Repository logo

Doctoral Degrees (Optometry)

Permanent URI for this collectionhttps://hdl.handle.net/10413/6740

Browse

Browsing Doctoral Degrees (Optometry) by Author "Mashige, Khathutshelo Percy."

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Barriers to eye health care among school going children in Swaziland: towards the development of a framework for access to child eye health care.
    (2018) Sukati, Velibanti Nhlanhla.; Moodley, Vanessa Raquel.; Mashige, Khathutshelo Percy.
    Background: Good vision and eye health plays an important role in the overall development and well-being of a child. Visual impairment in children has a significant impact on their social interaction, quality of life, and economic independence. Providing accessible and equitable eye health delivery for all children, particularly the disadvantaged, requires establishing a balance between their eye care demands and the services a country can afford to supply. Purpose: The study aimed to investigate the barriers to child eye health services in the public health system in Swaziland in order to recommend, through the development of an access framework, strategies to improve access and address their specific eye health needs. Methods: A mixed methods study design was used in the study which entailed a document review of neighbouring country’s eye health policies, quantitative surveys to establish parents, teachers and eye health professionals knowledge and practices about children eye health; clinical facility assessment questionnaire to determine the availability of eye care facilities and services for children and qualitative interviews with Health and Education officials to determine current levels and factors that impact on access for children. The analyses included descriptive analysis for the quantitative data, thematic analysis for qualitative data and content analysis for the documents. The qualitative (interviews) and quantitative data (questionnaires) were triangulated to develop the draft access framework, and the Delphi technique used for experts’ input and comments for the draft access framework. Results: South Africa has national eye health guidelines that advocate for better public eye health services guided by formulated objectives with set targets. Although strides towards providing eye health care in Mozambique are noticeable, the country still lacks concrete eye health guidelines. Three major themes emerged from both the Health and Education interviews, these being; level of access, structural barriers and knowledge barriers to child eye care services. The absence of an eye care referral system, an outdated National Health Policy, the lack of or skewed distribution of human eye care resource and clinics, and inadequate knowledge about eye health care for children were the most important issues contributing to poor access and provision of ophthalmic services. Poor access to basic education excludes many children, particularly those from rural areas, from benefiting from school health programmes, despite these being characterized by poor service delivery. The clinical facility assessments indicated that only a few children presented to the public sector eye care facilities that are available in the country and that the majority lacked working equipment and essential drugs for patient management. In addition, low vision and contacts lens fitting services were lacking while only two out of the five clinics conducted outreach programmes at schools. Many (60.1%) parents reported that they have never taken their children for an eye test and 31.7% felt that their children’s vision was fine. The presence of a health facility in a community influenced early child eye examination (p=0.001). The majority (90.1%) of teachers indicated that they were able to detect signs and symptoms of eye diseases, although, this was insignificantly associated with those who indicated being well informed about eye health (p=0.089). Children wearing spectacles was significantly associated with teachers who indicated being well informed about eye health (p<0.001) and those who were more likely to advise parents to take their children for eye testing (p=0.003). Nine (60%) eye health practitioners felt that they were less informed about eye health problems among children and six (40%) reported being well informed. Eight (53.3%) respondents indicated that there were no school and community eye care outreach programmes and seven (46.7%) reported that their clinics offered outreach programmes. This is the first access framework study for child eye care in Swaziland and provides an opportunity to be a benchmark for other developing countries facing similar challenges. The framework advocates for a holistic approach in order to eliminate the isolation of eye health services. It further adopts a consumer oriented approach, with a particular focus on the current and future eye health status of children. The framework will serve as a foundation for eye health policy formulation and programmes aimed at redressing, promoting and preventing visual impairment or blindness. Conclusion: A carefully planned public health system, supported by an effective eye health plan and public health agencies, is needed to promote access to eye health services by children in the public education system in Swaziland. There is also a need for parents to be informed about basic child eye health in order to seek appropriate care. Teachers need adequate training and understanding about child eye health, including visual disabilities, to remove barriers in the teaching system. Developing and implementing guidelines for promoting access to child eye health may be useful to improve eye health service delivery in the country. The Swaziland government need to adopt and translate the framework into practice according to its intent as the information contained will be useful to the Ministry of Health and Social Welfare, Ministry of Education and Training, eye health professionals and parents.
