Bulletin of The World Health Organization, Jun 1, 2009
Objective To estimate the potential global economic productivity loss associated with the existin... more Objective To estimate the potential global economic productivity loss associated with the existing burden of visual impairment from uncorrected refractive error (URE). Methods Conservative assumptions and national population, epidemiological and economic data were used to estimate the purchasing power parity-adjusted gross domestic product (PPP-adjusted GDP) loss for all individuals with impaired vision and blindness, and for individuals with normal sight who provide them with informal care. Findings An estimated 158.1 million cases of visual impairment resulted from uncorrected or undercorrected refractive error in 2007; of these, 8.7 million were blind. We estimated the global economic productivity loss in international dollars (I$) associated with this burden at I$ 427.7 billion before, and I$ 268.8 billion after, adjustment for country-specific labour force participation and employment rates. With the same adjustment, but assuming no economic productivity for individuals aged ³ 50 years, we estimated the potential productivity loss at I$ 121.4 billion. Conclusion Even under the most conservative assumptions, the total estimated productivity loss, in $I, associated with visual impairment from URE is approximately a thousand times greater than the global number of cases. The cost of scaling up existing refractive services to meet this burden is unknown, but if each affected individual were to be provided with appropriate eyeglasses for less than I$ 1000, a net economic gain may be attainable. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. املقالة. لهذه الكامل النص نهاية يف الخالصة لهذه العربية الرتجمة
Background: The aims of this study were to develop a process for assessing refractive error manag... more Background: The aims of this study were to develop a process for assessing refractive error management competence among the first two cohorts of students in a new optometry program at Unilúrio in Mozambique and to understand the effectiveness of implementing the process in the context of a low resource environment. Methods: The assessment methods were developed using information from a literature review and a focus group discussion and implemented on 15 students. Results: The exams consisted of direct observation of two patients, short-answer questions and a structured oral examination. Conclusion: The use of existing checklists and rating skills helped to identify areas of competence deficits. Areas for further development of the assessment process include increasing assessor training and guidelines for patient standardization.
BACKGROUND:The growing global burden of vision impairment makes it imperative that there are appr... more BACKGROUND:The growing global burden of vision impairment makes it imperative that there are appropriately trained human resources. Optometrists play a critical role in alleviating this burden, but the low number of optometrists available or the numbers in different countries has always been a challenge for eye care planning. Despite this, there have been limited studies conducted to quantify the deficits in the number of optometrists globally. Methods:A standardised English language questionnaire was used in this cross-sectional study to determine the number and distribution of optometrists globally between February 2017 and May 2020. The survey was translated where necessary and completed by key informants. Using the World Council of Optometry’s scope of practice guidelines, optometrists were defined at levels 2 to 4. Optometrist-to-population ratios were calculated for all countries and regions and compared to targets of 1:50 000 (in developing contexts) or 1:10 000 (in developed...
RESEARCH Open Access Trends and implications for achieving VISION
growth to reach the target in one country. For nurses, two additional countries will achieve the ... more growth to reach the target in one country. For nurses, two additional countries will achieve the target while one
Background: Diabetes mellitus (DM) and diabetic retinopathy (DR) are important issues in the dist... more Background: Diabetes mellitus (DM) and diabetic retinopathy (DR) are important issues in the district health system (DHS) of South Africa (SA). Guidelines for the management of DR in SA were developed more than a decade ago but not effectively implemented. Aim: The aim of this study was to develop a suitable model for DR that could be effectively implemented by a team of healthcare practitioners (HCPs) to co-manage DM and DR in the DHS of SA.
International Journal of Environmental Research and Public Health, 2021
In South Africa, primary eye care is largely challenged in its organisational structure, availabi... more In South Africa, primary eye care is largely challenged in its organisational structure, availability of human and other resources, and clinical competency. These do meet the standard required by the National Department of Health. This study seeks to assess the levels of knowledge, attitudes, and practices on eye health amongst Human Resources for eye health (HReH) and their managers, as no study has assessed this previously. A cross-sectional study was conducted in 11 districts of a South African province. A total of 101 participants completed self-administered, close-ended, Likert-scaled questionnaires anonymously. Binary logistic regression analysis was conducted, and values of p < 0.05 were considered statistically significant. Most participants had adequate knowledge (81.6%), positive attitudes (69%), and satisfactory practices (73%) in eye health. HReH showed better knowledge than their managers (p < 0.01). Participants with a university degree, those aged 30–44 years, a...
