Browsing by Author "Sukati, Velibanti Nhlanhla."

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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 The absence of an eye care referral system, an outdated National Health Policy, the lack of or skewed distribution of human eye care resource and clinics, and inadequate knowledge about eye health care for children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.
The epidemiology of ocular injuries among patients presenting to provincial hospitals in KwaZulu-Natal, South Africa.
Sukati, Velibanti Nhlanhla.; Hansraj, Rekha.
Purpose: Ocular injuries are increasingly becoming the permanent cause of visual blindness (Mufti et al, 2004). Most of the previous studies in this area are done in countries outside the African context. A limited number of general surveys in ocular trauma appear in the ophthalmic literature in South Africa. The purpose of this study was to provide epidemiological data on ocular injuries among patients utilising the provincial hospitals eye services in KwaZulu-Natal, South Africa. Methods: A quantitative retrospective study design was carried out by collecting data on 660 patient’s record cards with ocular injuries presenting to four selected provincial eye care clinics for a four year period (January 2005-December 2008). Using a data sheet devised for capturing of the information, the following data was retrieved: (i) demographics details, (ii) place of trauma (iii) nature of trauma, (iv) type of injury, (v) management and (vi) visual outcomes following primary eye care. All patients who presented to the eye clinics with ocular injuries within the specified four years, both genders, all race groups and all age groups were included in the study. Results: There were 440 patients’ records reviewed at rural hospitals and 220 at urban hospitals. Males were more likely than females to have ever experienced an eye injury (72.3% versus 27.7%, respectively) and urban males were more likely than rural males to incur an eye injury (79.1% versus 68.9%, respectively). The Black population has a higher prevalence of ocular injuries than other race groups: Blacks 93.8% followed by Indians 3.9%, Coloureds 2% and the least in Whites 0.3%. Over one-third of all the patients were between 21 and 30 years old with second highest percentage of patients being in the age category of 31 to 40 years. A significant percentage of patients were children (13.8%) up to the age of 12 years. Open globe injuries were more frequent (56.2%) than closed globe injuries (43.8%). Blunt trauma/contusion was the most frequent type of injury (35.2%). More than half of patients (50.9%) had associated ocular signs with the predominance of haemorrhages (15.9%). The majority of the patients presenting with ocular signs had incurred blunt trauma (54%). Only 3.5% of all injuries were bilateral and 96.5% were unilateral. Solid objects were responsible for more than half of the injuries (54.4%) occurring either in the home or at work, followed by assaults (24.3%) and chemical burns (6.2%). Three percent of patients’ records (n=17) had substance (alcohol) abuse documented. The home accounted for the majority of the eye injuries (60.6%) followed by the social environment (15.2%), workplace or industry (13.6%), commercial workplace and agriculture had the same number of injuries (4.1%) and sports or leisure facilities (2.4%). The home remained the single most frequent place for an injury to occur across all age groups, highest in the 21 to 30 age group (26.8%, n=107) followed by 21.3% (n=85) in the 0 to 12 age group. Thirty patients (4.5%) required surgical intervention at initial presentation. Three hundred and forty patients (51.5%) returned for follow up examination. Only 9 (9.2%) patients with initial poor vision (<6/60) achieved 6/12 or better visual acuity after treatment. In 17 (38.6%) patients, visual acuity remained the same as initial visual acuity (6/15-6/60) and got worse in 5 (7.8%) patients (<6/60). Twenty six (59.1%) patients achieved between 6/15-6/60 vision after presenting with poor vision and 59 (92.2%) remained with poor vision after treatment. Conclusion: Ocular trauma is a relatively common problem in the province of KwaZulu-Natal, occurring most frequently in young adults and males warranting presentation to the eye casualty department for treatment. Ocular trauma is usually unilateral, but can also be bilateral and this remains a significant major public health problem. People engaged in agriculture, in industry, in the home, in the social environment, in sports and people living in rural communities are at highest risk. This warrants specific, targeted, prevention measures to be put in place to minimize the incidence of visually damaging trauma.