Browsing by Author "Geneau, Robert"

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    Assessment of cataract blindness prevalence and factors associated with surgical coverage in Rwanda
    (2020) Owusu, Kyei Michael; Mathenge, Wanjiku; Geneau, Robert
    Background: The Rapid Assessment of Avoidable Blindness (RAAB) survey methodology is a cost-effective tool for assessing the burden of blindness and cataract surgical services in a population. This study analyses the 2015 Rwanda National RAAB data to ascertain whether there are gender differences in access to cataract surgical services and also assess whether there is an association between measured distances travelled to access cataract surgical services and the cataract surgical coverage (CSC) in the country. Methods: Secondary data non automated analysis was performed on the 2015 Rwanda RAAB data, which had a sample of 5,275 persons who underwent ophthalmic examinations as per RAAB protocols to elicit the prevalence and causes of blindness and answered a standard questionnaire on barriers to cataract surgery. Cataract blindness prevalence and cataract surgical coverage were estimated for males and females and assessed for significant differences. Distances from clustered patients' locations to the nearest eye surgical facility ere calculated using Google Maps and analyses performed to identify if a relationship exists between distances travelled and the CSC for the area. Results: The prevalence of bilateral cataract blindness for males was 0.4% (n=8; 95% CI=0.1-0.7) and females 0.5% (n=17; 95% CI=0.3-0.8) and the CSC for males and females were 69.2% and 68.5% respectively. The difference in CSC was not statistically significant. Females aged ≥70 years reported more barriers to cataract surgical services compared to men. At a VA <3/60 in the better eye, 1km increase in the distance to the nearest eye surgicalcentre was associated with a reduction in the CSC for the area of 4.8% (Linear regression: F (1,95) = 16.06, p = 0.0001, R-Squared = 0.1446, Adjusted R-Squared = 0.1356). Conclusions: Older women (≥70 years) were the most vulnerable to untreated cataract blindness in Rwanda and therefore special programs need to target them for cataract surgical services. Distance to surgical facilities with ophthalmologists is related to the cataract surgical coverage even in a small country like Rwanda.
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    Assessment of factors associated with diabetic retinopathy among diabetic patients in Zambia
    (2018) Kabaso, Kanasa; Geneau, Robert; Courtright, Paul
    Background: Diabetes Mellitus is an emerging public health problem in Africa. Evidence suggests that globalization, rapid urbanization and a nutritional transition have led to the rise in the prevalence of diabetes mellitus in Africa. Diabetic retinopathy is a common complication of diabetes mellitus that causes visual impairment and subsequent blindness. Early detection and prompt treatment can prevent blindness in up to 90% of patients. The common risk factors for diabetic retinopathy include hypertension, hyperglycemia and long duration of diabetes. Other risk factors include obesity, hyperlipidemia, smoking, puberty and pregnancy. There is limited data on diabetic retinopathy and its associated risk factors in Zambia. An understanding of these factors would help in the effective management of diabetic retinopathy. Methods: A secondary data analysis of data obtained from a hospital-based cross-sectional study of diabetic patients attending diabetic clinics in the Copperbelt Province in Zambia was carried out. All diabetic patients that attended the retinopathy-screening program between April 2012 and September 2012 were eligible for the primary study. The secondary data analysis was restricted to patients 18 years and older. Data analysis was carried out by R version 3.3.1. The characteristics of the study population were summarized using descriptive statistics. Univariate logistic regression analysis was used to select potential candidates for the multivariate regression model at p-value cutoff point ≤ 0.25 and variables of known clinical relevance were also included in the multivariable analysis. The final model fitness was checked using Hosmer and Lemeshow chi-square test. Finally, statistical significance was tested at P-value <0.05. Results: The prevalence of diabetic retinopathy was 19.4%. Multivariate analysis showed that the odds of diabetic retinopathy were significantly associated with age (OR =1.05: 95%Cl; 1.03-1.06), duration (OR=1.39: 95%Cl; 1.27-1.52), weight (OR =0.98: 95%Cl; 0.97-0.98), blood glucose (OR =1.04: 95Cl; 1.02-1.07) and systolic blood pressure (OR = 1.01: 95Cl; 1.00-1.02). Conclusion: Duration of diabetes, age, systolic blood pressure, weight and blood glucose levels were significantly associated with diabetic retinopathy in this study. More comprehensive population screening strategies and treatment programs addressing these risk factors should be put in place.
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    Evaluation of trichiasis surgeons' performance in selected trachoma endemic African countries
    (2021) Ofoegbu, Olubukola Oyinade; Geneau, Robert; Courtright, Paul; Minnies, Deon
    Purpose: Elimination of trachoma-related blindness requires addressing not only issues of trichiasis surgery availability and accessibility, but also quality. To improve surgeon performance, programmes undertake surgeon audits to identify surgeons needing re-training, reasons for poor outcomes, and actions to optimise surgical outcomes. This study aims to determine the frequency and associated factors of audits conducted in selected countries and factors associated with failed audits. Methods: A multicentric study was conducted as a secondary data analysis of surgeon audit results for eight African countries. Stata® was used to generate results for chi-square tests for association, odds ratio and 95% confidence intervals between independent samples for categorical variables and one-way ANOVA tests for continuous variables. Results: The study included 561 trichiasis surgeons and 193 (34.4%) had an audit. Dedicated eye care workers were more likely to have an audit (p<0.001) compared to general health workers. Among audited surgeons, 29 (15%) failed and were recommended for re-training. Surgeons using posterior lamellar tarsal rotation (PLTR) surgery (59.8%) and those trained more recently (mean 4.2 years) were more likely to pass the audit. Conclusion: Although surgeon audits are considered a routine part of programme activities in trachoma endemic countries, too few audits are being undertaken. Further research is needed to learn why surgeons practicing PLTR surgery and those trained more recently are more likely to pass their audit. To improve surgical outcomes, programmes must not only focus on surgical volume but carry out surgeon audits and use the audits to make programme decisions.
