Strengths and weaknesses of eye care services in sub-Saharan Africa: a meta-synthesis of eye health system assessments

BACKGROUND Approximately 90% of the 253 million blind or visually impaired people worldwide live in low- and middle-income countries. Lack of access to eye care is why most people remain or become blind. The World Health Organization Regional Office for Africa (WHO-AFRO) recently launched a primary eye care (PEC) package for sub-Saharan Africa—the WHO-AFRO PEC package—for integration into the health system at the primary health care (PHC) level. This has the potential to increase access to eye care, but feasibility studies are needed to determine the extent to which the health system has the capacity to deliver the package in PHC facilities. OBJECTIVE Our objective is to assess the technical feasibility of integrating the WHO-AFRO PEC package in PHC facilities in Nigeria. METHODS This study has several components, which include (1) a literature review of PEC in sub-Saharan Africa, (2) a Delphi exercise to reach consensus among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it in PHC facilities, (3) development of PEC technical capacity assessment tools, and (4) data collection, including facility surveys and semistructured interviews with PHC staff and their supervisors and village health workers to determine the capacities available to deliver PEC in PHC facilities. Analysis will identify opportunities and the capacity gaps that need to be addressed to deliver PEC. RESULTS Consensus was reached among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it as part of PHC. Quantitative tools (ie, structured questionnaires, in-depth interviews, and observation checklists) and topic guides based on agreed-upon technical capacities have been developed and relevant stakeholders have been identified. Surveys in 48 PHC facilities and interviews with health professionals and supervisors have been undertaken. Capacity gaps are being analyzed. CONCLUSIONS This study will determine the capacity of PHC centers to deliver the WHO-AFRO PEC package as an integral part of the health system in Nigeria, with identification of capacity gaps. Although capacity assessments have to be context specific, the tools and findings will assist policy makers and health planners in Nigeria and similar settings, who are considering implementing the package, in making informed choices. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17263

Download Full-text

The Technical Feasibility of Integrating Primary Eye Care Into Primary Health Care Systems in Nigeria: Protocol for a Mixed Methods Cross-Sectional Study

JMIR Research Protocols ◽

10.2196/17263 ◽

2020 ◽

Vol 9 (10) ◽

pp. e17263

Author(s):

Ada Aghaji ◽

Helen Burchett ◽

Shaffa Hameed ◽

Jayne Webster ◽

Clare Gilbert

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health System ◽

Assessment Tools ◽

Sub Saharan Africa ◽

Eye Care ◽

Technical Feasibility ◽

Primary Eye Care ◽

Primary Health ◽

Sub Saharan

Background Approximately 90% of the 253 million blind or visually impaired people worldwide live in low- and middle-income countries. Lack of access to eye care is why most people remain or become blind. The World Health Organization Regional Office for Africa (WHO-AFRO) recently launched a primary eye care (PEC) package for sub-Saharan Africa—the WHO-AFRO PEC package—for integration into the health system at the primary health care (PHC) level. This has the potential to increase access to eye care, but feasibility studies are needed to determine the extent to which the health system has the capacity to deliver the package in PHC facilities. Objective Our objective is to assess the technical feasibility of integrating the WHO-AFRO PEC package in PHC facilities in Nigeria. Methods This study has several components, which include (1) a literature review of PEC in sub-Saharan Africa, (2) a Delphi exercise to reach consensus among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it in PHC facilities, (3) development of PEC technical capacity assessment tools, and (4) data collection, including facility surveys and semistructured interviews with PHC staff and their supervisors and village health workers to determine the capacities available to deliver PEC in PHC facilities. Analysis will identify opportunities and the capacity gaps that need to be addressed to deliver PEC. Results Consensus was reached among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it as part of PHC. Quantitative tools (ie, structured questionnaires, in-depth interviews, and observation checklists) and topic guides based on agreed-upon technical capacities have been developed and relevant stakeholders have been identified. Surveys in 48 PHC facilities and interviews with health professionals and supervisors have been undertaken. Capacity gaps are being analyzed. Conclusions This study will determine the capacity of PHC centers to deliver the WHO-AFRO PEC package as an integral part of the health system in Nigeria, with identification of capacity gaps. Although capacity assessments have to be context specific, the tools and findings will assist policy makers and health planners in Nigeria and similar settings, who are considering implementing the package, in making informed choices. International Registered Report Identifier (IRRID) DERR1-10.2196/17263

Download Full-text

Situation Analysis of Uncorrected Refractive Errors In Sub-Saharan Francophone African Countries

10.21203/rs.3.rs-1084839/v1 ◽

2021 ◽

Author(s):

Amassagou Dougnon ◽

Nouhoum Guirou ◽

Seydou Bakayoko ◽

Fatoumata Korika Tounkara ◽

Sadio Maiga ◽

...

