scholarly journals Eye care infrastructure and human resources for managing diabetic retinopathy in India: The India 11-city 9-state study

2016 ◽  
Vol 20 (7) ◽  
pp. 3 ◽  
Author(s):  
G. V. S. Murthy ◽  
ClareE Gilbert ◽  
RGiridhara Babu ◽  
AashraiSai Venkat Gudlavalleti ◽  
Raghupathy Anchala ◽  
...  
BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047757
Author(s):  
Heba AlSawahli ◽  
Caleb D Mpyet ◽  
Gamal Ezzelarab ◽  
Ibrahim Hassanin ◽  
Mohammad Shalaby ◽  
...  

ObjectivesTo determine the prevalence of diabetes mellitus (DM), prevalence of diabetic retinopathy (DR) and sight-threatening conditions among persons with DM aged 50 years and older in Sohag governorate in Upper Egypt.DesignPopulation-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.SettingsSohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.Participants4078 people aged 50 years and older in 68 clusters were enrolled, of which 4033 participants had their random blood sugar checked and 843 examined for features of DR.Primary and secondary outcomesThe prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.ResultsThe prevalence of DM was 20.9% (95% CI 19.3% to 22.5%). The prevalence in females (23.8%; 95% CI 21.4% to 26.3%) was significantly higher than in males (18.9%; 95% CI 17.1% to 20.7%) (p=0.0001). Only 38.8% of persons diagnosed with diabetes had good control of DM. The prevalence of DR in the sample was 17.9% (95% CI 14.7% to 21.1%). The prevalence in females was higher (18.9%; 95% CI 14.0% to 23.8%) than in males (17.1%; 95% CI 13.0% to 21.2%). Up to 85.3% of study participants have never had eye examination. Sight-threatening DR (R4 and/or M2) was detected in 5.2% (95% CI 3.4% to 7.0%) with only 2.3% having had laser treatment.ConclusionThe prevalence of uncontrolled DM in Sohag governorate in Egypt is higher than the national prevalence. There is a high prevalence of sight-threatening retinopathy and/or maculopathy with few people having access to diabetic eye care. A public health approach is needed for health promotion, early detection and management of DR.


2021 ◽  
Vol 6 (3) ◽  
pp. e004484
Author(s):  
Helen Burn ◽  
Lisa Hamm ◽  
Joanna Black ◽  
Anthea Burnett ◽  
Matire Harwood ◽  
...  

PurposeGlobally, there are ~370 million Indigenous peoples. Indigenous peoples typically experience worse health compared with non-Indigenous people, including higher rates of avoidable vision impairment. Much of this gap in eye health can be attributed to barriers that impede access to eye care services. We conducted a scoping review to identify and summarise service delivery models designed to improve access to eye care for Indigenous peoples in high-income countries.MethodsSearches were conducted on MEDLINE, Embase and Global Health in January 2019 and updated in July 2020. All study designs were eligible if they described a model of eye care service delivery aimed at populations with over 50% Indigenous peoples. Two reviewers independently screened titles, abstracts and full-text articles and completed data charting. We extracted data on publication details, study context, service delivery interventions, outcomes and evaluations, engagement with Indigenous peoples and access dimensions targeted. We summarised findings descriptively following thematic analysis.ResultsWe screened 2604 abstracts and 67 studies fulfilled our eligibility criteria. Studies were focused on Indigenous peoples in Australia (n=45), USA (n=11), Canada (n=7), New Zealand (n=2), Taiwan (n=1) and Greenland (n=1). The main disease focus was diabetic retinopathy (n=30, 45%), followed by ‘all eye care’ (n=16, 24%). Most studies focused on targeted interventions to increase availability of services. Fewer than one-third of studies reported involving Indigenous communities when designing the service. 41 studies reflected on whether the model improved access, but none undertook rigorous evaluation or quantitative assessment.ConclusionsThe geographical and clinical scope of service delivery models to improve access to eye care for Indigenous peoples in high-income countries is narrow, with most studies focused on Australia and services for diabetic retinopathy. More and better engagement with Indigenous communities is required to design and implement accessible eye care services.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Agatha Mensah-Debrah ◽  
Kwesi Nyan Amissah Arthur ◽  
David Ben Kumah ◽  
Kwadwo Owusu Akuffo ◽  
Isaiah Osei Duah ◽  
...  

