Authorship Correction: Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centers on Service Use: Protocol for a Randomized Experimental Study (Preprint)

UNSTRUCTURED A vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community’s vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care. Our organization is planning an awareness-cum-engagement intervention—door-to-door basic eye checkup and visual acuity screening in VCs coverage areas—to connect with the community and improve the rational use of VCs. In this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ≤10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed. Background work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress. Through this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability. ClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718

Primary health care facility readiness to implement primary eye care in Nigeria: equipment, infrastructure, service delivery and health management information systems

Background Over two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for primary eye care. However, there are limited data on the capacities needed for delivery, to guide policymakers and implementers on the feasibility of integration. The overall purpose of this study was to assess the technical capacity of the health system at primary level to deliver the WHO primary eye care package. Findings with respect to service delivery, equipment and health management information systems (HMIS) are presented in this paper. Methods This was a mixed-methods, cross sectional feasibility study in Anambra State, Nigeria. Methods included a desk review of relevant Nigerian policies; a survey of 48 primary health facilities in six districts randomly selected using two stage sampling, and semi-structured interviews with six supervisors and nine purposively selected facility heads. Quantitative study tools included observational checklists and questionnaires. Survey data were analysed descriptively using STATA V.15.1 (Statcorp, Texas). Differences between health centres and health posts were analysed using the z-test statistic. Interview data were analysed using thematic analysis assisted by Open Code Software V.4.02. Results There are enabling national health policies for eye care, but no policy specifically for primary eye care. 85% of facilities had no medication for eye conditions and one in eight had no vitamin A in stock. Eyecare was available in < 10% of the facilities. The services delivered focussed on maternal and child health, with low attendance by adults aged over 50 years with over 50% of facilities reporting ≤10 attendances per year per 1000 catchment population. No facility reported data on patients with eye conditions in their patient registers. Conclusion A policy for primary eye care is needed which aligns with existing eye health policies. There are currently substantial capacity gaps in service delivery, equipment and data management which will need to be addressed if eye care is to be successfully integrated into primary care in Nigeria.

Evaluating Eye Health Care Services Progress Towards VISION 2020 Goals in Gurage Zone, Ethiopia.

Background Ethiopia signed the VISION 2020 Global Declaration and launched its eye health program in 2002. Since then, there has been limited systematic and comprehensive evaluation of the progress towards VISION 2020 goals in Ethiopia.Purpose To evaluate Gurage Zone progress towards VISION 2020 targets and process indicators.Method An institutional-based cross-sectional study was conducted among all public and private eye health care facilities in the Gurage Zone within the Southern Nations, Nationalities, and People Region of Ethiopia. The evaluation protocol was adopted from the VISION 2020 situational analysis data collection tool. We used this structure to evaluate progress in terms of human resources, infrastructure, and service delivery at the Zonal Health Office and facility level.Result At the time of the study, the Gurage Zone had a 1.7 million catchment area population. There was a total of five eye care centers, of which one was established by a Non-Governmental Organization. Three of these facilities were secondary eye care centers with an operating theater and two of them were primary eye care centers. At the zonal level, there is no survey data available on the prevalence of blindness. There was no systemic evaluation of VISION 2020 process indicators. The budget allocation specific to eye health care was less than 0.7% of the total budget of the office. The human resources for eye health in the catchment area were: one ophthalmologist, two cataract surgeons, five optometrists, and 12 ophthalmic nurses, which is below the VISION 2020 targets for human resources for eye health. In terms of equipment, neither primary eye care center had a slit lamp biomicroscope, and two of the three secondary eye care centers did not have intraocular pressure (IOP) measuring equipment. Only one secondary eye care center was providing glaucoma surgical services, and no center provided either emergency or elective pediatric surgery. The cataract surgical rate (CSR) determined by the study was 1967.ConclusionGurage Zone had not achieved VISION 2020 goals in terms of critical human resources and service delivery. We recommend that the Zonal Health Office carries out a focused and baseline evaluation of eye health care service achievements.

A review of David Elliot’s clinical procedures in primary eye care

No abstract available.