As over 405.1 million visually impaired and 36 million blind people globally age and live longer,... more As over 405.1 million visually impaired and 36 million blind people globally age and live longer, the considerable burden of eye health continues to grow. 6,7,8 Of great concern is the fact that 80% of avoidable blindness and VI are found in low-to-middle-income countries (LMICs), such as South Africa, that employ only 33% of the global health workforce. 5 In an effort to prioritise eye health and secure access to rehabilitation for the visually impaired, the WHO developed the Global Action Plan (GAP), a strategy aimed at reducing VI by 25% by 2020. 5 For this outcome to be achieved, the causes of VI needed to be noted so as to ensure that Background: The development of human resources for eye health (HReH), aimed at achieving a 25% reduction in visual impairment by the year 2020, was one of the VISION 2020 objectives. Aim: To assess HReH in the public sector of KwaZulu-Natal (KZN), and its effect on the accessibility of eye care in the province. Setting: All public eye facilities in KZN. Methods: A quantitative cross-sectional study using a close-ended questionnaire to assess distribution and outputs of HReH. At the end of the questionnaire, respondents gave general comments on their ability to provide services. Results: Human resource rates were 0.89 for ophthalmologists, 2.44 for cataract surgeons, 4.8 for optometrists and 4.7 for ophthalmic nurses per 1 million population. Most health facilities had some HReH working in them, albeit none had dispensing opticians. Regression analysis showed that 67.1% of variation in cataract surgery was because of the number of surgeons available. Cataract surgical rates were low with a waiting period of up to 18 months. In addition to the refractive error regression analysis of 33.7%, spectacle supply was low, with a backlog of up to 9 months in some facilities. Conclusion: Overall, HReH targets as per VISION 2020 and the National Prevention of Blindness have not been met in this region. Dispensing opticians are not employed in any of the province's health districts. An increase in the eye health workforce is necessary to improve the eye health outcomes for people dependent on public eye facilities.
The relative success of eye care programmes with quick outcomes, from cataract surgery to providi... more The relative success of eye care programmes with quick outcomes, from cataract surgery to providing eye glasses, has often mitigated against comprehensive eye care programmes. Success comes 'easily', so why focus on complex solutions? However, the need to upscale eye care programmes beyond the individual programme success and the need to address sustainability and community ownership of such programmes has forced, and is still forcing, many to rethink strategies. Given the lack of eye care practitioners with public health training and the predominance of curative approaches to eye care, there is a shortage of skills and exposure to adequately think or act beyond the curative paradigm.
Influence of Distance and Near Visual Impairment on Self-Reported Near Visual Functioning in a Multinational Study
Ophthalmology, 2021
PURPOSE To assess the influence of distance and near visual impairment on self-reported near visu... more PURPOSE To assess the influence of distance and near visual impairment on self-reported near visual functioning (VF) among adults in a multi-country study. DESIGN Population-based cross-sectional study. PARTICIPANTS Participants aged ≥35 years were randomly selected with cluster sampling at seven sites: rural sites in Nepal (Kaski) and India (Madurai), a semi-rural site in China (Shunyi), semi-urban sites in South Africa (Durban) and Niger (Dosso), and urban sites in the United States (Los Angeles) and China (Guangzhou). METHODS Binocular presenting distance and near visual acuity (VA) were measured with a LogMAR tumbling E chart at 4 meters and 40 cm, respectively. A 12-item near VF questionnaire interview was administered by trained local interviewers, with responses scored from 100 to 0 as visual "disability" increased. Multiple linear regression was used to investigate the association of age, gender, education and VA with overall eyesight, difficulty with activities and social functioning subscale scores. MAIN OUTCOME MEASURES VF subscale scores. RESULTS The study sample consisted of 6,851 questionnaire respondents. The VF subscale scores decreased significantly with worse distance and near VA, and even mildly impaired VA could result in reduced VF at all sites. In multiple linear regression modeling, lower VF subscale scores were associated with older age in four sites, female gender in three sites, and greater education in two sites. The influence of near VA was greater than that of distance VA in three sites, and in one site distance VA was more influential than near VA. With study site included in the regression modeling, lower scores for the overall eyesight subscale (compared to the Shunyi reference site) were found in Guangzhou, Kaski and Durban; lower difficulty in activities scores were found in Kaski and Durban, but better scores in Guangzhou and Madurai; social functioning scores were lower in Kaski, Durban and Dosso. CONCLUSIONS Along the entire VA spectrum, lower levels of distance and near VA led to significant reductions in VF subscale scores, with wide variation both within and between study sites. The impact of near vision on VF should receive greater emphasis with further investigation in various socio-economic and cultural settings.