Keyword(s):

Human Resources ◽

Health System ◽

Public Health Problem ◽

Sub Saharan Africa ◽

Refractive Errors ◽

Policy Documents ◽

Eye Health ◽

Research Activities ◽

French Speaking ◽

Sub Saharan

Abstract Background: Uncorrected refractive errors (URE) are a serious public health problem by their magnitude, the multiple consequences they result in, but also by the inability of the countries of French-speaking Sub-Saharan Africa (FSSA) to meet the needs of the population. Governance problems, associated with human resources problems, financing problems for care, infrastructure and consumables, led us to initiate this study, the objective of which is to analyze the situation of UREs in FSSA with the stakeholders involved in the eye health system. Materials and Methods: We carried out a cross-sectional survey of eye health actors and stakeholders in all of the French-speaking Sub-Saharan Africa countries from March 1st to August 31st, 2020. An online questionnaire was developed and translated into French, and then sent to the targeted eye health stakeholders involved in eye health. The survey and data collection were carried out in two phases: first by collecting information from the eye health officials of the countries which then enabled us to reach all the other actors in the country. Data were entered directly into SPSS 20 software followed by cleaning prior to analysis and presented as percent, mean or median, and standard deviation. Results: A total of 500 questionnaires were sent to the various actors involved in eye health in the 21 countries of French-speaking Sub-Saharan Africa. The number of people who opened the questionnaire is 215, of which 151 have completed at least one question.Eye health policy documents existed in countries according to 95% of respondents. In the words of 76.6%, 54.6% and 85.2% of the participants respectively, the mechanisms for describing the tasks of the agents, for reporting to the actors and for collecting data existed. Also, according to respectively 61.5%, 58.8 % and 61.3% of respondents, the following are not effective: existence of documents of standards and procedures, specific allocation of eye health in the budget of the Ministry of Health and the obligation of continuous training.Conclusion: Although policy documents that comply with standards do exist in the French-speaking region of sub-Saharan Africa, several challenges remain to be taken up; in particular the involvement of all stakeholders of the health system, and the strengthening in the areas of governance, financial and human resources, as well as the information and supply system for materials and consumables, hence the need to initiate more targeted research activities.

Download Full-text

Impact of middle level eye care personnel on the delivery of eye care services in South-western Nigeria

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20180740 ◽

2018 ◽

Vol 5 (3) ◽

pp. 871

Author(s):

Tayo J. Bogunjoko ◽

Adekunle O. Hassan ◽

Ogugua Okonkwo ◽

Toyin Akanbi ◽

Mildred Ulaikere ◽

...

Keyword(s):

Health System ◽

Training Programme ◽

Middle Level ◽

Sub Saharan Africa ◽

Vision 2020 ◽

Eye Care ◽

International Joint Commission ◽

Eye Health ◽

The Impact ◽

Hospital Group

Background: The objectives of the study were to review the training and assess the impact of middle level eye care personnel (community ophthalmic technician) with skills to complement the services of the ophthalmologist for efficient eye care system and fulfilling vision 2020 goals.Methods: The collaboration between 2010 and 2015 was reviewed with an institutional questionnaire for both Eye Foundation Centre and College of Health Technology in Ijebu, Nigeria: structure of 2 year training Programme and one year internship, community ophthalmic technicians (COT) as assistants to ophthalmologists, hierarchy/career options and challenges and ensuring clinical quality and their strength in the Eye Foundation Eye Health System were appraised.Results: From 2010 to 2015, a total of 72 COTs have graduated, 41(57%) of them employed by the Eye Foundation Hospital Group. Apart from this, 28 did their internship in 2015, 19 (68%) out of this at Eye Foundation establishments in southwestern and north central Nigeria. Others are employed by other government or nongovernmental agencies. From 2010 to 2015, outpatients’ visits have increased from 42,962 to 104,239 at its peak, surgical volume from 3,999 to 18,350 at the Eye Foundation Hospital Group. The COT programme has been accredited by International Joint Commission on Allied health personnel in Ophthalmology (IJCAHPO).Conclusions: COTs with skills are required in large numbers to complement the services of ophthalmologists for efficient eye health system. Their contribution is very important to meet the vision 2020 human resources objectives for Sub-Saharan Africa.

