Browsing by Author "Kalua, Khumbo"

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    Reasons for poor or borderline cataract surgical outcomes at Nkhoma hospital in Malawi: a retrospective analysis
    (2024) Chingwengwe, Martha; Minnies, Deon; Kalua, Khumbo
    Cataract is the main cause of blindness worldwide. Cataract surgery is the most effective intervention for cataract blindness. However, poor or borderline outcomes following cataract surgery reduces the effectiveness of this strategy to eliminate this cause of avoidable blindness. This study aimed to determine the reasons for poor or borderline cataract surgical outcomes in people who had undergone cataract surgery. This was a retrospective analysis of theatre records of people who had undergone cataract surgery at Nkhoma Hospital between January and December 2019. All people that recorded a post-operative visual acuity of 6/18 and worse in either or both eyes were included in the study. Data was collected on variables concerning demographics, aspects of referral, preoperative examination, intraoperative findings and post- operative examination. The study determined that 52.2% of poor or borderline cataract surgical outcomes at Nkhoma Hospital were because of ocular comorbidity known to cause vision loss and other comorbidity likely to affect vision adversely, 25.8% because of uncorrected refractive error (post-operative visual acuity with pinhole improved to 6/18 or better) and 3.7% because of intra-operative complications. For a total of 13.5% of the poor and borderline surgery outcome cases, no reasons could be determined with the data available. The study revealed that the reasons for poor or borderline surgery outcome at Nkhoma Hospital are complex and are influenced by decision-making about whether to perform the surgery, regardless of pre-operative visual acuity findings, presence of co-morbidities or the reasonable expectation to deliver an improved outcome following surgery. This emphasizes the need for improved knowledge and skills about referrals, pre-operative screening, post-operative follow-up and allocation of workloads to members of the entire cataract surgical service team.
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    Setting targets for human resources for eye health in sub-Saharan Africa: what evidence should be used?
    (BioMed Central, 2016) Courtright, Paul; Mathenge, Wanjiku; Kello, Amir B; Cook, Colin; Kalua, Khumbo; Lewallen, Susan
    With a global target set at reducing vision loss by 25% by the year 2019, sub-Saharan Africa with an estimated 4.8 million blind persons will require human resources for eye health (HReH) that need to be available, appropriately skilled, supported, and productive. Targets for HReH are useful for planning, monitoring, and resource mobilization, but they need to be updated and informed by evidence of effectiveness and efficiency. Supporting evidence should take into consideration (1) ever-changing disease-specific issues including the epidemiology, the complexity of diagnosis and treatment, and the technology needed for diagnosis and treatment of each condition; (2) the changing demands for vision-related services of an increasingly urbanized population; and (3) interconnected health system issues that affect productivity and quality. The existing targets for HReH and some of the existing strategies such as task shifting of cataract surgery and trichiasis surgery, as well as the scope of eye care interventions for primary eye care workers, will need to be re-evaluated and re-defined against such evidence or supported by new evidence.
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    Skills of general health workers in primary eye care in Kenya, Malawi and Tanzania
    (BioMed Central Ltd, 2014) Kalua, Khumbo; Gichangi, Michael; Barassa, Ernest; Eliah, Edson; Lewallen, Susan; Courtright, Paul
    BACKGROUND:Primary eye care (PEC) in sub-Saharan Africa usually means the diagnosis, treatment, and referral of eye conditions at the most basic level of the health system by primary health care workers (PHCWs), who receive minimal training in eye care as part of their curricula. We undertook this study with the aim to evaluate basic PEC knowledge and ophthalmologic skills of PHCWs, as well as the factors associated with these in selected districts in Kenya, Malawi, and Tanzania. METHODS: A standardized (26 items) questionnaire was administered to PHCWs in all primary health care (PHC) facilities of 2 districts in each country. Demographic information was collected and an examination aimed to measure competency in 5 key areas (recognition and management of advanced cataract, conjunctivitis, presbyopia, and severe trauma plus demonstrated ability to measure visual acuity) was administered. RESULTS: Three-hundred-forty-three PHCWs were enrolled (100, 107, and 136 in Tanzania, Kenya, and Malawi, respectively). The competency scores of PHCW varied by area, with 55.7%, 61.2%, 31.2%, and 66.1% scoring at the competency level in advanced cataract, conjunctivitis, presbyopia, and trauma, respectively. Only 8.2% could measure visual acuity. Combining all scores, only 9 (2.6%) demonstrated competence in all areas. CONCLUSION: The current skills of health workers in PEC are low, with a large per cent below the basic competency level. There is an urgent need to reconsider the expectations of PEC and the content of training.
