Planning and Developing Services for Diabetic Retinopathy in Sub-Saharan Africa

Document Type : Original Article

Authors

1 Royal Sussex County Hospital, Brighton, UK

2 International Centre for Eye Health, International Centre for Evidence in Disability (ICED), London School of Hygiene and Tropical Medicine, London, UK

3 VISION 2020 LINKS Programme, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK

Abstract

Background
Over the past few decades diabetes has emerged as an important non-communicable disease in SubSaharan Africa (SSA). Sight loss from Diabetic Retinopathy (DR) can be prevented with screening and early treatment. The objective of this paper is to outline the required actions and considerations in the planning and development of DR screening services.
 

Methods
A multiple-case study approach was used to analyse five DR screening services in Botswana, Ghana, Tanzania and Zambia. Cases included: two regional screening programmes, two hospital-based screening services and one nationwide screening service. Data was collected using qualitative methodologies including: document analysis, indepth interviews and observation. The World Health Organization (WHO) Health Systems Framework was adopted as the conceptual framework for analysis.
 
Results
Planning for a sustainable and integrated DR screening programme demanded a health systems approach. Collaboration with representatives from a variety of ministerial departments and professional bodies was required. Evolution of DR screening services may occur in a variety of ways including: increasing geographical coverage, integration into the general healthcare system, and stepwise progression from a passive, opportunistic service to one that systematically and proactively seeks to prevent DR. Lessons learned from the implementation of cervical cancer prevention programmes in resource-poor settings may assist the development of DR programmes in similar settings.
 
Conclusion
To promote good planning of DR screening services and ensure limited resources are used effectively, there is a need to learn from screening programmes in other medical specialities and a need to share experiences between newly-developing DR programmes in resource-poor countries. The WHO Health Systems Framework presents an invaluable tool to ensure a systematic approach to planning DR screening services.

Keywords

References

  1. Zheng Y, He M, Congdon N. The worldwide epidemic of diabetic retinopathy. Indian J Ophthalmol 2012; 60: 428-31. doi: 10.4103/0301-4738.100542
  2. Burgess PI, Msukwa G, Beare N. Diabetic retinopathy in sub-Saharan Africa : meeting the challenges of an emerging epidemic. BMC Med 2013; 11: 157.  doi: 10.1186/1741-7015-11-157
  3. International Council of Ophthalmology (ICO). ICO Guidelines for Diabetic Eye Care [internet]. 2014. Available from: http://www.icoph.org/resources/309/ICO-Guidelines-for-Diabetic-Eye-Care.html
  4. Beran D, Yudkin JS. Diabetes care in sub-Saharan Africa. Lancet 2006; 368: 1689-95. doi: 10.1016/s0140-6736(06)69704-3
  5. Alliance for Cervical Cancer Prevention (ACCp). Planning and Implementing Cervical Cancer Prevention and Control Programs.  Geneva: WHO; 2004.
  6. World Health Organization (WHO). Everybody’s Buisness. Strenthening Health Systems to Improve Health Outcomes. WHO's Framework For Action. Geneva: WHO; 2007.
  7. Blanchet K, Patel D. Applying principles of health system strengthening to eye care. Indian J Ophthalmol 2012; 60: 470-4. doi: 10.4103/0301-4738.100553
  8. Pope C, Mays N. Using case studies in health services and policy research. In: Keen J, Packwood T, editors. Qualitative Research in Health Care. London: BMJ Books; 2000.
  9. Baxter P, Jack S. Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers. The Qualitative Report 2008; 13: 544-59.
  10. Health Knowledge. Section 5: Data Collection Methods [Internet]. 2011 [cited 2014 Nov 30]. Available from: http://www.healthknowledge.org.uk/public-health-textbook/research-methods/1d-qualitative-methods/section5-data-collection-methods
  11. Boyce C, Neale P. Conducting In-Depth Interviews: A Guide for Designing and Conducting In-Depth Interviews. Pathfinder International; 2006.
  12. Nkomazana O. A national survey of visual impairment in Botswana. Community Eye Heal J  2007; 20: 2020.
  13. Jones S, Edwards RT. Diabetic retinopathy screening: a systematic review of the economic evidence. Diabet Med 2010; 27: 249-56. doi: 10.1111/j.1464-5491.2009.02870.x
  14. Goldie SJ, Gaffikin L, Goldhaber-fiebert JD, Gordillo-tobar A, Levin C, Wright TC. Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries. N Engl J Med 2005; 353: 2158-68. doi: 10.1056/nejmsa044278
  15. Goldie SJ, Kuhn L, Denny L, Mmed O, Pollack A, Wright TC. Policy Analysis of Cervical Cancer Screening Strategies in Low-Resource Settings. JAMA 2001; 285: 3107-16. doi: 10.1001/jama.285.24.3107
  16. Raffle A, Gray M. Screening: Evidence and Practice. Oxford: Oxford University Press; 2007.
  17. Atun RA, Bennett S, Duran A. When do vertical (stand-alone) programmes have a place in health systems? Copenhagen: WHO Regional Office for Europe; 2008.
  18. World Health Organization (WHO). Integrated health services – what and why ? Technical Brief No.1. Geneva: WHO; 2008.
  19. UK National Screening Committee. Essential Elements in Developing a Diabetic Retinopathy Screening Programme; 2009. p. 1-75.
  20. Ministry of Health and Social Welfare. United Republic of Tanzania. National Eye Care Strategic Plan 2011-2016.
  21. Potter A, Debrah O, Ashun J, Blanchet K. Eye Health Systems Assessment (EHSA): Ghana Country Report, Ghana Health Service, International Centre for Eye Health, Sightsavers. 2013.
  22. Melkus GD, Kurth AE, Newlin Lew K, Amoah AG, Ogedegbe G. Development and Implementation of a Diabetes Electronic Health Record in Ghana. 42nd Biennial Convention 2013 Theme: Give Back to Move Forward. Indianapolis, Indiana, USA; 2013.
  23. Scanlon P. Diabetic Retinopathy Screening: Progress or Lack of Progress. In: Tombran-Tink J, Barnstable CJ, Gardner TW, editors. Ophthalmology Research: Visual Dysfunction in Diabetes. New York: Springer; 2012. p. 17-29.
  24. Wormald R, Lindfield R. Screening in Ophthalmology. In: Johnson GJ, Minassian D, Weale R, West S, editors. The Epidemiology of Eye Disease. 3rd edition. London: Imperial College Press; 2012. p. 147-68.
  25. Mumba M, Hall A, Lewallen S. Compliance with eye screening examinations among diabetic patients at a Tanzanian referral hospital. Ophthalmic Epidemiol 2007; 14: 306-10. doi: 10.1080/09286580701272079
  26. Levy J, Jotkowitz AB. European Journal of Internal Medicine Diabetes in Africa: Screening for diabetic retinopathy. Eur J Intern Med 2010; 21: 145-6. doi: 10.1016/j.ejim.2010.02.010
  27. Mbanya JCN, Motala A, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan Africa. Lancet 2010; 375: 2254-66. doi: 10.1016/s0140-6736(10)60550-8

Files

History

  • Receive Date: 21 September 2014
  • Revise Date: 12 December 2014
  • Accept Date: 12 December 2014
  • First Publish Date: 01 January 2015

Share

How to cite

Statistics