Browsing by Author "Minnies, Deon"

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    Open Access
    Assessing the Knowledge and Practices regarding eye care and complications of Diabetes among Diabetic Patients 18 years and older, attending a tertiary Diabetic Clinic in Kampala, Uganda
    (2019) Hope, Mackline; Cook, Colin; Minnies, Deon
    Purpose The aim of this study was to audit the knowledge and practices regarding eye care and eye complications of diabetes mellitus (DM) among diabetic patients 18 years and above in Kampala, Uganda. Methods. A cross-sectional study was done to collect data on the demographics, level of awareness and practices of the 409 diabetic patients regarding eye care and eye complications of DM. Data collected was captured in EPIDATA version 3.1, exported to STATA version 15.0 for further management and analysis. Participants characteristics were summarized using summary statistics and graphs. Using a standard questionnaire, scores for knowledge and practice for diabetes; knowledge and practice on diabetic retinopathy were generated and in all the four scores aforesaid, participants were classified as having good or poor knowledge and practice1. Proportions of participants demonstrating good awareness and good practice were reported. Fishers and Pearson chi- square tests were used to test for associations between patient’s characteristics and knowledge and practice on DM. Bivariable and logistic regression analysis was performed and variables with a p-value of < 0.2 of the unadjusted odds ratio were further analyzed at multivariate logistic regression analysis to find out factors that significantly predict patient’s knowledge and practice on diabetes mellitus. Results. A total of 409 participants were interviewed in the study, majority were females 293 (71.6%) and mean age (SD) was 50 (12) years. A high proportion of participants 314 (76.9%) was aware that DM could affect the eyes but only 24 (5.9%) stated diabetic retinopathy as an eye complication in diabetic patients. Good knowledge about diabetes mellitus was demonstrated by 178 (43.5%) of the study participants. However, only 33.3% had good knowledge on eye care and diabetic retinopathy. It was determined that female diabetic patients and those who stayed with DM for 10 years and beyond were less likely to have good practice on DM compared to male patients and those who had been with DM for less than five years (OR, 95% CI: 0.58, 0.36-0.95, P=0.029: OR, 95% CI: 0.53, 0.32-0.87, P=0.011). It was also found that diabetic patients with good knowledge of DM were at least three times more likely to have good practice compared to those with the poor knowledge (OR, 95% CI: 3.2, 2.1 -4.8, P <0.001). Conclusion Lack of knowledge regarding the importance and need for periodic eye check-up for diabetic retinopathy was a significant finding in his study. Good knowledge on diabetes, gender and duration of DM had significant association with the patients practice patterns.
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    Evaluation of the quality of informed consent in a vaccine field trial in a developing country setting
    (BioMed Central Ltd, 2008) Minnies, Deon; Hawkridge, Tony; Hanekom, Willem; Ehrlich, Rodney; London, Leslie; Hussey, Greg
    BACKGROUND:Informed consent is an ethical and legal requirement for research involving human participants. However, few studies have evaluated the process, particularly in Africa.Participants in a case control study designed to identify correlates of immune protection against tuberculosis (TB) in South Africa. This study was in turn nested in a large TB vaccine efficacy trial.The aim of the study was to evaluate the quality of consent in the case control study, and to identify factors that may influence the quality of consent.Cross-sectional study conducted over a 4 month period. METHODS: Consent was obtained from parents of trial participants. These parents were asked to complete a questionnaire that contained questions about the key elements of informed consent (voluntary participation, confidentiality, the main risks and benefits, etc.). The recall (success in selecting the correct answers) and understanding (correctness of interpretation of statements presented) were measured. RESULTS: The majority of the 192 subjects interviewed obtained scores greater than 75% for both the recall and understanding sections. The median score for recall was 66%; interquartile range (IQR) = 55%-77% and for understanding 75% (IQR = 50%-87%). Most (79%) were aware of the risks and 64% knew that they participated voluntarily. Participants who had completed Grade 7 at school and higher were more likely (OR = 4.94; 95% CI = 1.57 - 15.55) to obtain scores greater than 75% for recall than those who did not. Participants who were consented by professional nurses who had worked for more than two years in research were also more likely (OR = 2.62; 95% CI = 1.35-5.07) to obtain such scores for recall than those who were not. CONCLUSION: Notwithstanding the constraints in a developing country, in a population with low levels of literacy and education, the quality of informed consent found in this study could be considered as building blocks for establishing acceptable standards for public health research. Education level of respondents and experience of research staff taking the consent were associated with good quality informed consent.