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    Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania
    (BioMed Central Ltd, 2014) Eliah, Edson; Lewallen, Susan; Kalua, Khumbo; Courtright, Paul; Gichangi, Michael; Bassett, Ken
    BACKGROUND:This project examined the surgical productivity and attrition of non-physician cataract surgeons (NPCSs) in Tanzania, Malawi, and Kenya. METHODS: Baseline (2008-9) data on training, support, and productivity (annual cataract surgery rate) were collected from officially trained NPCSs using mailed questionnaires followed by telephone interviews. Telephone interviews were used to collect follow-up data annually on productivity and semi-annually on attrition. A detailed telephone interview was conducted if a surgeon left his/her post. Data were entered into and analysed using STATA. RESULTS: Among the 135 NPCSs, 129 were enrolled in the study (Kenya 88, Tanzania 38, and Malawi 3) mean age 42 years; average time since completing training 6.6 years. Employment was in District 44%, Regional 24% or mission/ private 32% hospitals. Small incision cataract surgery was practiced by 38% of the NPCSs. The mean cataract surgery rate was 188/year, median 76 (range 0-1700). For 39 (31%) NPCSs their surgical rate was more than 200/year. Approximately 22% in Kenya and 25% in Tanzania had years where the cataract surgical rate was zero. About 11% of the surgeons had no support staff.Factors significantly associated with increased productivity were: 1) located at a regional or private/mission hospital compared to a district hospital (OR = 8.26; 95 % CI 2.89 - 23.81); 2) 3 or more nurses in the eye unit (OR = 8.69; 95% CI 3.27-23.15); 3) 3 or more cataract surgical sets (OR = 3.26; 95% CI 1.48-7.16); 4) a separate eye theatre (OR = 5.41; 95% CI 2.15-13.65); 5) a surgical outreach program (OR = 4.44; 95% CI 1.88-10.52); and 6) providing transport for patients to hospital (OR = 6.39; 95% CI 2.62-15.59). The associations were similar for baseline and follow-up assessments. Attrition during the 3 years occurred in 13 surgeons (10.3%) and was due to retirement or promotion to administration. CONCLUSIONS: High quality training is necessary but not sufficient to result in cataract surgical activity that meets population needs and maintains surgical skill. Needed are supporting institutions and staff, functioning equipment and programs to recruit and transport patients.
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    Task shifting in primary eye care: how sensitive and specific are common signs and symptoms to predict conditions requiring referral to specialist eye personnel?
    (BioMed Central Ltd, 2014) Andriamanjato, Hery; Mathenge, Wanjiku; Kalua, Khumbo; Courtright, Paul; Lewallen, Susan
    BACKGROUND:The inclusion of primary eye care (PEC) in the scope of services provided by general primary health care (PHC) workers is a 'task shifting' strategy to help increase access to eye care in Africa. PEC training, in theory, teaches PHC workers to recognize specific symptoms and signs and to treat or refer according to these. We tested the sensitivity of these symptoms and signs at identifying significant eye pathology. METHODS: Specialized eye care personnel in three African countries evaluated specific symptoms and signs, using a torch alone, in patients who presented to eye clinics. Following this, they conducted a more thorough examination necessary to make a definite diagnosis and manage the patient. The sensitivities and specificities of the symptoms and signs for identifying eyes with conditions requiring referral or threatening sight were calculated. RESULTS: Sensitivities of individual symptoms and signs to detect sight threatening pathology ranged from 6.0% to 55.1%; specificities ranged from 8.6 to 98.9. Using a combination of symptoms or signs increased the sensitivity to 80.8 but specificity was 53.2. CONCLUSIONS: In this study, the sensitivity and specificity of commonly used symptoms and signs were too low to be useful in guiding PHC workers to accurately identify and refer patients with eye complaints. This raises the question of whether this task shifting strategy is likely to contribute to reducing visual loss or to providing an acceptable quality service.