“The graduates of the Postgraduate Diploma in Community Eye Health: how do they manage?”

The Postgraduate Diploma in Community Eye Health (PgDCEH) has been offered at the University of Cape Town, South Africa since 2009 to develop management capacity in support of the delivery of effective and efficient eye care services in sub-Saharan Africa. We investigated how graduates applied the PgDCEH-acquired management competencies and the factors that enabled or constrained them to apply these competencies. A multiple case study design was used, employing mixed methods of data collection and analysis. Data collection comprised of a questionnaire survey, in-depth interviews and review of various supporting documents, including assignments submitted by students. Twenty-six of the 34 students who graduated from 2009 to 2014 submitted completed questionnaires. Of these, 15 purposively selected graduates and their secondary key informants participated in in-depth interviews. We found that the PgDCEH elicited some positive effects on the graduates, especially in their ability to perform management tasks and the level of confidence they have in their abilities. There were some personal achievements, but no significant programme improvements were observed. This study provided evidence that the PgDCEH as a health system strengthening intervention struggled to generate the anticipated response of improved eye care programme performance. Personal motivation, suitability of the training and opportunity to apply were the main factors determining how graduates apply management competencies. The utilization of the project management approach, a greater focus on health system maintenance and attention to the dynamic of change in people's lives are critical determinants of success in eye health programmes. The research also highlighted the importance of health care workers' personal motives and motivations as drivers of success and achievement on programme level, and that line management support, supervision and proper performance management are required to attain this. This research broadened understanding of how PgDCEH graduates interact with their work environment and uncovered ways to improve the design and delivery of management training for eye health workers in the future. Revision of the criteria for selection, strengthening focus on leadership, project and relationship management topics, and integrating the training into health professions' education programmes may substantially improve the impact of health management education. The study concluded that the constituent elements of the health system are not inanimate objects, as commonly portrayed, but people, who are connected in intimate, complex and multi-dimensional ways through communication, relationships and team dynamics to deliver health outcomes

A quantitative evaluation of the quality of informed consent in a developing country setting

Includes bibliographical references (leaves 59-62).Informed consent is an ethical and legal requirement for research involving human participants. However, there have been few studies that have evaluated the process, particularly in an African setting. In addition, standardized methods for assessing the quality of informed consent are not available in the literature. The aim of the study was to evaluate the quality of consent in a large tuberculosis vaccine immunology study and to identify factors associated with the quality of consent

Evaluation of the quality of informed consent in a vaccine field trial in a developing country setting

<p>Abstract</p> <p>Background</p> <p>Informed consent is an ethical and legal requirement for research involving human participants. However, few studies have evaluated the process, particularly in Africa.</p> <p>Participants in a case control study designed to identify correlates of immune protection against tuberculosis (TB) in South Africa. This study was in turn nested in a large TB vaccine efficacy trial.</p> <p>The aim of the study was to evaluate the quality of consent in the case control study, and to identify factors that may influence the quality of consent.</p> <p>Cross-sectional study conducted over a 4 month period.</p> <p>Methods</p> <p>Consent was obtained from parents of trial participants. These parents were asked to complete a questionnaire that contained questions about the key elements of informed consent (voluntary participation, confidentiality, the main risks and benefits, etc.). The recall (success in selecting the correct answers) and understanding (correctness of interpretation of statements presented) were measured.</p> <p>Results</p> <p>The majority of the 192 subjects interviewed obtained scores greater than 75% for both the recall and understanding sections. The median score for recall was 66%; interquartile range (IQR) = 55%–77% and for understanding 75% (IQR = 50%–87%). Most (79%) were aware of the risks and 64% knew that they participated voluntarily. Participants who had completed Grade 7 at school and higher were more likely (OR = 4.94; 95% CI = 1.57 – 15.55) to obtain scores greater than 75% for recall than those who did not. Participants who were consented by professional nurses who had worked for more than two years in research were also more likely (OR = 2.62; 95% CI = 1.35–5.07) to obtain such scores for recall than those who were not.</p> <p>Conclusion</p> <p>Notwithstanding the constraints in a developing country, in a population with low levels of literacy and education, the quality of informed consent found in this study could be considered as building blocks for establishing acceptable standards for public health research. Education level of respondents and experience of research staff taking the consent were associated with good quality informed consent.</p

