OR: 0.3) as a protective factor. The prevalence of RE and VI was relatively high, showing the need for greater intervention at the school level

Panorama de la Salud Ocular en Nampula, Mozambique

Antecedentes: La visión es fundamental para la integración del individuo en el medio externo, para la realización de las actividades cotidianas y para que tenga una vida social funcional. La aparición de patologías o alteraciones oculares puede ocasionar discapacidad visual (DV), que a su vez repercute negativamente en la calidad de vida del individuo, su familia y la sociedad en general, pudiendo ocasionar enormes pérdidas económicas. Objetivo general: Analizar el panorama de la salud ocular en Nampula, Mozambique. Objetivos específicos (OE): OE1: Determinar la prevalencia de la DV, sus causas y factores asociados en niños (65 años (OR: 29.1), analfabetos (OR: 13.8), nivel escolar primario (OR: 4.8) y secundario (aOR: 37.5), ocupación de agricultor (OR: 32.8) y jubilado (OR: 14.3) y presencia de enfermedades sistémicas (OR: 3.3). Las principales causas de discapacidad visual presente fueron el error refractivo no corregido y la catarata. OE2. Entre los participantes, 49.4% tenían síntomas oculares y 41.7% no tenían sus exámenes oftalmológicos al día. Las barreras para acceder a los servicios de atención oftalmológica más citadas fueron el hacinamiento en los hospitales (40.7%), las dificultades financieras (30.0%), la automedicación (20.5%), el tratamiento tradicional (17.8%) y la compra de gafas en la calle (11.6%). Los niveles más bajos de educación e ingreso familiar mensual, y la ocupación de agricultor se asociaron estadísticamente con la mayoría de las barreras como factores de riesgo. OE3. La provincia de Nampula no ha alcanzado la proporción recomendada de profesionales de la salud ocular por población en las diferentes categorías (técnicos oftálmicos con 0.8 por 100 mil habitantes; optometristas y oftalmólogos con 0.4 y 0.2 por 250 mil habitantes, respectivamente). También hubo una distribución desigual de los profesionales de la salud ocular en toda la provincia, con una mayor concentración de profesionales en la capital provincial (Ciudad de Nampula), por lo que la mayoría de los distritos no alcanzaron la proporción recomendada, presentando un balance negativo. Las unidades de salud de nivel primario y secundario carecían de algunos equipos para ofrecer servicios de salud ocular a su nivel. Todas las unidades de salud cuentan con tablas de medición de la agudeza visual, juegos de lentes de prueba y gafas de prueba. Sin embargo, existe falta de equipos para ofrecer servicios de refracción como retinoscopios, autorefractómetros y frontofocómetro en unidades de salud primarias y secundarias. El Hospital Central de Nampula es la única unidad con equipamiento para ofrecer servicios quirúrgicos en Nampula. OE4. Las versiones adaptadas al contexto mozambiqueño de los cuestionarios FV y QV mostraron buenas propiedades psicométricas. La diferencia entre AV, FV y QV antes y después de la cirugía fue estadísticamente significativa (p < 0.001), hubo una mejoría significativa después de la cirugía, y el tamaño del efecto fue mayor en las sub-escalas “percepción” y “mental”, respectivamente. Después de la cirugía, el 74.3% de los pacientes tenían buena AV, el 23.5% limite y el 2.2% mala AV. Conclusiones: La prevalencia de DV en niños y adultos es relativamente alta y se debe principalmente a causas prevenibles o tratables. La población ha enfrentado varias barreras para acceder a los servicios de salud ocular, en particular el hacinamiento en los hospitales y las dificultades económicas, por lo cual, la utilización de los servicios de salud ocular en la periferia urbana de la capital provincial ha sido menor a lo esperado y se supone que sea aún peor en los otros distritos fuera de la capital, ya que la disponibilidad de recursos humanos y materiales de salud ocular es más limitada. Los servicios de cirugía están centralizados a nivel del HCN (en la capital), lo que compromete la cobertura de los servicios de cirugía de catarata en la provincia de Nampula. Los pacientes se someten a cirugía de cataratas cuando algunos aspectos de su FV y QV ya están gravemente comprometidos, y los resultados de las cirugías realizadas en HCN aún no han alcanzado las recomendaciones de la OMS con respecto a AV, pero tienen un gran impacto en la FV y QV de los pacientes. Existe la necesidad de una mayor intervención con respecto a salud ocular en Nampula, especialmente para que los servicios de salud ocular estén disponibles para los más vulnerables, como las personas de bajos ingresos, las personas analfabetas, los jubilados y los agricultores