Abstract Background Although the equitable distribution of diabetic retinopathy (DR) services across Ghana remains paramount, there is currently a poor understanding of nationwide DR treatment services. This study aims to conduct a situation analysis of DR treatment services in Ghana and provide evidence on the breadth, coverage, workload, and gaps in service delivery for DR treatment. Methods A cross-sectional study was designed to identify health facilities which treat DR in Ghana from June 2018 to August 2018. Data were obtained from the facilities using a semi-structured questionnaire which included questions identifying human resources involved in DR treatment, location of health facilities with laser, vitreoretinal surgery and Anti–vascular endothelial growth factor therapy (Anti-VEGF) for DR treatment, service utilisation and workload at these facilities, and the average price of DR treatment in these facilities. Results Fourteen facilities offer DR treatment in Ghana; four in the public sector, seven in the private sector and three in the Christian Health Association of Ghana (CHAG) centres. There was a huge disparity in the distribution of facilities offering DR services, the eye care cadre, workload, and DR treatment service (retinal laser, Anti-VEGF, and vitreoretinal surgery). The retinal laser treatment price was independent of all variables (facility type, settings, regions, and National Health Insurance Scheme coverage). However, settings (p = 0.028) and geographical regions (p = 0.010) were significantly associated with anti-VEGF treatment price per eye. Conclusion Our results suggest a disproportionate distribution of DR services in Ghana. Hence, there should be a strategic development and implementation of an eye care plan to ensure the widespread provision of DR services to the disadvantaged population as we aim towards a disadvantaged population as we aim towards a universal health coverage.


2021 ◽  
Author(s):  
Rajeev S. Ramchandran ◽  
Reza Yousefi-Nooraie ◽  
Porooshat Dadgostar ◽  
Sule Yilmaz ◽  
Jesica Basant ◽  
...  

BACKGROUND Store and forward camera based evaluation or teleophthalmology is considered an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. OBJECTIVE Understanding the barriers and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption. METHODS This qualitative study in three urban low-income, largely minority-serving safety-net primary care clinics in Rochester, NY, USA interviewed nurses and doctors on implementing a teleophthalmology program using questions informed by Practical, Robust Implementation and Sustainability Model (PRISM) and Consolidated Framework for Implementation Research (CFIR) frameworks. RESULTS Primary care nurses operationalizing the program in their clinics saw increased work burden and lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, doctors, and administrative staff through in-service and peer-training by champions/super-users were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology due to challenges related to care coordination were highlighted. Financial aspects of the program (e.g. patient coverage and care provider reimbursement) were unclear to many staff, influencing adoption and sustainability. CONCLUSIONS Streamlining of processes and workflows, training and assigning adequate staff, effective care coordination between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology.


2019 ◽  
Vol 25 (4) ◽  
pp. 301-308 ◽  
Author(s):  
Yao Liu ◽  
Victoria P. Rajamanickam ◽  
Ravi S. Parikh ◽  
Stephanie J. Loomis ◽  
Carolyn E. Kloek ◽  
...  

2020 ◽  
Vol 21 (5) ◽  
pp. 856-862
Author(s):  
Mark Porter ◽  
Roomasa Channa ◽  
Jessica Wagner ◽  
Laura Prichett ◽  
Tin Yan Alvin Liu ◽  
...  

2021 ◽  
Author(s):  
Tiliksew Teshome ◽  
Omar Salamanca ◽  
Alana Calise ◽  
Jibat Gemida Soboka

Abstract Background Ethiopia signed the VISION 2020 Global Declaration and launched its eye health program in 2002. Since then, there has been limited systematic and comprehensive evaluation of the progress towards VISION 2020 goals in Ethiopia.Purpose To evaluate Gurage Zone progress towards VISION 2020 targets and process indicators.Method An institutional-based cross-sectional study was conducted among all public and private eye health care facilities in the Gurage Zone within the Southern Nations, Nationalities, and People Region of Ethiopia. The evaluation protocol was adopted from the VISION 2020 situational analysis data collection tool. We used this structure to evaluate progress in terms of human resources, infrastructure, and service delivery at the Zonal Health Office and facility level.Result At the time of the study, the Gurage Zone had a 1.7 million catchment area population. There was a total of five eye care centers, of which one was established by a Non-Governmental Organization. Three of these facilities were secondary eye care centers with an operating theater and two of them were primary eye care centers. At the zonal level, there is no survey data available on the prevalence of blindness. There was no systemic evaluation of VISION 2020 process indicators. The budget allocation specific to eye health care was less than 0.7% of the total budget of the office. The human resources for eye health in the catchment area were: one ophthalmologist, two cataract surgeons, five optometrists, and 12 ophthalmic nurses, which is below the VISION 2020 targets for human resources for eye health. In terms of equipment, neither primary eye care center had a slit lamp biomicroscope, and two of the three secondary eye care centers did not have intraocular pressure (IOP) measuring equipment. Only one secondary eye care center was providing glaucoma surgical services, and no center provided either emergency or elective pediatric surgery. The cataract surgical rate (CSR) determined by the study was 1967.ConclusionGurage Zone had not achieved VISION 2020 goals in terms of critical human resources and service delivery. We recommend that the Zonal Health Office carries out a focused and baseline evaluation of eye health care service achievements.


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