Willingness to pay for improved vision in Mozambique
Development Southern Africa, 2020
ABSTRACT The burden of vision impairment due to uncorrected refractive error (needing spectacles)... more ABSTRACT The burden of vision impairment due to uncorrected refractive error (needing spectacles) in Mozambique is known to be significant. To improve the planning and provision of eye health services, a better understanding of how vision is valued by patients is needed. The willingness to pay (WTP) for improved vision through correcting refractive error was investigated in Nampula, Mozambique, using stated choice and bidding game methodologies. The mean WTP values were found to be 388.92 Meticals (US$13) for stated choice and 469.89 Meticals (US$16) for the bidding game. The mean WTP values for rural dwellers were found to be lower than responses from those living in urban areas. If avoidable vision impairment is to be addressed in Mozambique, the cost of services must not be a barrier and the construction of a sustainable spectacle system that delivers for both rural and urban patients must be a priority.
Background: There are many gaps in the management of diabetes mellitus (DM) and diabetic eye dise... more Background: There are many gaps in the management of diabetes mellitus (DM) and diabetic eye disease in the district health system (DHS) of South Africa (SA). National guidelines recommend annual eye examinations for patients with DM.Aim: The purpose of this study was to describe the self-reported skill levels of healthcare practitioners (HCPs) to conduct eye examination procedures required for a proposed diabetic retinopathy (DR) screening model.Setting: The study was conducted in public health institutions of Waterberg district and Mankweng Hospital complex (Capricorn district) in Limpopo province, SA.Methods: A cross-sectional design using purposive sampling was conducted, and questionnaires were distributed to a total of 74 HCPs. The questionnaires distributed included questions relating to the competency levels of primary healthcare nurses (PHC nurses), optometrists, ophthalmic nurses and medical officers (MOs) regarding examination procedures in the management of patients with...
Background Uncorrected refractive error (URE) is a major cause of vision impairment among childre... more Background Uncorrected refractive error (URE) is a major cause of vision impairment among children that impacts negatively on their lives including distresses. We aim to understand the disability-related distress among vision-impaired children due to URE in rural and semi-rural South Africa using qualitative techniques. Methods Structured focus groups of children (aged 5-12 years old) with normal vision and vision impairment due to URE from four schools in Pinetown, KwaZulu Natal, South Africa, were performed (four mixed-gender group discussions and eight single gender group discussions). We recruited the study participants after the children underwent standardised vision screening. Criterion sampling was used when selecting study participants. The interviews were transcribed to identify meaning units and broken down to condensed meaning units, which were then grouped into megathemes. Themes were then generated. Results Thirteen children with normal vision and 63 children with vision impairment due to URE participated in the twelve focus group discussions with 36 boys (47%) and 40 girls (53%). Twelve themes were generated. The megathemes were Loss of Self Confidence (number of themes (n) = 3), Loss of self-worth (n = 3), Loss of interconnection/ interaction with community (n = 2), Humiliation (n = 2) and Discrimination (n = 2).
