Patients' Preoperative Expectation and Outcome of Cataract Surgery at Jimma University Specialized Hospital -Department of Ophthalmology

BACKGROUND: Patient's satisfaction for a given treatment is an important clinical outcome because a satisfied patient is more likely to comply with treatments, attend follow-ups and advocate the service to others. Therefore, knowing patients’ expectations before a planned procedure or treatment and the actual level of satisfaction and fulfillment of their initial expectations thereafter is much helpful. As far as the knowledge and experience of the researchers is concerned, there has not been any study conducted in Ethiopia to find out about patients’ preoperative expectations and postoperative level of satisfaction for actual outcomes. This study was therefore, conducted to describe and find out the relationship between preoperative expectations of cataract patients and the actual postoperative experience and their satisfaction level following the surgery at ophthalmology department in Jimma University Specialized Hospital. METHODS: A prospective cohort study of patients undergoing first eye cataract surgery was conducted from July 10 to Oct., 10, 2007 in the Ophthalmology department of Jimma University Specialized Hospital. Detailed interviews that included general and vision specific health status measures and patients’ preoperative expectations for cataract surgery outcomes were performed followed by visual acuity testing. Postoperatively, visual acuity testing was taken again and patients’ level of satisfaction with attained postoperative vision was assessed. Data were collected and filled in a separate questionnaire form for each patient, and entered into a computer and analyzed using SPSS for Windows version 12.0. RESULTS: Of the 200 patients operated for cataract, 179 (89.5%) were followed for the whole five weeks. The average expected preoperative Visual Function-15 score was 96.3, compared to an achieved (postoperative) Visual Function-15 score of just 96.2. However, the most unrealistic expectations observed were reading small prints and doing fine handiwork. The final pinhole visual acuity postoperatively was > 6/18 in 126 (70.4%) patients. Of the 78 (39%) patients who were bilaterally blind preoperatively, 5 (2.5%) patients remained blind postoperatively. CONCLUSIONS: Significant improvements were obtained in clinical, functional, and perceived vision by cataract surgery involving extracapsular cataract extraction with posterior chamber intraocular lens implantations. Expectations regarding visual functioning after cataract surgery were very high, and in most cases and in most cases they were fulfilled. KEYWORDS: Cataract surgery, patient’s satisfaction, visual function, Jimma, Ethiopia

Knowledge Discovery from Satellite Images for Drought Monitoring in Food Insecure Areas

Attributed to climatic change and uncertainty of weather conditions, drought has become a recurrent phenomenon. It is manifested by erratic and uncertain rainfall distribution in rainfall dependent farming areas. The hitherto methods of monitoring drought employed conventional methods that rely on availability of metrological data. The objectives of this research were to: 1) identify the critical factors for efficiently implementing geo-spatial information for drought monitoring, 2) develop a new approach for extracting knowledge from satellite imageries for real time drought monitoring in food insecure areas, and 3) validate and calibrate the new approach for national and regional applications. For this research, satellite data from MSG and NOAA AVHRR were used. The preliminary results confirmed that real time MSG satellite data can be used for monitoring drought in food insecure areas. The output of this research helps decision makers in taking the appropriate actions in time for saving millions of lives in drought affected areas using advanced satellite technology

Using Satellite Images for Drought Monitoring: A Knowledge Discovery Approach

The main objective of this research was to develop a new concept and approach to extract knowledge from satellite imageries for near real-time drought monitoring. The near real-time data downloaded from the Atlantic Bird satellite were used to produce the drought spatial distribution. Our results showed that approximately 40% of the observed areas exhibited negative deviation. In this study, the possibility of using the near real-time spatio-temporal Meteosat Second Generation (MSG) data for drought monitoring in food insecure areas of Ethiopia was tested, and promising results were obtained. The output of this research is expected to assist decision makers in taking timely and appropriate action in order to save millions of lives in drought-affected areas

Establishing a multicenter longitudinal clinical cohort Study in Ethiopia: Advanced Clinical Monitoring of Antiretroviral Treatment Project

