Cascading training the trainers in ophthalmology across Eastern, Central and Southern Africa.

BACKGROUND: The Royal College of Ophthalmologists (RCOphth) and the College of Ophthalmology of Eastern Central and Southern Africa (COECSA) are collaborating to cascade a Training the Trainers (TTT) Programme across the COECSA Region. Within the VISION 2020 Links Programme, it aims to develop a skilled motivated workforce who can deliver high quality eye care. It will train a lead, faculty member and facilitator in 8 countries, who can cascade the programme to local trainers. METHODS: In phase 1 (2013/14) two 3-day courses were run for 16/17 selected delegates, by 3 UK Faculty. In phase 2 (2015/16) 1 UK Faculty Member ran 3 shorter courses, associated with COECSA events (Congress and Examination). A COECSA Lead was appointed after the first course, and selected delegates were promoted as Facilitators then Faculty Members on successive courses. They were given appropriate materials, preparation, training and mentoring. RESULTS: In 4 years the programme has trained 87 delegates, including 1 COECSA Lead, 4 Faculty Members and 7 Facilitators. Delegate feedback on the course was very good and Faculty were impressed with the progress made by delegates. A questionnaire completed by delegates after 6-42 months demonstrated how successfully they were implementing new skills in teaching and supervision. The impact was assessed using the number of eye-care workers that delegates had trained, and the number of patients seen by those workers each year. The figures suggested that approaching 1 million patients per year were treated by eye-care workers who had benefited from training delivered by those who had been on the courses. Development of the Programme in Africa initially followed the UK model, but the need to address more extensive challenges overseas, stimulated new ideas for the UK courses. CONCLUSIONS: The Programme has developed a pyramid of trainers capable of cascading knowledge, skills and teaching in training with RCOphth support. The third phase will extend the number of facilitators and faculty, develop on-line preparatory and teaching materials, and design training processes and tools for its assessment. The final phase will see local cascade of the TTT Programme in all 8 countries, and sustainability as UK support is withdrawn

Status and Trends of Agricultural and Rural Development Indicators in the COMESA Region

This report is divided into eight sections, section one provides an introduction about the COMESA region and the structure of the economy in the region. Section two presents trends of various socioeconomic indicators in the region. Section three contains gender related information while section four focuses on food security in COMESA. Some examples of subnational food security situations are also given here. Section five focuses on various indicators related to agriculture in COMESA including agriculture and food production, input utilization in agriculture, and application of irrigation in agriculture. Section six provides information on expenditures in agriculture and agricultural value addition in the region. In section seven, various indicators on trade are reviewed. The last section, section eight, contains summary, conclusions, and policy recommendations

Status, distribution and determinants of poverty in the COMESA region: A review of existing knowledge

Poverty and vulnerability are among the major problems in Eastern and Southern Africa (ESA). To design appropriate poverty reduction initiatives for the region, it is not only important to understand the distribution of poverty but also the determinants. Various reports have documented information on the status, distribution and determinants of poverty in each of the countries. Nonetheless, not much information has been documented in a form that is easily accessible to decision makers and planners involved in designing and implementing programmes for addressing poverty reduction and food insecurity at the regional level. This paper reviews the existing knowledge on the status, distribution and determinants of poverty in the ESA region to fill that knowledge gap. It emerges from the literature that poverty in the region differs across socio-economic groups and across space. The existing poverty maps suggests that most districts and provinces whose poverty rates are lower than the national averages are located in rain fed mixed crop–livestock systems and that the highest proportion of them are in the humid and sub humid systems. High poverty rates also occur in the livestock only systems. About half of the poor provinces and districts fall in areas with short growing periods; this affects their agricultural potential. The areas are also constrained by market access. Investment in irrigation, improved water management and improved market access would play a vital role in these regions. The review suggests that household level determinants of poverty in the region include, but are not limited to: household characteristics—family composition, size and structure, age and marital status of head, gender of the head, education and other human capital capabilities; access to basic services such as social amenities, water and sanitation, credit and infrastructure; employment, occupation and incomes; asset ownership; access to remittances; burden of disease; variations in agricultural production; and declining food stocks and high food prices. Community/regional/country level determinants include: geography and related factors such as market access, agro-ecological zones, climate and ethnicity; the environment; population density; area of residence (rural vs. urban); income, growth and inequality; conflict, insecurity and political instability; and governance and corruption. However, it is difficult to separate the determinants of community level poverty from the determinants at the household level. The review further suggests that the determinants of poverty are fairly robust across many COMESA countries. This suggests the need for a consultative approach to poverty reduction in the region

Common interest

SummaryOne of the West's frontline bases during the Cold War has been turned into an innovative conservation project. Nigel Williams reports

Results of Automated Retinal Image Analysis for Detection of Diabetic Retinopathy from the Nakuru Study, Kenya.

OBJECTIVE: Digital retinal imaging is an established method of screening for diabetic retinopathy (DR). It has been established that currently about 1% of the world's blind or visually impaired is due to DR. However, the increasing prevalence of diabetes mellitus and DR is creating an increased workload on those with expertise in grading retinal images. Safe and reliable automated analysis of retinal images may support screening services worldwide. This study aimed to compare the Iowa Detection Program (IDP) ability to detect diabetic eye diseases (DED) to human grading carried out at Moorfields Reading Centre on the population of Nakuru Study from Kenya. PARTICIPANTS: Retinal images were taken from participants of the Nakuru Eye Disease Study in Kenya in 2007/08 (n = 4,381 participants [NW6 Topcon Digital Retinal Camera]). METHODS: First, human grading was performed for the presence or absence of DR, and for those with DR this was sub-divided in to referable or non-referable DR. The automated IDP software was deployed to identify those with DR and also to categorize the severity of DR. MAIN OUTCOME MEASURES: The primary outcomes were sensitivity, specificity, and positive and negative predictive value of IDP versus the human grader as reference standard. RESULTS: Altogether 3,460 participants were included. 113 had DED, giving a prevalence of 3.3% (95% CI, 2.7-3.9%). Sensitivity of the IDP to detect DED as by the human grading was 91.0% (95% CI, 88.0-93.4%). The IDP ability to detect DED gave an AUC of 0.878 (95% CI 0.850-0.905). It showed a negative predictive value of 98%. The IDP missed no vision threatening retinopathy in any patients and none of the false negative cases met criteria for treatment. CONCLUSIONS: In this epidemiological sample, the IDP's grading was comparable to that of human graders'. It therefore might be feasible to consider inclusion into usual epidemiological grading

Global point-of-care ultrasound education and training in the age of COVID-19.

The COVID-19 pandemic has disrupted traditional global point-of-care ultrasound (POCUS) education and training, as a result of travel restrictions. It has also provided an opportunity for innovation using a virtual platform. Tele-ultrasound and video-conferencing are alternative and supportive tools to augment global POCUS education and training. There is a need to support learners and experts to ensure that maximum benefit is gained from the use of these innovative modalities