Bulletin of The World Health Organization, Jun 1, 2009
Objective To estimate the potential global economic productivity loss associated with the existin... more Objective To estimate the potential global economic productivity loss associated with the existing burden of visual impairment from uncorrected refractive error (URE). Methods Conservative assumptions and national population, epidemiological and economic data were used to estimate the purchasing power parity-adjusted gross domestic product (PPP-adjusted GDP) loss for all individuals with impaired vision and blindness, and for individuals with normal sight who provide them with informal care. Findings An estimated 158.1 million cases of visual impairment resulted from uncorrected or undercorrected refractive error in 2007; of these, 8.7 million were blind. We estimated the global economic productivity loss in international dollars (I$) associated with this burden at I$ 427.7 billion before, and I$ 268.8 billion after, adjustment for country-specific labour force participation and employment rates. With the same adjustment, but assuming no economic productivity for individuals aged ³ 50 years, we estimated the potential productivity loss at I$ 121.4 billion. Conclusion Even under the most conservative assumptions, the total estimated productivity loss, in $I, associated with visual impairment from URE is approximately a thousand times greater than the global number of cases. The cost of scaling up existing refractive services to meet this burden is unknown, but if each affected individual were to be provided with appropriate eyeglasses for less than I$ 1000, a net economic gain may be attainable. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. املقالة. لهذه الكامل النص نهاية يف الخالصة لهذه العربية الرتجمة
Background: The aims of this study were to develop a process for assessing refractive error manag... more Background: The aims of this study were to develop a process for assessing refractive error management competence among the first two cohorts of students in a new optometry program at Unilúrio in Mozambique and to understand the effectiveness of implementing the process in the context of a low resource environment. Methods: The assessment methods were developed using information from a literature review and a focus group discussion and implemented on 15 students. Results: The exams consisted of direct observation of two patients, short-answer questions and a structured oral examination. Conclusion: The use of existing checklists and rating skills helped to identify areas of competence deficits. Areas for further development of the assessment process include increasing assessor training and guidelines for patient standardization.
BACKGROUND:The growing global burden of vision impairment makes it imperative that there are appr... more BACKGROUND:The growing global burden of vision impairment makes it imperative that there are appropriately trained human resources. Optometrists play a critical role in alleviating this burden, but the low number of optometrists available or the numbers in different countries has always been a challenge for eye care planning. Despite this, there have been limited studies conducted to quantify the deficits in the number of optometrists globally. Methods:A standardised English language questionnaire was used in this cross-sectional study to determine the number and distribution of optometrists globally between February 2017 and May 2020. The survey was translated where necessary and completed by key informants. Using the World Council of Optometry’s scope of practice guidelines, optometrists were defined at levels 2 to 4. Optometrist-to-population ratios were calculated for all countries and regions and compared to targets of 1:50 000 (in developing contexts) or 1:10 000 (in developed...
RESEARCH Open Access Trends and implications for achieving VISION
growth to reach the target in one country. For nurses, two additional countries will achieve the ... more growth to reach the target in one country. For nurses, two additional countries will achieve the target while one
Background: Diabetes mellitus (DM) and diabetic retinopathy (DR) are important issues in the dist... more Background: Diabetes mellitus (DM) and diabetic retinopathy (DR) are important issues in the district health system (DHS) of South Africa (SA). Guidelines for the management of DR in SA were developed more than a decade ago but not effectively implemented. Aim: The aim of this study was to develop a suitable model for DR that could be effectively implemented by a team of healthcare practitioners (HCPs) to co-manage DM and DR in the DHS of SA.
International Journal of Environmental Research and Public Health, 2021
In South Africa, primary eye care is largely challenged in its organisational structure, availabi... more In South Africa, primary eye care is largely challenged in its organisational structure, availability of human and other resources, and clinical competency. These do meet the standard required by the National Department of Health. This study seeks to assess the levels of knowledge, attitudes, and practices on eye health amongst Human Resources for eye health (HReH) and their managers, as no study has assessed this previously. A cross-sectional study was conducted in 11 districts of a South African province. A total of 101 participants completed self-administered, close-ended, Likert-scaled questionnaires anonymously. Binary logistic regression analysis was conducted, and values of p < 0.05 were considered statistically significant. Most participants had adequate knowledge (81.6%), positive attitudes (69%), and satisfactory practices (73%) in eye health. HReH showed better knowledge than their managers (p < 0.01). Participants with a university degree, those aged 30–44 years, a...