Download Full-text

Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00822-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hafte Kahsay Kebede ◽

Lillian Mwanri ◽

Paul Ward ◽

Hailay Abrha Gesesew

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Hiv Care ◽

Care Services ◽

Validity Assessment ◽

Sub Saharan ◽

Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

Download Full-text

The impact of antenatal care on under‐five mortality in Ethiopia: a difference‐in‐differences analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03531-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Samuel Oduse ◽

Temesgen Zewotir ◽

Delia North

Keyword(s):

Antenatal Care ◽

Child Survival ◽

First Trimester ◽

Sub Saharan Africa ◽

P Value ◽

Difference In Differences ◽

Under Five ◽

Care Services ◽

Sub Saharan ◽

The Impact

Abstract Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

Download Full-text

Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis

AIDS Research and Therapy ◽

10.1186/s12981-021-00395-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Benjamin Momo Kadia ◽

Christian Akem Dimala ◽

Noah T. Fongwen ◽

Adrian D. Smith

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Health System ◽

Sample Size ◽

Meta Analysis ◽

Sub Saharan Africa ◽

System Level ◽

Comprehensive Treatment ◽

Barriers And Enablers ◽

Sub Saharan

Abstract Introduction Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients’ access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA. Method A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers. Results Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level. Conclusions In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.

Download Full-text

Health system challenges affecting falls prevention in persons living with HIV: perspectives from physiotherapists in four sub-Saharan regions

Primary Health Care Research & Development ◽

10.1017/s1463423620000663 ◽

2021 ◽

Vol 22 ◽

Author(s):

Maria Y. Charumbira ◽

Karina Berner ◽

Quinette A. Louw

Keyword(s):

Primary Care ◽

Health Care ◽

Health System ◽

Fall Prevention ◽

Falls Prevention ◽

Sub Saharan Africa ◽

Prevention Services ◽

Persons Living With Hiv ◽

Sub Saharan ◽

Living With Hiv

Abstract Aim: The aim of this study was to explore the perspectives of physiotherapists in four selected regions of sub-Saharan Africa regarding health system challenges impacting the integration of physiotherapy-led falls prevention services in the primary care of persons living with HIV (PLWH). Background: Falls may pose a significant problem among younger PLWH in low- and middle-income countries. Physiotherapists’ role in optimising function and quality of life can do much in the prevention of falls in PLWH and reducing the harm that results. However, falls prevention strategies have not been implemented effectively especially in primary health care settings in sub-Saharan Africa. Physiotherapists’ account of the health system challenges they encounter may provide insights into potential strategies that may be considered in optimising fall prevention for PLWH in poorly resourced settings. Methods: A descriptive qualitative study was conducted in selected urban districts in the capital cities of four sub-Saharan African countries. In-depth interviews were conducted with 21 purposively selected physiotherapists involved in the primary care of PLWH. Audio recordings of interviews were transcribed verbatim and analysed using deductive thematic content analysis. Findings: The main results are presented in the theme ‘Health care system challenges’ and in nine categories informed by the WHO health system framework: lack of policies and clinical practice guidelines, shortage/Inaccessible falls prevention services, inadequate human resource, physiotherapists not adequately equipped in falls prevention, inaccessible/No facilities for BMD measurement, inefficient data capturing systems, lack of evidence regarding falls among PLWH, unclear physiotherapy role descriptions, inefficient referral system. Physiotherapists highlighted the need for more information and research regarding fall prevention for PLWH, promote their role in the primary care of PLWH and adopt a patient-centred approach to fall prevention.

Download Full-text