Work capacity and surgical output for cataract in the national capital region of Delhi and neighbouring districts of north India.

OBJECTIVES: To ascertain time taken for cataract surgery by ophthalmologists in the National Capital Region of Delhi and neighbouring districts, to determine what work output is feasible with the available ophthalmologists. METHODS: The time-motion study was conducted during January to June 2006 in the National Capital Region of Delhi and neighbouring districts in North India. Data was collected by observing all activities from entry of a patient into the operating theatre to exit. A total of 156 cataract surgeries performed by 45 ophthalmologists in 38 hospitals were observed. A stop watch was used to record activity time, rounded off to the nearest 10 seconds. Case duration, surgical and clinical times were calculated. RESULTS: Ninety percent ophthalmologists completed surgery in 41.3 minutes. The 10th and 90th percentile for case duration time was 15.5 and 78.4 minutes respectively. Median surgical time was lowest for ophthalmologists working in the NGO sector (10 minutes), compared to the government (23.5 minutes), and private sector (17.3 minutes). Cataract surgical output can be increased in the country if operation theatre time is utilized optimally.

Epidemiological study of ocular trauma in an urban slum population in Delhi, India.

PURPOSE: To study the epidemiology and clinical profile of victims of ocular trauma in an urban slum population. MATERIALS AND METHODS: This cross-sectional study, conducted on 500 families each in three randomly selected urban slums in Delhi, collected demographic data for all members of these families, and clinical data for all those who suffered ocular trauma at any time, that required medical attention. Data was managed on SPSS 11.0. RESULTS: Of 6704 participants interviewed, 163 episodes of ocular trauma were reported by 158 participants (prevalence = 2.4%, confidence interval = 2.0 to 2.7) Mean age at trauma was 24.2 years. The association between the age of participants and the history of ocular trauma was significant ( P < 0.001), when adjusted for sex, education and occupation. Males were significantly more affected. Blunt trauma was the commonest mode of injury (41.7%). Blindness resulted in 11.4% of injured eyes ( P = 0.028). Of 6704 participants, 1567 (23.4%) were illiterate, and no association was seen between education status and trauma, when adjusted for sex and age at injury. A significant association was noted between ocular trauma and workplace (Chi-square = 43.80, P < 0.001), and between blindness and place (Chi-square = 9.98, P = 0.041) and source (Chi-square = 10.88, P = 0.028) of ocular trauma. No association was found between visual outcome and the time interval between trauma and first consultation (Chi-square = 0.50, P = 0.78), between receiving treatment and the best corrected visual acuity (Chi-square = 0.81, P = 0.81), and between the person consulted and blinding ocular trauma (Chi-square = 1.88, P = 0.170). CONCLUSION: A significant burden of ocular trauma in the community requires that its prevention and early management be a public health priority.

Need for optical and low vision services for children in schools for the blind in North India.

CONTEXT: Children admitted in blind schools need low vision assessment for improving functional vision (useful residual vision). AIM: To ascertain the need for spectacles and magnifiers as low vision devices (LVD) in children with useful residual vision, attending blind schools. SETTING AND DESIGN: Cross-sectional study conducted in 13 blind schools in Delhi, North India. MATERIALS AND METHODS: Of a total of 703 children (less than 16 years of age) examined, 133 (18.91%) with useful residual vision were refracted and analyzed. High addition plus lenses (range 5-30 diopters) were used as spectacle magnifiers for near LVD assessment. "World health organization (WHO)/ prevention of blindness (PBL) eye examination record for children with blindness and low vision", was used to collect data. SPSS (statistical package for the social science), version 10.0 was used for analysis. RESULTS: Based on the vision of 133 children at initial examination, 70.7% children were blind and 12.0% were severely visually impaired (SVI). 20.3% children improved by at least one WHO category of blindness after refraction. With best correction, 50.4% children were still blind and 13.5% were SVI. Visual acuity in the better eye after refraction in 47 children (35.3%), improved with spectacles. Children with aphakia (17), coloboma (5), refractive error (5) and microphthalmos (4) benefited from spectacles. Of 124 children with low vision but having useful residual vision, 51 (41.1%) were able to read N-10 unaided or with distance spectacles and 30 children (22.6%) improved to N-10 with spectacle magnifiers and were prescribed the same. CONCLUSION: Visually impaired children with aphakia and congenital anomalies of the eye benefit from refraction and low vision services.

Status of speciality training in ophthalmology in India.