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    Global burden of trichiasis in women as compared to men: Findings from the Global Trachoma Mapping Project
    (2019) Moyo, George; Courtright, Paul; Geneau, Robert
    The secondary analysis undertaken for this MPH dissertation examines the global prevalence of trichiasis in relation to gender in trachoma endemic countries. Part A is the research protocol which outlines the background and the process of this research. This study is a population-based analytical study using data from the Global Trachoma Mapping Project (GTMP). GTMP was a standardized population-based trachoma prevalence survey undertaken to provide trachoma prevalence estimates. GTMP data was collected using the World Health Organisation–recommended population based prevalence survey methodology. Trachoma suspect district were identified for inclusion and multistage random sampling was used to sample households for examination of residents for clinical trachoma. Part B presents the background and highlights the importance of this research by exploring the existing theoretical and empirical literature relevant to the topic. It describes how trachoma is transmitted, its clinical manifestations, and the way it can lead to blindness. Results from previous studies on gender and trichiasis are presented. Part C presents the research project in a format suitable for journal submission. The background of this research project is summarized and the meta-analysis is conducted at the global level, at the country level, the regional level, the state level and at the EU level but all in accordance to prevalence of trichiasis in the EUs. The implications of the findings are discussed and limitations in interpretation presented.
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    Health System Analysis of Diabetes and Diabetic Retinopathy Services in Nigeria – The Case of Akwa Ibom State
    (2018) Samuel, Stephen Maduabuchi; Geneau, Robert; Mpyet, Caleb
    This research project, undertaken for a MPH dissertation investigated and analysed the situation of diabetes and diabetic retinopathy services and management systems in four (4) government hospitals in Akwa Ibom State Nigeria using the World Health Organisation (WHO) Tool for the Assessment of Diabetic Retinopathy and Diabetes Management Systems (TADDS). Part A is the research protocol, which explains the background and the key components of this research study. This is a cross sectional descriptive case study involving primary data collection. We conducted the case study using the WHO TADDS to survey health personnel involved in the management of diabetes mellitus (DM) and diabetic retinopathy (DR) in four (4) government hospitals in Akwa Ibom State. Concurrently, semi-structured interviews were conducted with key informants to investigate and analyse the situation of DM and DR services in Akwa Ibom State in Nigeria. Part B is a structured literature review of published articles, online reports, and summaries related to DR. It covers the review of scientific evidence (clinical overview) about the aetiology and prevention of DR and the known risk factors; the review of epidemiological evidence on DM and DR globally and in sub-Saharan Africa (SSA); and the review of the evidence on effectiveness and cost-effectiveness of public health and health system interventions for the prevention and management of DR. Part C is the journal-ready manuscript. In this part, the format of the journal Ophthalmic Epidemiology was used to present the research project and its main findings. Part D contains all the relevant appendices used during the research project.
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    Relationship between the prevalence of trachomatous inflammation in children (age 1-9years) and the prevalence of trichiasis in adults (age 15years and above) at a presumed steady state
    (2017) Antwi-Adjei, Ellen K; Courtright, Paul; Geneau, Robert
    Background: Trachoma is the leading cause of infectious eye disease that leads to blindness. Continuous re-infection by the bacteria, Chlamydia trachomatis, leads to scarring of the cornea and subsequently to blindness. It is commonly found in the poorest and remotest part of Africa, Asia, Latin America and Mid-east, where hygienic conditions are also poorer. The Alliance for the Global Elimination of Blinding Trachoma by the year 2020 (GET 2020) was launched by World Health Organization (WHO) with the main aim of eliminating trachoma as a public health problem globally by year 2020. The Alliance funded Sightsavers, as part of the strategy to meet this target, to set up the Global Trachoma Mapping Project (GTMP) which was to map all endemic places for intervention through a population-based prevalence survey. There are five main signs of the disease and the number of people affected by each sign explains the magnitude and the intervention needed in that population. WHO recommends the active trachoma survey in children age 1-9 years and the blinding signs in adults' age 15 years and above. More researches, that establish quicker means of intervention for the endemic trachoma areas, are needed using the GTMP data in order to meet the year 2020 target. Methods: Baseline data from the Global Trachoma Mapping Project (GTMP) was used as a secondary dataset for this research. All eligible regions in Ethiopia were included. The GTMP teams conducted surveys in seven regions. All age groups were included, but for the purpose of planning, the study assessed TF in children age 1-9 years and TT in adults age 15 years and above. The prevalence of TF in children and TT in adults are indicators for programme decision making for intervention and establishing the relationship between them would aid in the intervention. The relationship if established could help in planning the extent of intervention needed in a given population. Data on sanitation and hygiene as well as altitude, which were collected as part of GTMP, were assessed to determine if they contributed to relationship between TF and TT. Results: The study included a total of 282,558 individuals living in 174 evaluation units from seven regions of Ethiopia, among whom 256,587 gave consent to be examined. This study found a significant relationship between the prevalence of TF in children and the prevalence of TT in adults when analysis is done at the evaluation unit level (correlation rho, 0.59; p-value <0.0001). Hence, 59% of the prevalence of TT in adults can be explained for by the presence of TF in children. Sub-group analysis showed that the correlation persisted at the regional level. Conclusion: A better understanding of the relationship between the prevalence of TF and the prevalence of TT together with the factors influencing this association using this large dataset may aid in prioritization of districts for intervention and has implications for global activities for the elimination of trachoma.