Assessing the barriers and facilitators of access to diabetic retinopathy screening in sub- Saharan Africa: a literature review.

Diabetic retinopathy (DR) is the leading cause of blindness in working age adults. An increase in visual loss has been projected for sub-Saharan Africa (SSA) with the diabetes epidemic in the region. Screening is a cost-effective way to reduce this scourge, but adequate services are scarce. This review aims to evaluate the evidence on barriers and facilitators of access to DR screening with a view to making evidence-based recommendations for the development of effective and sustainable programmes in SSA. A systematic literature search of Africa-Wide Information, Embase, Cochrane library, Global Health, and Medline databases was done using diabetic retinopathy, screening, and Sub-Saharan Africa as concepts. Google Scholar was also searched to identify relevant literature. Studies were included if they were done in SSA and reported on barriers and/or facilitators of access to DR screening. The database search yielded 616 papers and google scholar yielded 9223 papers. Of these, 54 papers were assessed for eligibility and 18 met the inclusion criteria. These were appraised with appropriate checklists. Fourteen themes were synthesised. Most were supply challenges affecting all dimensions of access and the six components of the health systems building blocks. Several studies had poor methodologies, and this has implications for the evidence provided. The findings of this review show a weakness in the health systems suggesting this is the major indirect barrier to DR screening in SSA. Measures to strengthen the health system for DR screening is strongly recommended.

The Impact of Glaucoma on the Mental Health of Primary Open-Angle Glaucoma Patients Attending a Teaching Hospital in South East Nigeria.

Objective: To evaluate the effect of glaucoma on the mental health of primary open-angle glaucoma patients using Hospital Anxiety and Depression Scale (HADS). Materials and Methods: This was a hospital-based comparative study in which 180 glaucoma patients and controls 18 years and above who met the inclusion criteria were selected consecutively in the Eye Clinic of Federal Medical Centre, Owerri, Imo State, in 2017. Data were collected using a questionnaire and the HADS protocol. All the participants underwent comprehensive ocular examination, and glaucoma was graded using visual field perimetric indices and mean deviation. Results: The mean age for cases was 58.14 ± 13.88 years, whereas that of the control group was 57.19 ± 13.76 years. The majority of glaucoma respondents had the moderate form of the disease followed by the severe form. The glaucoma patients showed evidence of poor mental health with 59 (32.8%) of them anxious and 39 (21.7%) depressed compared to controls (P < 0.001). The mean scores for anxiety and depression were 6.02 ± 4.8 and 5.20 ± 4.5, respectively, for glaucoma patients, whereas those for the control group were 0.63 ± 1.8 and 0.64 ± 2.1, respectively (P < 0.001). There was no uniform correlation between the mental health of patients and the variables under study. Conclusion: Primary open-angle glaucoma affects the mental health of patients. This effect is worsened by the severity of the disease and influenced by the occupation and educational level of the patients. Multidisciplinary management of primary open-angle glaucoma patients is recommended.

Impact of Visual Impairment and Blindness on Quality of Life of Patients in Owerri, Imo State, Nigeria.

PURPOSE: This study sought to determine the quality of life (QOL) of patients with visual impairment in Federal Medical Centre, Owerri, Imo State, with a view to making recommendations for comprehensive management of patients. MATERIALS AND METHODS: This was a hospital-based, cross-sectional study carried out at the Eye Clinic of Federal Medical Centre, Owerri, Imo State, Southeast Nigeria. New patients aged 18 years and older were consecutively recruited. Data were obtained using a semi-structured questionnaire and a World Health Organization's QOL Scale-Short Form (WHO-QOL-BREF). Participants had comprehensive eye examinations, and data were analyzed using the Statistical Package for the Social Sciences version 22. RESULTS: One hundred and eight (53.7%) females and 93 (46.3%) males with a mean age of 55.92 ± 16.94 years participated in the study. The major causes of visual impairment were uncorrected refractive error, glaucoma, and cataract. Glaucoma (6.5%) was the leading cause of blindness. The overall QOL score was 61.10 ± 19.75, with the lowest mean score in the environmental domain. With increasing visual impairment, there was a 19.1% reduction in QOL. QOL was also affected by age, duration of visual impairment, and history of poor near vision. CONCLUSION: The leading causes of visual impairment and blindness in this study are avoidable and treatable. Health education, appropriate intervention, and support groups should be encouraged. This may serve to reduce the burden of visual impairment and improve the QOL of patients.