PURPOSE: To systematically evaluate the quality of ophthalmology training in India. METHODS: Questionnaires were sent to existing medical schools and accredited training institutions. Institutions were followed up thrice to obtain responses. Data were analysed using Stata 8.0. RESULTS: Responses were received from 128 (89.5%) of the 143 institutions. Each year, 900 training slots were available across the country. Faculty: student ratios were better in accredited training institutions than in postgraduate medical schools. Fifty three (41.4%) of 128 institutions subscribed to more than 2 international journals. Fewer than 1 in 6 institutions conducted research projects. 11 (8.6%) institutions reported more than five publications in international peer-reviewed journals over three years. Only a third of the responding institutions had a wet lab. CONCLUSIONS: There is a need to improve the training facilities and optimally utilise the infrastructure available in postgraduate medical schools.

Human resources and infrastructure for eye care in India: current status.

BACKGROUND: An ophthalmic workforce and infrastructure planning survey was undertaken to provide a valid evidence base for human resource and infrastructure requirements for elimination of avoidable blindness. This is the first time that such an extensive survey has been done in India. METHODS: Pre-tested questionnaires were administered to all district-level blindness officials and ophthalmology training institutions during April 2002-March 2003. Supplementary data sources were used wherever necessary. Data analysis was done in Stata 8.0. Projections of the existing ophthalmologists and dedicated eye beds were made for the entire country using the mean, median and range for each individual state. RESULTS: The response rate was 89.3%. More than half the eye care facilities were located in the private sector. Sixty-nine per cent of the ophthalmologists were employed in the private and non-governmental sectors; 71.5% of all dedicated eye beds were managed by these two sectors. Five states (Maharashtra, Uttar Pradesh, Karnataka, Andhra Pradesh and Tamil Nadu) had half the practising ophthalmologists in India. There was a wide disparity in access to ophthalmologists and dedicated eye beds across the country. Using the median to obtain medium projections, it is estimated that there are 9478 practising ophthalmologists and 59 828 dedicated eye beds in India. CONCLUSIONS: India will be able to meet the requirements for trained ophthalmologists and dedicated eye beds to achieve the goals of Vision 2020. Some states will need special attention. Instead of an across-the-board increase in ophthalmologists and eye beds, regions which are deficient will need to be prioritized and concerted action initiated to achieve an equitable distribution of the available resources.

Rapid assessment of cataract blindness in India.

28,055 persons aged 50 yrs+ from seven states in India were surveyed by a rapid assessment technique for cataract blindness. The prevalence of bilateral blindness (vision < 6/60 in the better eye) was 11.68 percent (95% C.I. 10.54-12.81). The age-gender adjusted blindness prevalence rate was 11.04 percent (95% C.I. 11.033-11.044). Age and occupational status were associated with blindness prevalence. Cataract was the commonest cause of low vision and blindness in this population. Respondents aged 60-69 years had a 2.74 times higher risk, while those aged 70 years+ had a 4.86 times higher risk of being blind, compared to those 50-59 years. Productively employed individuals had lowest blindness rates. Blindness rates were five times higher among respondents who were not working and two times higher among those engaged solely in household activities. The prevalence of cataract was 43.32 percent (95% C.I. 41.14-45.50) among those aged 50+ years. The prevalence increased with increasing age. Gender did not influence the prevalence of cataract in the present survey. Extrapolating from the present survey, it is estimated that 11.9 million blind people (vision < 6/60 in the better eye) in India are in urgent need of cataract surgery.

Qualitative research in ophthalmic sciences.

Qualitative research was the preserve of social scientists before making inroads into medical sciences, as the medical fraternity was wedded to evidence-based medicine. Qualitative research methods are now being increasingly used in medicine. The goal of qualitative research is to help in the understanding of social phenomenon in their natural settings. These methods help to unravel mysteries relating to complex human interactions and to study the role of human behaviour in health and disease. Recent evidence points to the complementary roles of qualitative and quantitative methods in medical research. Qualitative methods include observations, interviews, focus groups, projective techniques, analysis of personal documents and accounts, sorting and ranking, and case studies. This communication describes the application of qualitative methods in ophthalmic research.

Cost of vitamin A and iron supplementation to "at risk" population.

