An analysis of referral pathways for paediatric eye care patients in Ghana

Background: Of an estimated 1.4 million children blind globally, 300,000 are in Africa and nearly 9,000 in Ghana; yet 50% of childhood blindness is avoidable through timely referral for treatment. Although Korle-Bu Teaching Hospital (KBTH) in Ghana has a tertiary paediatric eye centre, little is known about the referral system. Objectives: To evaluate the referral pathways for children referred to a tertiary paediatric eye centre in Ghana, and to examine concordance between reasons for referral and final diagnosis. Methods: A retrospective cross-sectional audit of consecutive medical records of children aged 0-15 years referred to the paediatric eye centre of KBTH between April-December 2012 was conducted. Demographic, clinical and referral information was collected from the patient register, medical records and referral letters using a pre-designed spreadsheet and analysed using SPSS. Results: The mean age of the 517 children referred was 2.3 years. The median time delay to present at the eye centre after referral was 4.0 days, and between the first presentation and initial paediatric ophthalmologist consultation was 23.0 days. The commonest reasons for referral were strabismus/nystagmus (21%), lens (15%) and developmental (11%) issues. The main referrers were ophthalmic nurses, general practitioners and ophthalmologists, referring 22%, 19% and 17% of cases respectively. There were 10% self-referrals. Ophthalmic nurses mostly referred strabismus/nystagmus (35% of cases) and cataract (44%), ophthalmologists referred 25% and 30% respectively, whilst optometrists mostly referred cataract (11%) and general practitioners/specialists mostly referred developmental anomalies (86% of cases). There was high agreement between KBTH specialists and referrers in patients with strabismus (78%), cataract (91%) and oculoplastics (69%). KBTH staff concurred with reasons for referral by optometrists, other ophthalmologists, self referrers , ophthalmic nurses and general practitioners in 80%, 70%, 69%, 67% and 42% of cases respectively. Conclusions: Ophthalmic and non-eye trained professionals differed in their referral patterns. The percentage of parents who sought care directly at KBTH was low but largely appropriate. Targeted campaigns to improve knowledge of the more common ocular conditions in the various professions in Ghana will improve overall referral accuracy from just 61%. It should be noted, this study did not investigate carers’ compliance with referral advice and hence the real number of children with oculovisual conditions needing tertiary care requires further investigation

Visual impairment among eye health workers in a tertiary eye centre in Ghana

Objective: To determine causes of visual impairment (VI) among staff of the Eye Centre at the Korle Bu Teaching Hospital.Design: This was a cross-sectional study.Setting: The Eye Centre, Korle Bu Teaching Hospital (KBTH), from October 2016 to March 2017 on all consenting members of staff.Participants: Eighty-four (79.3%) of 106 consenting staff members participated in this study.Data collection/Intervention: A detailed history (demographic, ocular, medical co-morbid conditions), ocular examination and relevant diagnostic investigations were conducted. Interventions initiated included treatment for glaucoma, dry eye and allergic conjunctivitis and spectacles prescription for refractive errors.Main outcomes: Prevalence of avoidable causes of VI (glaucoma, cataract, refractive errors). Secondary outcomes included prevalence of unavoidable causes of VI. Results Eighty-four (79.3%) members of staff participated in this study. Most of the participants were females, 54(64.3 %). Age ranged from 23 to 60 years with an average of 35.8±9.9 years (mean ± SD). Prevalence of VI was 9.5 % (8/84), all due to uncorrected refractive error. Other known causes of VI included open angle glaucoma in 12(14.3 %), macular scar of unknown cause, 1(1.2 %) and sutural cataract, 1(1.2 %) but were all visually insignificant.Conclusions: The prevalence of VI among the staff of the Eye Centre of the KBTH was 9.5 %, all due to refractive errors. Other known causes of avoidable visual impairment and blindness encountered were glaucoma (14.3 %), macular scar (1.2 %) and cataract (1.2 %), all asymptomatic. Routine eye screening should be part of periodic medical examination for employees

Visual impairment among eye health workers in a tertiary eye centre in Ghana

Objective: To determine causes of visual impairment (VI) among staff of the Eye Centre at the Korle Bu Teaching Hospital.Design: This was a cross-sectional study.Setting: The Eye Centre, Korle Bu Teaching Hospital (KBTH), from October 2016 to March 2017 on all consenting members of staff.Participants: Eighty-four (79.3%) of 106 consenting staff members participated in this study.Data collection/Intervention: A detailed history (demographic, ocular, medical co-morbid conditions), ocular examination and relevant diagnostic investigations were conducted. Interventions initiated included treatment for glaucoma, dry eye and allergic conjunctivitis and spectacles prescription for refractive errors.Main outcomes: Prevalence of avoidable causes of VI (glaucoma, cataract, refractive errors). Secondary outcomes included prevalence of unavoidable causes of VI.Results Eighty-four (79.3%) members of staff participated in this study. Most of the participants were females, 54(64.3 %). Age ranged from 23 to 60 years with an average of 35.8±9.9 years (mean ± SD). Prevalence of VI was 9.5 % (8/84), all due to uncorrected refractive error. Other known causes of VI included open angle glaucoma in 12(14.3 %), macular scar of unknown cause, 1(1.2 %) and sutural cataract, 1(1.2 %) but were all visually insignificant.Conclusions: The prevalence of VI among the staff of the Eye Centre of the KBTH was 9.5 %, all due to refractive errors. Other known causes of avoidable visual impairment and blindness encountered were glaucoma (14.3 %), macular scar (1.2 %) and cataract (1.2 %), all asymptomatic. Routine eye screening should be part of periodic medical examination for employees