Pediatric cataract surgery in Madagascar.

BACKGROUND: Cataract is the main cause of blindness among children in Africa, having replaced vitamin A deficiency and measles. The management of childhood cataract in Africa, especially francophone countries, is inadequate. AIMS AND OBJECTIVE: The objective is to study the age at presentation of children diagnosed with cataract, their visual outcomes, and follow-up patterns after surgery in Madagascar. MATERIALS AND METHODS: This was a retrospective case series of children operated on for cataract in one of the busiest eye hospitals in Madagascar between September 1999 and July 2009. Data were obtained from theater logs and patient case notes and entered in a Microsoft Excel spreadsheet. Data entry was carried out using Microsoft Excel and analysis using Intercooled Stata version 9.0. Student t-test and Pearson's Chi-square were used to test associations where appropriate. RESULTS: A total of 60.5 percent of the 86 children operated on during the study period were boys. The mean age at presentation was 6.9 years (±SD 4.3) for congenital cataract, 13.1 years (±SD 2.9) for developmental cataract and 9.4 years (±SD 4.0) for traumatic cataract. A total of 36 children (41.9%) came back for follow-up, while 72 children (83.7%) were lost to follow-up 5 weeks after surgery. The mean follow-up period was 5 weeks (±SD 17.9). Children, who were brought back for follow-up were younger than those who were not. Although 64 (74.4%) of children had refraction during their encounters with the eye care facility, only 3 (3.5%) were provided with glasses. At last documented follow-up, 2.7% of the children had 6/18 vision or better. CONCLUSIONS: In Madagascar, presentation for congenital and developmental cataract is very late, visual outcome poor and follow-up inadequate. There is an urgent need for a childhood blindness program to effectively deal with pediatric cataract, an avoidable cause of blindness and visual disability in children on the island nation.

[Social marketing to increase the rate of cataract surgery in the Sava region of Madagascar]. / Marketing social pour augmenter le taux d'opérations de la cataracte dans la région de Sava, Madagascar.

OBJECTIVE: Lack of information is one of the main reasons why people who are visually impaired or blind as a result of cataracts do not visit eye care centers for surgery that can restore their sight. This study was conducted to determine the best ways to inform the main target groups about the possibility of restoring sight to those whose visual impairment and blindness is due to cataracts and about outreach visits by the mobile eye clinic of FLM SALFA, Sambava, in the Sava region of Madagascar from November 2008 through October 2009. METHODS: Two community eye health workers conducted awareness campaigns and delivered posters to radio stations, religious leaders, and administrative authorities of the 17 most populated municipalities in the region of Sava, two weeks before these visits. All participants who visited the mobile clinic were interviewed, and the ophthalmologist's diagnosis was noted on the questionnaire. RESULTS: Women accounted for 51.5% of the 955 participants. Radio was the most effective means of communication in the region overall, and specifically for reaching men (P=0.044); churches were more successful for reaching women (P = 0.000). Cataract was diagnosed in 16.2% of men and 8.1% of women (p = 0.0001). CONCLUSION: To significantly increase the number of people, especially women, having cataract surgery in the Sava region, it is essential to work closely with the leaders of all religious groups, as well as with radio stations.

Assessment of diabetic retinopathy in newly diagnosed black Kenyan type 2 diabetics.

OBJECTIVE: To determine the prevalence and pattern of diabetic retinopathy in newly diagnosed black African patients with type 2 diabetes mellitus and the associated risk factors. DESIGN: Cross-sectional hospital-based study. SETTING: Eye clinic of Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Africans aged 20 years and above with newly diagnosed type 2 diabetes mellitus of up to 12 months duration. RESULTS: One hundred and forty one eyes of 71 patients were included in this study, while slides of 92 eyes of 65 patients were of good enough quality for evaluation. The mean duration of diabetes was 11.7 weeks (SD 16.6) and 11.3 (SD 10.1) in men and women respectively. Overall, the prevalence of diabetic retinopathy and clinically significant macula oedema was 30.4% and 8.7% respectively. There was a positive association between diabetic retinopathy and systolic blood pressure. CONCLUSION: The prevalence of diabetic retinopathy in newly diagnosed Africans with type 2 diabetes in Kenya is very high. This suggests longstanding undiagnosed diabetes.