This is a cost descriptive study which estimates the cost of providing iron and vitamin A supplementation through the primary health care system in India. The norms for the primary health care workers were taken as per national norms. The costs included the proportionate cost of the building, workers' salary and the cost of the supplements. The total cost of providing iron supplementation through the PHC was estimated at Rs. 43,800. The cost per beneficiary for adult folifer was Rs. 3.60, for paediatric folifer was Rs. 2.90 and for syrup folifer, it was Rs. 15.50. The overall cost of providing iron and folic acid supplements to the "at risk" population was estimated as Rs 4.40 per beneficiary per year. The cost of vitamin A supplementation to under three through the PHC system was estimated at Rs. 3.20 per beneficiary per year. Both iron as well as vitamin A supplementation through the PHC system appear to be low cost interventions.

Industrial ocular morbidity in a north Indian town.

A study on industrial ocular morbidity was carried out in 6 industrial establishments at Saharanpur. The mean age of the respondents was 35.3 years. 58.2% were regular floor staff. 10.6% professed suffering from an industrial ocular injury. 60% of these injuries were sustained by ocular metallic trauma. 51.9% complained of ocular symptoms at the time of the survey. The frequency of ocular complaints increased with age. The point prevalence of ocular morbidity was 746.03/1000 industrial workers. Refractive errors were the commonest ocular condition (56.7%) observed, followed by Trachoma (32.6%). The highest prevalence of morbidity was recorded among workers above 44 years. Clerical and managerial personnel had higher prevalence compared to other jobs. Only 3.6% of the floor workers were using protective devices while on the job.

Cataract related blindness in India & its social implications.

The prevalence of blindness in India is 14.9 per 1000. Eighty per cent of this blindness is due to cataract alone. Most of the cataract blinds in the country are in the rural areas while the surgical service delivery network is concentrated in the urban areas. Thus a large proportion of patients in the rural areas continue to remain blind. This situation has many social implications. There is loss of productivity, breakdown of interpersonal relationships, depressive manifestations, loss of self esteem and most patients lead an isolated humiliating life. Patients lack information on the available services and continue to remain blind for years even after being diagnosed as operable. This is unfortunate because cataract surgery is one of the most cost effective health interventions known and most operated patients, irrespective of the surgical technique, are immensely satisfied with the level of visual rehabilitation after surgery.

A study of ocular morbidity among elderly population in a rural area of central India.

A cross-sectional study was conducted in five randomly selected villages in Wardha district of Maharashtra state to study the magnitude and factors related to the prevalence of ocular diseases among the elderly population. A total of 903 persons above 50 years were screened. The prevalence of low vision was 32% while that of blindness was 12.2%. Ocular morbidity rate was 1.21 lesions per elderly person and it increased significantly with increasing age (p < 0.001). Ocular diseases were found to be more prevalent among males, low socio-economic status group and landless labourers (p < 0.001). There was a high prevalence of refractive errors (40.8%), cataract (40.4%), aphakia (11.1%) followed by pterygium (5.2%), glaucoma (3.1%) and corneal opacities (3%). Prevalence of diseases of the lens and iris increased significantly with increasing age (p < 0.001). There is a need to evolve strategies for reducing the burden of ocular diseases and improve geriatric eye health under the existing infrastructure of health care delivery in our country.

Epidemiological aspects of visual impairment above 50 years in a rural area.

A cross-sectional survey was conducted in 5 villages in central India to find out the extent, causes and epidemiological factors for visual impairment among 903 individuals aged above 50 years; 44.3% of them were visually impaired (29.4% with low vision and 14.9% blind). Age-specific visual impairment increased at a rate of 13.2% with each decade of advancing age. Landless labourers suffered more from visual impairment than other occupational groups (p < 0.05). Socioeconomic and literacy status of the population did not significantly influence the prevalence of visual impairment. Major causes of visual impairment were cataract (48.5%), refractive errors (24.5%), age-related macular degeneration (10%), glaucoma (6.8%), and others (10.2%). In view of the high prevalence of visual impairment among the elderly individuals, it is necessary to intensify our efforts in motivating them for early detection and treatment.

Cost analysis of eye camps and camp-based cataract surgery.

