Red reflex examination in reproductive and child health clinics for early detection of paediatric cataract and ocular media disorders: cross-sectional diagnostic accuracy and feasibility studies from Kilimanjaro, Tanzania.

BACKGROUND/OBJECTIVES: Late presentation of congenital cataract in the developing world has led to poor outcomes such that cataract is the leading cause of childhood blindness. Our hypothesis was that, sensitivity of red-reflex testing is greater than sensitivity of torchlight examination. We aimed to compare sensitivity of new red reflex screening tools and assess the feasibility of Arclight red reflex screening in the community. SUBJECT/METHODS: We compared the diagnostic accuracy of four different screening tools for cataract and retinoblastoma performed by ophthalmic nurses, using a clinic based enriched sample of 41 positives and 60 negatives. We then conducted a separate feasibility study, training non-specialist community nurses. Following the training, community nurses examined 2827 children <5 years with Arclight who were attending their clinics for growth monitoring and immunisation. FINDINGS: Diagnostic accuracy study: estimated sensitivities were 97.6% for Catcam, 92.7% for Arclight, 90.2% for PEEK retina and 7.3% for torchlight. Estimated specificities were above 90% for Catcam, Arclight and torchlight and 87% for PEEK retina. Feasibility study: twenty-four out of 2728 children screened failed community screening, seven were true positive (six cataract, one retinoblastoma). Prevalence of bilateral cataract was 1.5/1000 (95% CI: 0.40-3.75 per 1000). CONCLUSIONS: Arclight and CatCam have higher sensitivity than torchlight, are easy to learn and use by primary health care nurses. Red reflex testing should be recommended in the WHO guidelines instead of torchlight examination to help early detection of potential blinding causes including congenital cataract and retinoblastoma.

Prevalence of syphilis, neurosyphilis and associated factors in a cross-sectional analysis of HIV infected patients attending Bugando Medical Centre, Mwanza, Tanzania.

BACKGROUND: HIV-syphilis co-infection can enhance the rapid progression of early or late latent syphilis to neurosyphilis and can cause catastrophic neurological complications. In studies in Mwanza, syphilis affects ~ 8% of healthy outpatients and studies done in the 1990s have suggested that up to 23.5% of HIV-syphilis co-infected patients also have neurosyphilis. METHODOLOGY: This was a cross sectional study in which adult HIV infected patients who were hospitalized or attending the outpatient Care and Treatment Clinic (CTC) were interviewed using a structured questionnaire and screened for syphilis using serum Treponema Pallidum Hemagglutination Assay (TPHA). Blood was also taken for CD4+ T cells and viral load. Those who were found to have syphilis underwent neurological examination for any neurologic deficit and were offered a lumbar puncture. RESULTS: The prevalence of syphilis in HIV infected patients was found to be 9.6%. The majority of patients were female (72.5%) and median age was 42 years [interquartile range, 32-50]. Most patients were on ART (99.4%). In the study population of 1748 participants, 9.6% were TPHA positive; the majority (89.2%) reported not knowing their syphilis status and not previously been treated. One hundred and forty-one participants with syphilis had neurological examinations performed. Four of these had abnormal findings that necessitated a lumbar puncture. Neurosyphilis was confirmed in one patient (0.7%). CONCLUSION: The high prevalence of syphilis in HIV infected patients indicates that there is a need to increase efforts in targeting this population to reduce sexually transmitted infections. Screening for syphilis should be done for all HIV patients given the high prevalence of the infection and the risk that aggressive forms of neurosyphilis can occur despite recovery of CD4+ T cell counts in untreated syphilis.

Retinopathy in adults with hypertension and diabetes mellitus in Western Tanzania: a cross-sectional study.