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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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    A quantitative evaluation of the quality of informed consent in a developing country setting
    (2005) Minnies, Deon; Ehrlich, Rodney; Hawkridge, Anthony
    Informed consent is an ethical and legal requirement for research involving human participants. However, there have been few studies that have evaluated the process, particularly in an African setting. In addition, standardized methods for assessing the quality of informed consent are not available in the literature. The aim of the study was to evaluate the quality of consent in a large tuberculosis vaccine immunology study and to identify factors associated with the quality of consent.
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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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    The factors that determine successful follow up of children diagnosed with incurable blindness using health information collected during their visits to the Red Cross Childrens Hospital
    (2025) Mjwana, Noluthando; Minnies, Deon; Opare, Abraham; Freeman, Nicola
    Background: Most children diagnosed with incurable blindness will need access to health, education, and social services, to support them during their potentially high number of disabled life years. The accuracy of key informants' contact information is therefore essential to ensure that proper follow up is carried out, so that the necessary services are available to them. We investigated the factors determining successful follow up of children diagnosed with incurable blindness during their visits to the Red Cross War Memorial Children's Hospital (RXH) in Cape Town, using their health information. Methods: This was a quantitative cross-sectional study, using data from a cohort of blind children who were referred to a blind school from 2011 to 2020, a total of 178 children, from 0 years up to 12 years of age. Contact information was collected from the children's hospital files at the Red Cross Children's Hospital. Using the telephone numbers obtained, calls were made, and the results of the calls were recorded. For those calls that were responded to, an introduction of who the researcher is, was made, then the purpose and explanation for the call was provided and the respondent was informed that participation is voluntary and that the interview can be stopped at any time should the respondent wish to do so. After that, consent to proceed with an interview was requested, and after it was granted, the researcher explained to the respondent that a few questions about the child's whereabouts, and basic information about health, education and social activities will be asked. A second round of calls were made, using an identifiable cell phone number. This was to ensure that for all the parents or guardians with whom contact was made but were not reachable for any reason during the initial round, a second attempt was made to reach them. Lastly, the nurse of the blind school was interviewed to triangulate the results of the telephonic interviews. The interview with the nurse was to confirm, whether the children on the data list were registered with the school as well as to ascertain the support services that 2 are on offer at the school for the blind. Results: The findings of the study indicated that of the total of 178 participants' folders checked, 127 (71%) folders did contain real and contactable telephone numbers, 10 (6%) folders had incorrectly recorded contact numbers, and 41 (23%) folders had no contact numbers as they were missing. Of the 127 folders with contactable numbers, only 29 (23%) of the key informants responded. Of these, 25 out of 29 (86%) confirmed that the children were alive with 4 (16%) mortalities reported. With regards to information on various support services offered, 7 out of 25 (24%) confirmed to have access to health services, which included hospital visits on scheduled appointment dates, with 16 (64%) receiving support for social services such as grants for relief on financial burden and 15 (60%) of the children are in receipt of education support services or attending special schools. Conclusion: As evidenced by the low response rate, contact with most of the parents was not achieved, resulting in less data to inform us of successful follow of the children. This lack of success can be attributed to the high inaccuracy in the capturing of the contact details, in the missing contact numbers as well as calls for some contacts which were no longer in-service. While little can be done with numbers being out of service, the incorrectly captured information coupled with lack of contact numbers requires that further scrutiny is applied to the patient folders when recording their information and that regular checks and updates are done to ensure that contact numbers are available and that they are accurate.