BACKGROUND. Although cataract accounts for half the blindness in the world, the resources available are not sufficient to meet the existing need for operations. The most effective low cost cataract surgery is probably performed in community camps. METHODS. We estimated the costs incurred in performing cataract operations in makeshift comprehensive eye care camps. Both the capital and recurrent inputs were costed at current market rates. RESULTS. Rupees 1,508,600 (US$ 47,100) was spent on conducting 17 camps during April 1992 to March 1993. Recurrent inputs were responsible for 83% of the total costs. Sixty per cent of the recurrent inputs were borne by non-governmental organizations. The total capital expenditure was borne by the mobile ophthalmic units. Food and drugs for patients (40%), and staff salaries and allowances (35%) were the major recurrent expenditure, while 60% of the capital expenditure was accounted for by vehicles. The unit cost of cataract surgery was Rs 772 (US$ 23). CONCLUSIONS. We suggest that comprehensive eye camps are cost-effective.

Evaluation of an innovative school eye health educational mode.

An innovative mode of using school children as health educators for transmitting messages on eye health care in the school environment was evaluated. Fifty children were evaluated at baseline and immediately after the educational session. A significant change in cognitive aspects of eye care was demonstrated (p < 0.001). Knowledge on vitamin A related aspects and childhood ocular trauma improved substantially compared to all other aspects of eye care.

Evaluation of vitamin A status by conjunctival impression cytology among school aged population.

Conjunctival impression cytology was used to determine the extent of preclinical and clinical vitamin A deficiency in school children aged 8-13 years. Nearly 23% of the examined children had an abnormal cytology reflecting a poor vitamin A status. The differences in cytology results were not significantly affected by either age or sex.

Sociobiologic factors influencing low birth weight at a rural project hospital.

The incidence of low birth weight (less than or equal to 2500 g) was 38.9% among 2292 singleton live births at a rural project hospital in Haryana. Only 7.0% of the newborns weighed 2000 g or less. Female babies had a higher incidence of low birth weight. Other factors considered were maternal age, parity and literacy and father's literacy. Young mothers (less than 20 years) had a higher incidence of low birth weight. Similarly parents who were illiterate or educated to below the primary grade also had a higher incidence of low birth weight. The maximum percentage of low birth weight was seen in the primiparous mothers. An increase of low birth weight was also seen after the 4th parity. The best outcome was at para 4.

Knowledge, attitude and practices regarding acute respiratory infections.

One hundred and six mothers in a rural area were interviewed to determine as to how they recognise pneumonia in children, what therapies they practice with mild acute respiratory illnesses and pneumonias and the feeding practices they adopt. Most mothers recognised pneumonia by noticing fast respiratory rate and difficulty in breathing. More severe cases were recognised by these signs among a higher percentage of mothers. As regards management of mild ARI episodes, more than half the mothers preferred not to give any treatment or use only home remedies. In pneumonias, a majority of them preferred to consult a qualified doctor. Nearly a third of them were of the opinion that they would take the child to hospital if the disease was severe. Regarding feeding practices, most of them stated that they would continue feeding, fluids and breast feeds. Only 10% desired to stop and another 15% would decrease the amounts.

Vitamin A intake and vitamin A deficiency in rural children.

The prevalence of vitamin A deficiency was estimated in 366 rural children in the age group of 1 to 15 years. In a systematically selected subsample of 90 children, the dietary intake of vitamin A was assessed. The prevalence of vitamin A deficiency signs ranged from 24.1 to 34.8%. The adequacy of dietary intake of vitamin A ranged from 8 to 12% when compared with the recommended dietary allowance. The dietary intake of children with and without vitamin A deficiency was not different (p greater than 0.05). The main source of beta carotene in the diet was cereals accounting for 47.9% of the total beta carotene intake.

Knowledge of mothers regarding immunization in a high coverage area--need for strengthening health education.

One hundred mothers of 'fully' immunized 12-24 month old children were administered a schedule to elicit knowledge regarding immunization. The mean age of the mothers was 27.05 years. Knowledge regarding vaccine availability was good, except in case of measles. A much lower proportion were aware of correct doses and intervals. Only DPT was reported to produce side-effects by a majority. The hypothesis that in a high coverage area, mothers would be armed with more specific immunization information was not borne out.

Socio-biological determinants of birth weight.

A study on a few selected socio-biological determinants of birth weight was conducted at a rural project hospital in Haryana. Records of 2292 singleton live births over a period of two years (1985-1987) were analysed, by bivariate and multivariate methods. The mean birth weight of the infants was 2715 g (S.D. 453). Mean birth weight of male infants was 92 g more than female infants. Literacy levels of both parents, maternal age, parity, place of residence and antenatal care were found to have significant influence on the birthweight. Multiple regression showed that maternal age, maternal literacy and place of residence had minimal influence on the birth weight compared to other factors.