Visual impairment and associated factors in adults from three suburban communities in Nampula, Mozambique

Clinical relevance: Scientific evidence on the burden of visual impairment, its causes, and associated factors are essential to monitor progress in eye health, identify priorities and develop strategies and policies that meet the needs of the population, towards the eradication of preventable blindness. Background: The aim of this study was to determine the prevalence of visual impairment, its causes and associated factors in adults living in suburban communities in Nampula. Methods: This is a cross-sectional study conducted from November 2019 to February 2020. Eye examinations were performed on adults aged ≥18 years covered by the Lúrio University program, ‘one student, one family’. The odds ratio (OR) and adjusted odds ratio (aOR) were calculated to study the association between the dependent variable (presenting visual impairment) and independent variables (gender, age, school level, residence, family income and systemic diseases), with a 95% confidence interval. Results: Distance and near presenting visual impairment had a prevalence of 16.3% and 21.1%, respectively, and were statistically associated with the age groups between 45–65 (OR:4.9) and >65 years (OR: 29.1), illiterate (OR:13.8), primary (OR:4.8) and secondary (aOR:37.5) school level, farmer (OR:32.8) and retired (OR:14.3) occupation, and presence of systemic diseases (OR :3.3). The main causes of presenting visual impairment were uncorrected refractive error and cataract. Conclusion: The prevalence of presenting visual impairment is relatively high, given the enormous effort undertaken within the framework of VISION 2020: The Right to Sight global initiative. There is a need to develop intervention plans targeted at the highest risk groups, with a view to achieving the ‘one student, one family’ program goals with respect to eye health

Assessment of cataract surgery outcomes in Nampula (Mozambique): visual acuity, visual function and quality of life

Background Despite advances in surgical techniques, cataract remains the leading cause of preventable blindness, and massive surgeries have been adopted as a strategy to change this situation. Monitoring the results of cataract surgeries has become imperative to ensure their quality. Therefore, this study aims to assess the cataract surgery outcomes performed at the Central Hospital of Nampula Mozambique. Methods This is a prospective and longitudinal study in which translation, cultural adaptation and validation of the visual function (VF) and quality of life (QoL) questionnaire were performed. The appearance, content, construct, criterion, internal consistency and responsiveness were validated using the most common methods and indicators. Visual acuity (VA), VF and QoL were evaluated on 447 patients before and after surgery by t-test and effect sizes. Results VF and QoL questionnaires showed one-dimension, good values of TLI (0.973, 0.951) and SRMR (0.057, 0.054), and for each item, weights > 0.7, H2 > 0.5, ranges > 5.8 and the RMSEA < 0.08. Correlations for criterion validity were high and for responsiveness were high for QoL and moderate for VF one and the ordinal Cronbach’s alpha coefficients were greater than 0.97. Difference between VA, VF and QoL before and after surgery was statistically significant (p < 0.001). After surgery, 74.3% of patients had good, 23.5% had borderline and 2.2% had poor VA. Conclusions The cataract surgery outcomes are outside the WHO recommendations regarding VA, but they have had a great impact on improving VF and QoL. The questionnaires showed excellent psychometric properties and should be used in daily clinical practice to evaluate the results of cataract surgeries.Funding for open access publishing: Universidad de Sevilla/CBU