BackgroundSYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-up, tracked the implementation and adoption of six elements of surgical efficiency— use of multiple surgical beds, pre-bundled kits, task shifting, task sharing, forceps-guided surgical method, and electrocautery—as standards of surgical efficiency in Kenya, South Africa, Tanzania, and Zimbabwe.Methods and FindingsThis multi-country study used two-staged sampling. The first stage sampled VMMC sites: 73 in 2011, 122 in 2012. The second stage involved sampling providers (358 in 2011, 591 in 2012) and VMMC procedures for observation (594 in 2011, 1034 in 2012). The number of VMMC sites increased significantly between 2011 and 2012; marked seasonal variation occurred in peak periods for VMMC. Countries adopted between three and five of the six elements; forceps-guided surgery was the only element adopted by all countries. Kenya and Tanzania routinely practiced task-shifting. South Africa and Zimbabwe used pre-bundled kits with disposable instruments and electrocautery. South Africa, Tanzania, and Zimbabwe routinely employed multiple surgical bays.ConclusionsSYMMACS is the first study to provide data on the implementation of VMMC programs and adoption of elements of surgical efficiency. Findings have contributed to policy change on task-shifting in Zimbabwe, a review of the monitoring system for adverse events in South Africa, an increased use of commercially bundled VMMC kits in Tanzania, and policy dialogue on improving VMMC service delivery in Kenya. This article serves as an overview for five other articles following this supplement.

Background: Numerous factors have been shown to reduce symptomatic and non-symptomatic forms for computer vision syndrome. However, little is known on the impact among computer users diagnosed with severe symptoms of computer vision syndrome. The study assessed whether reduced visual acuity, ocular pathology and refractive error are associated with computer vision syndrome. Methods: A cross sectional university based study in Kenya. Seven hundred and eighty three participants were included in the study. Visual acuity was determined using snellens chart and converted to logMAR chart. Ocular pathology was determined through comprehensive examination using a slit lamp. Computer vision syndrome was determined using a validated questionnaire. Finally Retinoscopy was conducted to determine the type of refractive error. Results: Participants with refractive error above ± 0.50 dioptres had a greater odds, multivariate adjusted ratio 0.73 (95% CI 0.63-0.90) for developing computer vision syndrome. Similar to visual acuity with multivariate adjusted odds ratio of 0.31 (95% CI 0.24-0.47) and ocular pathologies being significantly associated with computer vision syndrome (p=.04). Ocular condition like sub conjunctival hemorrhage was not significantly associated with computer vision syndrome (P=.12). Conclusion: Reduced visual acuity, presence of ocular pathology and refractive error were associated with greater likelihood of computer vision syndrome. Particularly among those who had never had optical correction. Eye care providers are well placed to come up with proper diagnosis of CVS.

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Background Computer vision syndrome is a multi-factorial condition of the eye that results in symptoms of stress and discomfort among computer users. It causes chronic vision-related morbidity and reduced work productivity. Ninety percent and 75% of computer users globally and in Africa respectively suffer from CVS. It is an insidious chronic condition that however, has hitherto received little attention, both by health providers as well as computer users. Also, it is likely to be under diagnosed as it mimics other eye conditions. The risk factors for CVS include prolonged period of electronic device use and glare. In Kenya, lack of awareness of the disease is a key barrier to early detection, health seeking and use of interventions. The burden of CVS and how much computer users in learning institutions are aware of and perceive CVS remains unknown.Methods This study adopted cross-sectional study design to determine the level of awareness, perception of CVS, uptake of preventive measures by students at Maseno University. In total, we administered questionnaires to 384 randomly selected students.Results The mean age was 19.5 years (SD= 0.747) with 18-24 years as the modal age group. Females comprised 51.3% (n=197) and males 48.7%. Participants who had at least 5 symptoms of CVS were 60.4% (n= 232). Awareness level was classified as low in 47.8%; medium level in 38.2% and high level in 13.8% of respondents . Sixty percent of respondents did not perceive CVS as an issue of public health concern compared to 39.8% who perceived CVS as an issue of public health concern ( p=0.001). In terms of precautionary measures, only duration of computer use (46.2%, p = 0.001 ) were practiced. The study results show that at least 3 out of 5 students have at least five symptoms of CVS, whereas awareness of the disease and related risks remain low.Conclusion The results of the present study indicate that CVS is a less recognized health concern among university students. Consequently, screening for the disease sensitization of students on CVS and awareness campaigns to improve early recognition and diagnosis of disease as well as uptake of interventions is recommended.

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