ABSTRACT
BACKGROUND/AIMS: Trachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher training (RT) for experienced surgeons (1-22 years) on the outcomes of upper lid (UL) TT surgery in rural Ethiopia. METHODS: Patients undergoing UL TT surgery in at least one eye by a participating surgeon were included. Patients were split into two cohorts: patients enrolled prior to (C1) and after (C2) RT. RT consisted of a 1-week programme with practice on a HEAD START mannequin and supportive supervision in live surgery by expert trainers. Data were collected at preoperative enrolment, and at 6-month and 12-month follow-up visits. The primary outcome was development of postoperative TT (PTT). A series of multivariate generalised estimating equations were fit to model PTT involving potential covariates of interest. RESULTS: A total of 261 eyes contributed by 173 patients were studied between 2017 and 2019. By 1-year postoperatively, 37/128 eyes (28.9%) in C1 and 22/133 eyes (16.5%) in C2 had developed PTT (p=0.03). Other than surgeon RT participation, no factors studied were associated with differences in PTT. CONCLUSION: Our results indicate a significant reduction in the risk of PTT after experienced surgeons' participation in RT as compared with eyes receiving surgery before RT. This observation suggests a significant potential benefit of the RT with HEAD START mannequin practice and supportive supervision during surgery, and suggests RT may be a valuable strategy to improve surgical outcomes.
ABSTRACT
Background: Ethiopia is the second most populous nation in Africa with children and adolescents constituting more than 40% of the population. Evidence shows the onset of significant degrees of mental illnesses is detectable in this age range. For such early identification to be made there should be a system responding to those needs. Objective: The objective of this study was to explore the extent to which the education system is responsive to the psychosocial and mental health needs of children in primary schools through putting appropriate professionals in place, raising teachers' awareness and putting in place viable policies and guidelines. Methods: An exploratory qualitative study was conducted in public and private primary schools in Gondar city Data was collected through focus group discussions from seventeen participants drawn from both schools and key informant interviews with two experts from the zonal Department of Education. A thematic qualitative data analysis was employed. Themes were identified with the help of the Nvivo 12 plus software. Results: We found teachers' mental health awareness is very low with parameters such as magnitude, case identification and support. There is an exception in terms of causal attributions of mental illness that matches with scientific literature. Psychosocial support and mental health resources are not available and schools do not provide capacity building mental health trainings for teachers which might help them to identify, handle and make referrals of mental health cases. We also found the Ethiopian education policy and other guidelines do not address the issue of mental health at primary school level. Conclusion: The Ethiopian education system is not responsive to the psychosocial and mental health needs of children in primary schools. Implications: Arresting minor impairments before they become major disabilities is vital. Investing in childhood mental health enables a healthy and productive society to be cultivated. The Ethiopian education system should therefore respond to the psychosocial and mental health needs of children in primary schools.
