Eye Health Integration in Southern and Eastern Africa: A Scoping Review.

Integrated health systems are deemed necessary for the attainment of universal health coverage, and the East, Central, and Southern Africa Health Community (ECSA-HC) recently passed a resolution to endorse the integration of eye health into the wider health system. This review presents the current state of integration of eye health systems in the region. Eight hundred and twelve articles between 1946 and 2020 were identified from four electronic databases that were searched.

Travel time to cataract surgical services in Kenya, Malawi and Rwanda: demonstrating a standardised indicator of physical access to cataract surgery.

Background: Travel time can be used to assess health services accessibility by reflecting the proximity of services to the people they serve. We aimed to demonstrate an indicator of physical access to cataract surgery and identify subnational locations where people were more at risk of not accessing cataract surgery.

Methods: We used an open-access inventory of public health facilities plus key informants in Kenya, Malawi and Rwanda to compile a geocoded inventory of cataract facilities.

International collaboration for the development of clinical guidelines in low and middle-income countries: case study on the development of a national framework and clinical guidelines for diabetic retinopathy in Ghana.

Background: Diabetic retinopathy is a leading cause of blindness in many countries across the world. Ghana has seen a rise in diabetic retinopathy and is working on various strategies to prevent blindness. Clinical guidelines are seen as a promising strategy for improving quality and reducing cost of care.

Rationale for integration of services for diabetes mellitus and diabetic retinopathy in Kenya.

Background: Good diabetes mellitus (diabetes) and diabetic retinopathy (DR) management depends on the strength of the health system, prompting us to conduct a health system assessment for diabetes and DR in Kenya. We used diabetes and DR as tracer conditions to assess the strengths and weaknesses in the health system, and potential interventions to strengthen the health system. In this paper, we report on the need and relevance of integration to strengthen diabetes and DR care.

Grand Challenges in global eye health: a global prioritisation process using Delphi method.

Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations.

Methods: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists.

E-learning in medical education during COVID-19 pandemic: experiences of a research course at Kenya Medical Training College.

Background: E-learning has been widely adopted as a teaching and learning approach in medical education internationally. However, its adoption in low- and middle-income countries is still at an infantile stage. The use of e-learning may help to overcome some of the barriers to access to quality education and provide flexible, low-cost, user-centred, and easily updated learning.

Effectiveness of interventions to increase uptake and completion of treatment for diabetic retinopathy in low- and middle-income countries: a rapid review protocol.

Background: Vision loss due to diabetic retinopathy can largely be prevented or delayed through treatment. Patients with vision-threatening diabetic retinopathy are typically offered laser or intravitreal injections which often require more than one treatment cycle. However, treatment is not always initiated, or it is not completed, resulting in poor visual outcomes.

Effectiveness of task-shifting for the detection of diabetic retinopathy in low- and middle-income countries: a rapid review protocol.

Background: Diabetic retinopathy is the most common ocular complication of diabetes and a cause of vision loss in adults. Diabetic retinopathy screening leading to early identification of the disease followed by timely treatment, can prevent vision loss in people living with diabetes. A key barrier to the implementation of screening services in low- and middle-income countries is the low number of ophthalmologists per million population.

Feasibility of a cluster randomized controlled trial on the effectiveness of peer-led health education interventions to increase uptake of retinal examination for diabetic retinopathy in Kirinyaga, Kenya: a pilot trial.

Background: People living with diabetes can reduce their risk of vision loss from diabetic retinopathy by attending screening, which enables early detection and timely treatment. The aim of this pilot trial was to assess the feasibility of a full-scale cluster randomized controlled trial of an intervention to increase uptake of retinal examination in this population, as delivered within existing community-based diabetes support groups (DSGs).

Methods: All 16 DSGs in Kirinyaga county were invited to participate in the study.

Are we advancing universal health coverage through cataract services? Protocol for a scoping review.

Introduction: Universal health coverage (UHC) includes the dimensions of equity in access, quality services that improve health and protection against financial hardship. Cataract continues to be the leading cause of blindness globally, despite cataract surgery being an efficacious intervention. The aim of this scoping review is to map the nature, extent and global distribution of data on cataract services for UHC in terms of equity, access, quality and financial protection.

Equity was rarely considered in Cochrane Eyes and Vision systematic reviews and primary studies on cataract.

Objective: We sought to understand the extent to which Cochrane Eyes and Vision systematic reviews of interventions for cataract, and primary studies, consider equity.

Study Design And Setting: This is a review of Cochrane Eyes and Vision systematic reviews (CSRs) on cataract published on the Cochrane Library (end of March 2019) (n = 23), and recently published primary studies included in those reviews (n = 62), using the PROGRESSPlus framework.

Results: One CSR considered equity as a topic.

Global eye health and the sustainable development goals: protocol for a scoping review.

Introduction: In 2015, most governments of the world committed to achieving 17 sustainable development goals (SDGs) by the year 2030. Efforts to improve eye health contribute to the advancement of several SDGs, including those not exclusively health-related. This scoping review will summarise the nature and extent of the published literature that demonstrates a link between improved eye health and advancement of the SDGs.

Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial.

Background: There is limited evidence on how implementation of peer support interventions influences effectiveness, particularly for individuals with diabetes. We conducted a cluster randomized controlled trial to compare the effectiveness of a peer-led health education package versus usual care to increase uptake of screening for diabetic retinopathy (DR).

Methods: Our process evaluation used a mixed-method design to investigate the recruitment and retention, reach, dose, fidelity, acceptability, and context of implementation, and was guided by the Consolidated Framework for Implementation Research (CFIR).

Cataract Services are Leaving Widows Behind: Examples from National Cross-Sectional Surveys in Nigeria and Sri Lanka.

The Sustainable Development Goals aim to leave no one behind. We explored the hypothesis that women without a living spouse-including those who are widowed, divorced, separated, and never married-are a vulnerable group being left behind by cataract services. Using national cross-sectional blindness surveys from Nigeria (2005-2007; = 13,591) and Sri Lanka (2012-2014; = 5779) we categorized women and men by marital status (married/not-married) and place of residence (urban/rural) concurrently.

Evidence for national universal eye health plans.

Many low- and middle-income countries use national eye-care plans to guide efforts to strengthen eye-care services. The World Health Organization recognizes that evidence is essential to inform these plans. We assessed how evidence was incorporated in a sample of 28 national eye-care plans generated since the was endorsed by the World Health Assembly in 2013.

Effectiveness of peer support to increase uptake of retinal examination for diabetic retinopathy: study protocol for the DURE pragmatic cluster randomized clinical trial in Kirinyaga, Kenya.

Background: All patients with diabetes are at risk of developing diabetic retinopathy (DR), a progressive and potentially blinding condition. Early treatment of DR prevents visual impairment and blindness. The natural history of DR is that it is asymptomatic until the advanced stages, thus annual retinal examination is recommended for early detection.