ABSTRACT
Integration of primary eye-care (PEC) into the existing primary healthcare (PHC) system is efficient in reaching rural communities. Baseline assessment of human and material resources for primary eye- care delivery in a rural local government area of southwestern Nigeria with projected population of 126 625 was conducted. Data on number and cadre of all PHC facilities and health-workers were collected. All facilities were visited and materials required for basic PEC inspected. Forty-one (42.3%) community health extension workers, 42 (43.3%) health assistants, 3 (3.1%) community officers of health and 11 (11.2%) registered nurses administered PHC in 27 health facilities. No worker had training in PEC and none of the centres had all the materials for basic PEC delivery. Although procurement of materials and training of health-workers in basic PEC delivery is required, the healthcare facilities and workers currently available are adequate to commence integration of PEC into the PHC system.
La integración de la atención primaria visual (APV) en el sistema existente de atención primaria de la salud (APS) alcanza eficientemente las comunidades rurales. Partiendo de una línea de base, se llevó a cabo una evaluación de los recursos humanos y materiales para la administración de la atención primaria visual en un área gubernamental local rural del sudoeste de Nigeria, para una población de 126 625, según la previsión. Se recogieron datos sobre las cifras y los cuadros de todas las instalaciones para la atención primaria de la salud (APS) y los trabajadores de la salud. Se visitaron todas las instalaciones y se inspeccionaron los materiales requeridos para la APS básica. Cuarenta y un (42.3%) trabajadores de extensión comunitaria de la salud, 42 (43.3%) asistentes de salud, 3 (3.1%) funcionarios de salud de la comunidad y 11 (11.2%) enfermeras graduadas, estuvieron encargados de administrar la APS en 27 instalaciones de salud. Ninguno de los trabajadores tenía entrenamiento en APV y ninguno de los centros disponía de todos los materiales para brindar APV básica. Si bien se requiere obtener materiales y entrenamiento de los trabajadores de la salud, las instalaciones de atención a la salud y los trabajadores de la salud de que se dispone en la actualidad, son adecuados para comenzar la integración del la APV en el sistema de APS.
Subject(s)
Humans , Community Health Workers/supply & distribution , Eye Diseases/therapy , Health Services Accessibility , Primary Health Care , Rural Health Services , Bandages/supply & distribution , Cross-Sectional Studies , Developing Countries , Nigeria , Ophthalmic Solutions/supply & distribution , Primary Health Care/statistics & numerical data , Rural Health Services/statistics & numerical dataABSTRACT
SUMMARY BACKGROUND: Trabeculectomy is the commonest surgical procedure for glaucoma. The outcome of trabeculectomy in the treatment of all types of glaucoma over a 4-year period in a Nigerian population was reviewed. OBJECTIVE: To determine the surgical rate and effectiveness of trabeculectomy in lowering of intra ocular pressure (IOP) and preservation of visual acuity. METHODS: Retrospective review of all trabeculectomies (TEs) done at the Obafemi Awolowo University Teaching Hospital, Ile-Ife between January 1999 and December 2002. The outcome of trabeculectomy was correlated with the biomicroscopic appearance of the filtering bleb, visual acuity and IOP levels. Descriptive statistics were applied to the data. RESULTS: Of the 647 glaucoma patients only fifty-three (8.2%), 34 males and 19 females, had trabeculectomy done during the study period. Seventy-two consecutive eyes of these 53 Nigerian patients were operated upon. Majority, 63 (87.5%) were in the primary glaucoma group of which 46 (63.9%) were open angle glaucoma type. Nine eyes (12.5%) belonged to the secondary glaucoma group (neovascular, uveitic and traumatic angle recession). Successful control of intra-ocular pressure with medical therapy was recorded only in 13.9% of the patients. The mean pre-operative and first post-operative day IOP were 32.5+/- 6.2mmHg and 10.6+/- 2.3mmHg respectively. Mean post-op IOP at 3 months and one year were 14.6+/- 4.2mmHg, and 13.5+/- 5.8mmHg respectively. One year after surgery 34 eyes (61.8%) had intraocular pressure (IOP) of 20mm Hg or less without glaucoma medication. Hyphema 11 (15.3%) was the commonest post-operative complication documented. CONCLUSIONS: Surgical intervention in the management of glaucoma, especially trabeculectomy is not commonly done in this Teaching Hospital. IOP control with medication alone is not adequate in the long term. A significant proportion of the eyes (61.8%) had complete success in IOP control following trabeculectomy.