As over 405.1 million visually impaired and 36 million blind people globally age and live longer,... more As over 405.1 million visually impaired and 36 million blind people globally age and live longer, the considerable burden of eye health continues to grow. 6,7,8 Of great concern is the fact that 80% of avoidable blindness and VI are found in low-to-middle-income countries (LMICs), such as South Africa, that employ only 33% of the global health workforce. 5 In an effort to prioritise eye health and secure access to rehabilitation for the visually impaired, the WHO developed the Global Action Plan (GAP), a strategy aimed at reducing VI by 25% by 2020. 5 For this outcome to be achieved, the causes of VI needed to be noted so as to ensure that Background: The development of human resources for eye health (HReH), aimed at achieving a 25% reduction in visual impairment by the year 2020, was one of the VISION 2020 objectives. Aim: To assess HReH in the public sector of KwaZulu-Natal (KZN), and its effect on the accessibility of eye care in the province. Setting: All public eye facilities in KZN. Methods: A quantitative cross-sectional study using a close-ended questionnaire to assess distribution and outputs of HReH. At the end of the questionnaire, respondents gave general comments on their ability to provide services. Results: Human resource rates were 0.89 for ophthalmologists, 2.44 for cataract surgeons, 4.8 for optometrists and 4.7 for ophthalmic nurses per 1 million population. Most health facilities had some HReH working in them, albeit none had dispensing opticians. Regression analysis showed that 67.1% of variation in cataract surgery was because of the number of surgeons available. Cataract surgical rates were low with a waiting period of up to 18 months. In addition to the refractive error regression analysis of 33.7%, spectacle supply was low, with a backlog of up to 9 months in some facilities. Conclusion: Overall, HReH targets as per VISION 2020 and the National Prevention of Blindness have not been met in this region. Dispensing opticians are not employed in any of the province's health districts. An increase in the eye health workforce is necessary to improve the eye health outcomes for people dependent on public eye facilities.
The relative success of eye care programmes with quick outcomes, from cataract surgery to providi... more The relative success of eye care programmes with quick outcomes, from cataract surgery to providing eye glasses, has often mitigated against comprehensive eye care programmes. Success comes 'easily', so why focus on complex solutions? However, the need to upscale eye care programmes beyond the individual programme success and the need to address sustainability and community ownership of such programmes has forced, and is still forcing, many to rethink strategies. Given the lack of eye care practitioners with public health training and the predominance of curative approaches to eye care, there is a shortage of skills and exposure to adequately think or act beyond the curative paradigm.
Influence of Distance and Near Visual Impairment on Self-Reported Near Visual Functioning in a Multinational Study
Ophthalmology, 2021
PURPOSE To assess the influence of distance and near visual impairment on self-reported near visu... more PURPOSE To assess the influence of distance and near visual impairment on self-reported near visual functioning (VF) among adults in a multi-country study. DESIGN Population-based cross-sectional study. PARTICIPANTS Participants aged ≥35 years were randomly selected with cluster sampling at seven sites: rural sites in Nepal (Kaski) and India (Madurai), a semi-rural site in China (Shunyi), semi-urban sites in South Africa (Durban) and Niger (Dosso), and urban sites in the United States (Los Angeles) and China (Guangzhou). METHODS Binocular presenting distance and near visual acuity (VA) were measured with a LogMAR tumbling E chart at 4 meters and 40 cm, respectively. A 12-item near VF questionnaire interview was administered by trained local interviewers, with responses scored from 100 to 0 as visual "disability" increased. Multiple linear regression was used to investigate the association of age, gender, education and VA with overall eyesight, difficulty with activities and social functioning subscale scores. MAIN OUTCOME MEASURES VF subscale scores. RESULTS The study sample consisted of 6,851 questionnaire respondents. The VF subscale scores decreased significantly with worse distance and near VA, and even mildly impaired VA could result in reduced VF at all sites. In multiple linear regression modeling, lower VF subscale scores were associated with older age in four sites, female gender in three sites, and greater education in two sites. The influence of near VA was greater than that of distance VA in three sites, and in one site distance VA was more influential than near VA. With study site included in the regression modeling, lower scores for the overall eyesight subscale (compared to the Shunyi reference site) were found in Guangzhou, Kaski and Durban; lower difficulty in activities scores were found in Kaski and Durban, but better scores in Guangzhou and Madurai; social functioning scores were lower in Kaski, Durban and Dosso. CONCLUSIONS Along the entire VA spectrum, lower levels of distance and near VA led to significant reductions in VF subscale scores, with wide variation both within and between study sites. The impact of near vision on VF should receive greater emphasis with further investigation in various socio-economic and cultural settings.