Background: The purpose of this paper is to describe the establishment of the  Advanced Clinical Monitoring of ART Project in Ethiopia for monitoring and  evaluation of the longitudinal effectiveness of the ART program and to show the opportunities it presents. This cohort was established in response to the 2005 call by WHO for establishing additional mechanisms for stronger monitoring of ART and the need for creating the platform to generate evidence to guide the care given for the ever increasing number of patients on ART in Ethiopia.Method: A participatory and multi-stage process which started from a consensus building workshop and steered by a mother protocol as well as guiding documents which dictated the degree of engagement and expectations was followed. The primary and secondary aims of the study were agreed upon. A multi-site longitudinal observational clinical cohort was established by a consortium of stakeholders including seven Ethiopian medical schools and their affiliated referral hospitals, John Hopkins University, Ethiopian Public Health Institute, Ministry of Science and Technology, US Centers for Disease Prevention and Control - CDC-Ethiopia, and the Federal Ministry of Health. Adult and adolescent cohorts covering the age range of 14+ years) and pediatric cohorts covering those below age 14 years were the two main cohorts. During the initial recruitment of these cohorts information was extracted from existing documents for a total of 2,100 adult participants. In parallel, a prospective cohort of 1,400 adult and adolescent patients were enrolled for ART initiation and follow-up. Using similar recruitment procedures, a total of 120 children were enrolled in each of retrospective and prospective cohorts. Replacement of participants were made in subsequent years based on lost follow up and death rates to maintain adequacy of the sample to be followed-up.Achievements: Between January 2005 and August 2013 a total of 4,339 patients were followed for a median of 41.6 months and data on demographic characteristics, baseline and ongoing clinical features, hospitalization history, medication and laboratory information were collected. 39,762 aliquots and 25,515 specimens of plasma and dry-blood-spots respectively were obtained and stored longitudinally from October 2009 to August 2013. The project created a research platform for researchers, policy and decision makers. Moreover, it encouraged local and international investigators to identify and answer clinically and programmatically relevant research questions using the available data and specimens. Calls for concept notes paired with multiple trainings to stimulate investigators to conduct analyses further boosted the potential for doing research.Conclusions: A comprehensive and resourceful mechanism for scientific inquiry was established to support the national HIV/ART program. With meaningful involvement and defined roles, establishment of a study, which involved multiple institutions and investigators, was possible. Since ACM is the largest multi-site clinical cohort of patients on antiretroviral treatment in Ethiopia---which can be used for research and for improving clinical management---considering options to sustain the project is crucial. Key Words: Ethiopia, HIV clinical cohort, Antiretroviral therapy, Establishing Longitudinal Cohort Study, ART Monitoring and Evaluatio

Antibiotic Selection Pressure and Macrolide Resistance in Nasopharyngeal Streptococcus pneumoniae: A Cluster-Randomized Clinical Trial

Jeremy Keenan and colleagues report that during a cluster-randomized clinical trial in Ethiopia, nasopharyngeal pneumococcal resistance to macrolides was significantly higher in communities randomized to receive azithromycin compared with untreated control communities

Risk Factors for Ocular Chlamydia after Three Mass Azithromycin Distributions

Trachoma, which is the leading infectious cause of blindness worldwide, is caused by repeated ocular infection with Chlamydia trachomatis. Treatment for trachoma includes mass azithromycin treatments to the entire community. The World Health Organization recommends at least 3 rounds of annual mass antibiotic distributions in areas with trachoma, with further mass treatments based on the prevalence of trachoma. However, there are other options for communities that have received several rounds of treatment. For example, programs could continue antibiotic treatments only in those households most likely to have infected individuals. In this study, we performed trachoma monitoring on children from 12 Ethiopian communities one year after a third mass azithromycin treatment, and conducted a household survey at the same time. We found that children were more likely to be infected with ocular chlamydia if they had ocular inflammatory signs or ocular discharge, or if they had missed the preceding antibiotic treatment, had an infected sibling, or came from a larger community. These risk factors suggest that after mass azithromycin treatments, trachoma programs could consider continuing antibiotic distributions to households that have missed prior antibiotic distributions, in households with children who have the clinical signs of trachoma, and in larger communities

Glaucoma awareness among people attending ophthalmic outreach services in Southwestern Ethiopia

Abstract Background Individuals may need to be aware of glaucoma and seek assessment regularly in order to diagnose the condition early. Awareness of glaucoma has not been previously documented in an Ethiopian setting. Objective The main aim of this study was to assess the level of awareness of glaucoma among people attending outreach ophthalmic services. Methods We conducted a cross-sectional survey in April 2009 of all people 40 years of age or older who presented during a two-week outreach service period in Agaro town, southwestern Ethiopia. Data on demographics and awareness of glaucoma were collected through face to face interview using a pretested structured questionnaire. Results 340 people participated in the study. Their mean age was 54.5 (SD 10.6) years. About 43% were illiterates and 37.6% were farmers. Only eight people (2.4%) were aware of glaucoma. The association between awareness and attaining high school or better education was statistically significant (p Conclusion Awareness of glaucoma in this population is very low. An efficient information, education and communication (IEC) strategy needs to be designed to increase knowledge of the community about glaucoma so that early diagnosis and treatment of individuals with this condition may be possible.</p

Magnitude and causes of childhood blindness and severe visual impairment in Sekoru District, Southwest Ethiopia: a survey using the key informant method.

There are very few population-based data on childhood blindness in the Horn of Africa. In Sekoru district, Ethiopia, we performed a whole-of-population cross-sectional survey using the key informant method to determine the magnitude and causes of childhood blindness (presenting visual acuity <3/60 in the better eye) and severe visual impairment (SVI; presenting visual acuity <6/60 but ≥3/60 in the better eye). Forty-two key informants were trained to identify blind/SVI children aged <16 years. Identified children were examined by an ophthalmologist. Causes of blindness/SVI were established by clinical examination. Key informants visited 94% of 22,666 households, identifying 112 children, of whom 36 (32%) were confirmed to be blind/SVI by the ophthalmologist. Twenty (56%) of the 36 were male. The mean age was 10.7 years. The district prevalence of childhood blindness/SVI was 0.062% (95% CI 0.042-0.082%). Lens-related abnormalities (mainly congenital cataract) were the commonest causes. Avoidable causes of blindness accounted for 89% of cases. Paediatric ophthalmic services are required here, as elsewhere in rural Ethiopia. Assessment by key informants has an acceptable positive predictive value in this setting. This method warrants further evaluation as a tool for measuring the prevalence of other rare conditions in rural and remote populations