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Doctoral Degrees (Optometry)

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

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Browsing Doctoral Degrees (Optometry) by Author "Moodley, Vanessa Raquel."

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    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.
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    Development of an algorithmic approach for the early detection and management of keratoconus.
    (2023) Masiwa, Lynett Erita.; Moodley, Vanessa Raquel.
    Empirical evidence, supported by anecdotal evidence suggests that some Keratoconic pre-pubescent children present for their first clinical examinations with advanced signs of KC and visual impairment that cannotr be corrected with readily accessible optical aids. This is evidenced by higher prevalences of KC reported in some African communities. This negatively impacts on the lives of these children and hinders the practitioner’s capacity to successfully manage the patient and provide good functional vision, often resulting in visual impairment. The study set out to verify this observation and to offer a potential solution to the problem that is the late presentation of young subjects with KC residing in Harare. Method: A questionnaire, Visual acuity check, retinoscopy and anterior segment assessment were used to award subjects attending primary school in urban Harare aged 6-12years a keratoconus risk score as per scoring sheet developed. A comprehensive exam including refraction, slit lamp exam and keratometry were then performed on the high-risk subjects for the diagnosis of clinical KC. Topography, contrast sensitivity measurement and pachymetry map analysis were then performed for the diagnosis of pre-clinical KC. Results: 1159 subjects were recruited, 57% were female, 99% of African ethnicity and Christian background. Prevalence of clinical KC was found to be 630: 100 000 and pre-clinical KC was found to be 1360:100 000. Anterior surface abnormalities were present in 30% of the subjects considered to be high risk for the development of KC. The age range of the subjects diagnosed with clinical KC was 8-12years. VKC, reduced VA, itchy eyes and eye rubbing were the most frequently encountered symptoms. Conclusion: The odds of having KC are increased if the child is aged between 8 and 12 years and of African ethnicity, regardless of gender. Increased probability of developing KC was found in the presence of VKC, reduced VA, itchy eyes and frequent eye rubbing.. The early detection and management algorithm developed will allow for the timely diagnosis of KC and in turn offer improved prognosis as the earlier management of the condition will be possible with all treatment options still viable.