  • Thumbnail Image
    Item
    Ocular health of cocoa farmers in Ghana : an assessment and intervention study.
    Boadi-Kusi, Samuel Bert.; Hansraj, Rekha.; Mashige, Khathutshelo Percy.
    Background: Cocoa farmers are known to face a lot of ocular health hazards such as chemicals, ultraviolet radiations, farm equipment, plants, dust and allergens among others in the field of work. This study sought to examine and understand the factors that affect the ocular health of cocoa farmers in Ghana in order to improve their knowledge and awareness on ocular health and safety practices through a training intervention. Methods: The study employed two quantitative approaches: a cross-sectional survey and a quasi- experimental pre-post-test study design. The cross-sectional study involved administration of a questionnaire and conducting a comprehensive eye examination among participants, while the pre-post-test study used a structured questionnaire to gather baseline knowledge and post training knowledge on ocular health and safety practices among the participants to establish a change. A multistage random sampling approach was used to select participants from four cocoa growing districts of Ghana. Results: Five hundred and fifty-six, out of the 576, who were recruited for the first phase of the study, met the inclusion criteria, giving an eligibility rate of 96.5%. The participants consisted of 359 (64.6%) males and 197 (35.4%) females with a mean age of 54.9 years (± 11.2). Educational attainment among the participants was low, with 142 (25.5%) having had no formal education. Participants spent an average of 33.3 (±13.4) hours per week on the farm, with males spending more time 35.3 (±13.9) than females 29.6 (± 11.8) (p<0.001) and also spent more hours on the farm than females (p<0.001). Participants reported poor distance and near vision, itching/redness, pain and tearing as major complaints. Anterior eye conditions recorded included pterygium 23.7% (CI: 20.3-27.5), allergic conjunctivitis 9.7% (CI: 7.4 - 12.5) and corneal scar/opacity 6.1% (CI: 4.3 - 8.4). Other conditions included cataract 25.5% (CI: 22.0-29.3), glaucoma 15.8 (CI: 12.9 - 19.1) and macular disorders 4.9% (CI: 3.2 - 7.0). Posterior segment conditions and uncorrected refractive errors (67.6%) were the major causes of moderate and severe visual impairment (MSVI) (16.7%) and legal blindness (4.9%) among the population studied. Presbyopia was present in 83.1% (CI: 79.7 - 86.1) of the participants. The rate of ocular injuries was 143/12 854.5 worker years or 11.3/1 000 worker years (95% CI: 9.4 - 31.0), which led to a lost work time injuries of 137 injuries/ 12 854.5 worker years or 37.3/1000 worker years (95% CI: 34.1- 40.8) and were predominantly in males. Blunt injuries from plants/branches and chemical injuries were mostly reported. Only 34 (6.1%) reported using ocular protection. Barriers to use of ocular protection included non availability of the equipment, lack of funds and ignorance or lack of training. More than half of the participants (52.4%) had never seen an eye care practitioner, while 25% reported seeking eye care within the last one year preceding the study. Those who were registered with the National Health Insurance Scheme were more likely to attend a hospital/clinic for eye care services (OR = 3.93, 1.40 - 11.06, p = 0.009). Barriers to utilization of eye facilities included lack of funds, long distance to facility and long waiting time at eye facilities. Two hundred participants enrolled for the quasi-experimented pre-post-tested study, and had varied opinions on ocular health and safety practices on the farm. They demonstrated a good knowledge on the ocular hazards they face at work, although most were unaware of the effect of some of the hazards on the eye. Farmers also had a poor knowledge on ocular protection but a fair knowledge on first aid for ocular emergencies. Participants improved their knowledge scores (overall 40 points) on ocular health and safety practices from a pre- median score of 172 (IQR: 164 - 177.5) to 212 (IQR: 206 - 219.5) following the pre- and postevaluation of the training intervention. Conclusions: Eye disorders are prevalent among cocoa farmers in Ghana. Farmers are engaged in improper ocular health and safety practices on the farm. They also make insufficient use of appropriate protective eye devices and health services. The study demonstrated that, with an ocular health intervention, cocoa farmers can improve on their knowledge and awareness level on ocular health and safety practices which may be of benefit to the farmer, employers and the national economy.