RESUMO
Pakistan has an extensive network of public facilities aimed to provide primary health care including eye care. Yet no data exist on the number and purpose of eye visits to these facilities. This study aimed to describe the pattern of eye diseases in public primary care hospitals in a district in Pakistan's Sindh province. This study was conducted in 14 randomly selected government primary health care centers 10 Basic Health Units and 4 Rural Health Centers in district Nawab shah, a central district of Sindh province. Doctors in these centers were trained in diagnosis and management of common eye diseases at the primary level and requested to record data prospectively on the total number of patient visits, total number of eye consultations and reasons for eye consultation. Data were entered and analyzed using EPI Info Software. Over a period of one month, 9759 visits were made to the 14 selected primary health care centers. Eye diseases accounted for 1.8% of the total visits. Adults were more likely to have an eye consultation compared with children [Odds Ratio: 2.96; P < 0.01]. Conjunctivitis [34.1%], cataract [22.0%], and corneal problems [6.9%] were the most common reasons for eye consultations. Despite solid evidence of a high burden of eye diseases at the community level in Pakistan, eye diseases accounted for only a very small proportion of the total consultations in the primary health care facilities. Efforts are needed to assess barriers to optimal utilization of existing primary health care services for eye diseases
RESUMO
Population-based data on the prevalence of diabetic retinopathy in Pakistan are lacking. We determined the prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan. In summer 2002, five community-based eye camps were set up in Karachi, Pakistan's largest city. All individuals aged 30 years or older who visited the camps were requested to participate in the study. Those who agreed were screened for diabetes and those found to have the disease were referred to an eye hospital for diabetic retinopathy screening. Verbal informed consent was obtained from all participants at the examination site. Our main outcome measure was diabetic retinopathy, which was classified as non-proliferative diabetic retinopathy [NPDR], severe NPDR, and proliferative diabetic retinopathy [PDR]. Our grading was based on clinical examination. A total of 912 subjects were screened for diabetes mellitus. Of these, 160[17.5%] had diabetes- 1.8% had type I diabetes and 15.9% had type II diabetes. One hundred and eight individuals visited the hospital for ophthalmic examination. Of them, 15.7% had diabetic retinopathy. The prevalence of diabetic retinopathy was higher among individuals with type I diabetes, with greater duration of diabetes, and among women. The commonest form of diabetic retinopathy was non-proliferative [76.5% [mild: 35.3%, moderate: 29.4%, and severe: 11.8%]], followed by maculopathy [17.6%] and proliferative diabetic retinopathy [5.9%]. More systematic and population-based research is needed to estimate the prevalence of and identify risk factors for diabetic retinopathy in Pakistan