Spectrum of Eye Disorders Seen in a Pediatric Eye Clinic South East Nigeria.

PURPOSE: This study aims to determine the prevalence, pattern, and time of presentation for the ocular disorders seen among children attending a pediatric eye clinic in Nigeria. MATERIALS AND METHODS: A retrospective chart review of all first-time patients at a pediatric eye clinic, within 2005-2007 was carried out. Data on cohort demographics, duration of illness before the presentation, and types of ocular disorders were collected and analyzed. Statistical significance was indicated by P < 0.05. RESULTS: A total of 335 cases were reviewed, comprising 171 males and 164 females. The majority of children were in the 10-14 age group (31.94%). Allergies (40.72%) were the most common ocular disorder followed by refractive errors (22.16%), trauma (7.98%), and inflammation/infections (7.98%). Among others, ocular disorders seen in decreasing frequency were ocular motility imbalance (5.41%), tumors (1.28%), and ptosis (0.77%). Least common was juvenile glaucoma (0.51%). Majority (42.09%) presented more than 1 year after onset of illness while only 16.2% presented within 1 month of their illness. CONCLUSION: Most common causes of ocular disorder in this study were allergy, refractive error, and trauma. Majority of the children presented late, and most of the disorders can result in visual impairment/blindness if not treated early. This emphasizes the need for appropriate health education to avert most cases of childhood blindness/visual impairment.

Body mass index and other anthropometric variables in children with sickle cell anaemia.

OBJECTIVES: The objectives of this study were to determine the anthropometric variables of children with sickle cell anaemia and comparing it with those with normal haemoglobin genotype. METHODS: A cross sectional study of anthropometric measurements was conducted over a period of six months. Children with sickle cell anaemia in steady state aged between 6-20 years were recruited. Nutritional assessment was done using anthropometrical variables. Data were analyzed using the Statistical Package for Social Sciences program (SPSS), version 20. RESULTS: The sickle cell patients comprised of 20 males and 20 females. There were an equal number of controls with an equal male to female ratio of 1:1. Forty eight percent (19) of the children with sickle cell anemia were underweight (< 5th %ile) and this is statistically significant. χ(2)=18.02 and p=0.000. When compared with subjects with normal haemoglobin genotype only five of them (13%) were underweight. χ(2)=10.286 and p=0.001. The controls weighed significantly more than the HbSS patients and also had significantly larger body surface compared to the HbSS population (P<0.05). CONCLUSION: BMI and other anthropometric variables among children with sickle cell anemia were low when compared with children with normal Haemoglobin genotype.

Pulmonary function indices in children with sickle cell anemia in Enugu, south-east Nigeria.

OBJECTIVES: To determine the pulmonary function indices of children with sickle cell anemia (SCA) attending the pediatric sickle cell clinic at the University of Nigeria Teaching Hospital, Enugu, south-east Nigeria and to compare these indices with the results obtained from other regions.  METHODS: A case control study of lung function in children with SCA aged 6-20 years. The study was carried out in the University of Nigeria/University of Nigeria Teaching Hospital, Enugu State, Nigeria between October 2014 and January 2015. Measurements of the peak expiratory flow rate, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) were evaluated. RESULTS: A total of 80 subjects were recruited into the study, comprising 40 homozygous HbSS (hemoglobin SS) patients and an equal number of controls. Children with SCA had statistically lower values of FEV1 (1.6±0.52), FVC (1.76±0.95), and peak expiratory flow rate (PEFR) (309.00±82.64) when compared with normal hemoglobin genotype FEV1 (12.01±0.53), FVC (2.12±0.54), and PEFR (364.10±87.85). The mean FVC, FEV1/FVC, and PEFR were also higher in the male control group compared with the HbSS male group, but these differences were not statistically significant. Female controls had significantly larger FEV1, FVC, and PEFR values compared with the HbSS females.  CONCLUSION: The lung function indices were significantly lower in children and adolescents with SCA compared with the matched controls with a hemoglobin genotype AA.