OBJECTIVE: Little is known about the retinal manifestations of arterial hypertension (HTN) and diabetes mellitus (DM) in Western Tanzania and how to maximise the utilisation of scarce eye health resources. To address this, we determined the prevalence of hypertensive and diabetic retinopathy (DR), associated risk factors and relevant patient knowledge. METHODS: Adults with HTN or DM attending outpatient clinics at Bugando Medical Center (BMC) from June to August 2017 were enrolled. Fundus photographs were obtained, and data were collected on blood pressure (BP), body mass index (BMI), blood sugar, visual acuity (VA) and responses to questions about the effects of HTN and DM on the eye. RESULTS: A total of 180 persons were screened. When only individuals with DR were considered, bivariate regression found systolic BP was significantly associated with severity of DR (P = 0.034). Receiver operating characteristic (ROC) curve analysis using the maximum Youden index revealed the optimum cut-off using duration of DM to predict any DR was 8 years (AUC = 0.75, 95% CI 0.65-0.85). Fewer persons with HTN were aware of the effect of high BP on the eye (61.6%) than persons with DM who were aware of the effect of high blood sugar on the eye (74.4%) (P = 0.048). CONCLUSION: Efforts should be made to vigorously treat HTN among adults with DM and refer adults with duration of DM of 8 years or more for a dilated retinal examination. Additional efforts should be made to promote awareness of the sight threatening potential of HTN in resource-limited settings.

OBJECTIF: On en sait peu sur les manifestations rétiniennes de l'hypertension artérielle (HTA) et du diabète sucré (DS) dans l'ouest de la Tanzanie et sur la manière de maximiser l'utilisation des rares ressources de la santé oculaire. Pour répondre à ceci, nous avons déterminé la prévalence de la rétinopathie hypertensive et diabétique (RD), les facteurs de risque associés et la connaissance du patient concerné. MÉTHODES: Les adultes atteints d'HTA ou de DS fréquentant les cliniques ambulatoires au Bugando Medical Center (BMC) de juin à août 2017 ont été inscrits. Des photos du fond de l'œil ont été obtenues et des données ont été recueillies sur la pression artérielle (TA), l'indice de masse corporelle (IMC), la glycémie, l'acuité visuelle (AV) et les réponses aux questions sur les effets de l'HTA et du DS sur l'œil. RÉSULTATS: Au total, 180 personnes ont été dépistées. Lorsque seules les personnes atteintes de RD étaient considérées, la régression bivariée a révélé que la TA systolique était significativement associée à la sévérité de la RD (P = 0,034). L'analyse de la courbe des caractéristiques de fonctionnement du récepteur (ROC) à l'aide de l'indice de Youden maximal a révélé que le seuil optimal utilisant la durée du DS pour prédire toute RD était de 8 ans (ASC = 0,75 ; IC95%: 0,65 à 0,85). Moins de personnes atteintes de HTA étaient conscientes de l'effet d'une TA élevée sur l'œil (61,6%) que les personnes atteintes de DS qui étaient conscientes de l'effet de l'hyperglycémie sur l'œil (74,4%) (P = 0,048). CONCLUSION: Des efforts doivent être faits pour traiter effectivement l'HTA chez les adultes atteints de DS et référer les adultes avec une durée de DS de 8 ans ou plus pour un examen de la rétine dilatée. Des efforts supplémentaires devraient être faits pour promouvoir la prise de conscience du potentiel de menace pour la vue de l'HTA dans les zones à ressources limitées.

The Arclight Ophthalmoscope: A Reliable Low-Cost Alternative to the Standard Direct Ophthalmoscope.

Background. The Arclight ophthalmoscope is a low-cost alternative to standard direct ophthalmoscopes. This study compared the Arclight ophthalmoscope with the Heine K180 direct ophthalmoscope to evaluate its reliability in assessing the vertical cup disc ratio (VCDR) and its ease of use (EOU). Methods. Eight medical students used both the Arclight and the Heine ophthalmoscopes to examine the optic disc in 9 subjects. An EOU score was provided after every examination (a higher score indicating that the ophthalmoscope is easier to use). A consultant ophthalmologist provided the reference standard VCDR. Results. 288 examinations were performed. The number of examinations that yielded an estimation of the VCDR was significantly higher for the Arclight ophthalmoscope (125/144, 85%) compared to the Heine ophthalmoscope (88/144, 61%) (p < 0.001). The mean difference from the reference standard VCDR was similar for both instruments, with a mean of -0.078 (95% CI: -0.10 to -0.056) for the Arclight and -0.072 (95% CI: -0.097 to -0.046) for Heine (p = 0.69). The overall EOU score was significantly higher for the Arclight ophthalmoscope (p < 0.001). Conclusion. The Arclight ophthalmoscope performs as well as, and is easier to use than, a standard direct ophthalmoscope, suggesting it is a reliable, low-cost alternative.