Willingness to pay for improved vision in Mozambique
Development Southern Africa, 2020
ABSTRACT The burden of vision impairment due to uncorrected refractive error (needing spectacles)... more ABSTRACT The burden of vision impairment due to uncorrected refractive error (needing spectacles) in Mozambique is known to be significant. To improve the planning and provision of eye health services, a better understanding of how vision is valued by patients is needed. The willingness to pay (WTP) for improved vision through correcting refractive error was investigated in Nampula, Mozambique, using stated choice and bidding game methodologies. The mean WTP values were found to be 388.92 Meticals (US$13) for stated choice and 469.89 Meticals (US$16) for the bidding game. The mean WTP values for rural dwellers were found to be lower than responses from those living in urban areas. If avoidable vision impairment is to be addressed in Mozambique, the cost of services must not be a barrier and the construction of a sustainable spectacle system that delivers for both rural and urban patients must be a priority.
Background: There are many gaps in the management of diabetes mellitus (DM) and diabetic eye dise... more Background: There are many gaps in the management of diabetes mellitus (DM) and diabetic eye disease in the district health system (DHS) of South Africa (SA). National guidelines recommend annual eye examinations for patients with DM.Aim: The purpose of this study was to describe the self-reported skill levels of healthcare practitioners (HCPs) to conduct eye examination procedures required for a proposed diabetic retinopathy (DR) screening model.Setting: The study was conducted in public health institutions of Waterberg district and Mankweng Hospital complex (Capricorn district) in Limpopo province, SA.Methods: A cross-sectional design using purposive sampling was conducted, and questionnaires were distributed to a total of 74 HCPs. The questionnaires distributed included questions relating to the competency levels of primary healthcare nurses (PHC nurses), optometrists, ophthalmic nurses and medical officers (MOs) regarding examination procedures in the management of patients with...
Background Uncorrected refractive error (URE) is a major cause of vision impairment among childre... more Background Uncorrected refractive error (URE) is a major cause of vision impairment among children that impacts negatively on their lives including distresses. We aim to understand the disability-related distress among vision-impaired children due to URE in rural and semi-rural South Africa using qualitative techniques. Methods Structured focus groups of children (aged 5-12 years old) with normal vision and vision impairment due to URE from four schools in Pinetown, KwaZulu Natal, South Africa, were performed (four mixed-gender group discussions and eight single gender group discussions). We recruited the study participants after the children underwent standardised vision screening. Criterion sampling was used when selecting study participants. The interviews were transcribed to identify meaning units and broken down to condensed meaning units, which were then grouped into megathemes. Themes were then generated. Results Thirteen children with normal vision and 63 children with vision impairment due to URE participated in the twelve focus group discussions with 36 boys (47%) and 40 girls (53%). Twelve themes were generated. The megathemes were Loss of Self Confidence (number of themes (n) = 3), Loss of self-worth (n = 3), Loss of interconnection/ interaction with community (n = 2), Humiliation (n = 2) and Discrimination (n = 2).
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