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    “The graduates of the Postgraduate Diploma in Community Eye Health: how do they manage?”
    (2020) Minnies, Deon; Reid, Steve; Cook, Colin; Hartman, Nadia
    The Postgraduate Diploma in Community Eye Health (PgDCEH) has been offered at the University of Cape Town, South Africa since 2009 to develop management capacity in support of the delivery of effective and efficient eye care services in sub-Saharan Africa. We investigated how graduates applied the PgDCEH-acquired management competencies and the factors that enabled or constrained them to apply these competencies. A multiple case study design was used, employing mixed methods of data collection and analysis. Data collection comprised of a questionnaire survey, in-depth interviews and review of various supporting documents, including assignments submitted by students. Twenty-six of the 34 students who graduated from 2009 to 2014 submitted completed questionnaires. Of these, 15 purposively selected graduates and their secondary key informants participated in in-depth interviews. We found that the PgDCEH elicited some positive effects on the graduates, especially in their ability to perform management tasks and the level of confidence they have in their abilities. There were some personal achievements, but no significant programme improvements were observed. This study provided evidence that the PgDCEH as a health system strengthening intervention struggled to generate the anticipated response of improved eye care programme performance. Personal motivation, suitability of the training and opportunity to apply were the main factors determining how graduates apply management competencies. The utilization of the project management approach, a greater focus on health system maintenance and attention to the dynamic of change in people's lives are critical determinants of success in eye health programmes. The research also highlighted the importance of health care workers' personal motives and motivations as drivers of success and achievement on programme level, and that line management support, supervision and proper performance management are required to attain this. This research broadened understanding of how PgDCEH graduates interact with their work environment and uncovered ways to improve the design and delivery of management training for eye health workers in the future. Revision of the criteria for selection, strengthening focus on leadership, project and relationship management topics, and integrating the training into health professions' education programmes may substantially improve the impact of health management education. The study concluded that the constituent elements of the health system are not inanimate objects, as commonly portrayed, but people, who are connected in intimate, complex and multi-dimensional ways through communication, relationships and team dynamics to deliver health outcomes.
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    User accessibility to refractive error correction services in selected Zambian hospitals
    (2022) Kapatamoyo, Esnart; Minnies, Deon; Muma, Kangwa Ichengelo Mulenga
    Background: Uncorrected Refractive Errors (UREs) are the most common cause of vision loss globally. The burden is particularly worse in low- and middle-income countries like Zambia, where access to Refractive Error Correction Services (RECS) is limited. This study aimed to assess the user's accessibility to RECS in selected Zambian Hospitals. Methods: Twenty (20) public health facilities offering RECS were conveniently selected using a crosssectional design. These represented 20 districts in eight provinces of Zambia. A questionnaire-based on access to health care services framework was administered. The framework assessed service accessibility in terms of availability, geographical accessibility, and affordability. Facility managers completed and submitted the questionnaire via email. Results: Completed questionnaires were received from 20 facilities. Nineteen facilities were located in rural areas whilst one facility was located in an urban area. Most facilities (84%) had the Ministry of Health recommended equipment, though essential equipment such as tonometers were lacking in most facilities (70%). Fifteen facilities (75%) reported having Optometry Technologists as the main staff offering services. Only two facilities (10%) had an Ophthalmologist each and no facility had an Optometrist. School-based programmes were not carried out in all facilities. Only one (5%) facility was able to dispense spectacles soon after refraction as it had a spectacle manufacturing workshop. For some facilities (60%), a poor road network posed a challenge to geographical accessibility. Insufficient funding limited access to RECSs. Facility representative stated that not all patients could meet the cost of services in all the facilities. Conclusion: Access to refractive error correction services in the 20 facilities was limited due to a combination of eye health programme deficiencies and general challenges typical in low- and middle-income countries. Funding, human resources and equipment were insufficient. Inadequate road network and infrastructure undermined service delivery. The accessibility shortcomings identified should be used to improve user accessibility of refractive services.