Availability of refractive error correction services in selected Zambian hospitals: a cross-sectional quantitative study

Objective To assess the availability of refractive error correction services (RECS) in selected Zambian hospitals.Methods Between October 2021 and March 2022, we conducted a cross-sectional study design among 20 eye health service providers selected from 20 public health facilities offering RECS in 20 districts from 8 provinces of Zambia. A stratified random sampling technique was used to select study participants. A questionnaire was developed based on the access to healthcare services framework and distributed via email to respondents to collect their perspectives on the availability of RECS.Results All 20 respondents returned the completed questionnaires. Most facilities met the Ministry of Health recommended equipment requirement, though tonometers were lacking in some facilities. Out of the 20 facilities, 75% reported having optometry technologists as the main staff offering eye health services; 10% had an ophthalmologist; no facility had an optometrist; none conducted school-based programmes and only 1 facility (5%) was able to dispense spectacles soon after refraction because it had a spectacle manufacturing workshop.Conclusion These findings show limited availability of RECS in the 20 health facilities. They also confirm that challenges in staffing levels, insufficient equipment and low rate of spectacle dispensing negatively affect availability of these services. Furthermore, insufficient infrastructure undermines service delivery. Addressing these challenges is cardinal to improving RECS delivery and enhancing universal eye healthcare coverage in Zambia

Search strategy.

Retrospective studies on artificial intelligence (AI) in screening for diabetic retinopathy (DR) have shown promising results in addressing the mismatch between the capacity to implement DR screening and increasing DR incidence. This review sought to evaluate the diagnostic test accuracy (DTA) of AI in screening for referable diabetic retinopathy (RDR) in real-world settings. We searched CENTRAL, PubMed, CINAHL, Scopus, and Web of Science on 9 February 2023. We included prospective DTA studies assessing AI against trained human graders (HGs) in screening for RDR in patients with diabetes. Two reviewers independently extracted data and assessed methodological quality against QUADAS-2 criteria. We used the hierarchical summary receiver operating characteristics (HSROC) model to pool estimates of sensitivity and specificity and, forest plots and SROC plots to visually examine heterogeneity in accuracy estimates. From our initial search results of 3899 studies, we included 15 studies comprising 17 datasets. Meta-analyses revealed a sensitivity of 95.33% (95%CI: 90.60–100%) and specificity of 92.01% (95%CI: 87.61–96.42%) for patient-level analysis (10 datasets, N = 45,785) while, for the eye-level analysis, sensitivity was 91.24% (95%CI: 79.15–100%) and specificity, 93.90% (95%CI: 90.63–97.16%) (7 datasets, N = 15,390). Subgroup analyses did not provide variations in the diagnostic accuracy of country classification and DR classification criteria. However, a moderate increase was observed in diagnostic accuracy in the primary-level healthcare settings: sensitivity of 99.35% (95%CI: 96.85–100%), specificity of 93.72% (95%CI: 88.83–98.61%) and, a minimal decrease in the tertiary-level healthcare settings: sensitivity of 94.71% (95%CI: 89.00–100%), specificity of 90.88% (95%CI: 83.22–98.53%). Sensitivity analyses did not show any variations in studies that included diabetic macular edema in the RDR definition, nor studies with ≥3 HGs. This review provides evidence, for the first time from prospective studies, for the effectiveness of AI in screening for RDR in real-world settings. The results may serve to strengthen existing guidelines to improve current practices.</div

Overall patient-level and eye-level meta-analysis of the accuracy of AI in detecting RDR compared with trained HGs.

Overall patient-level and eye-level meta-analysis of the accuracy of AI in detecting RDR compared with trained HGs.</p

Risk of bias and applicability concerns graph: Review authors’ judgments about each domain presented as percentages across included studies using the QUADAS-2 tool.

Risk of bias and applicability concerns graph: Review authors’ judgments about each domain presented as percentages across included studies using the QUADAS-2 tool.</p

HSROC plot of sensitivity vs specificity of AI for detecting RDR on eye-level analysis.

HSROC plot of sensitivity vs specificity of AI for detecting RDR on eye-level analysis.</p