Integrating eye health training into the primary child healthcare programme in Tanzania: a pre-training and post-training study

Malik, Aeesha N J; Mafwiri, Mlika; Gilbert, Clare; Kim, Min J; Schellenberg, Joanna

doi:10.1136/bmjpo-2019-000629

Cited by 7 publications

(11 citation statements)

References 6 publications

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“…Un estudio experimental realizado en la República Unida de Tanzanía mostró que era aceptable incluir un módulo de atención oftalmológica en el programa de capacitación sobre salud infantil para 60 trabajadores de atención primaria de salud infantil sobre las pruebas de reflejo rojo utilizando ArclightTM y que ello aumentaba los conocimientos de los trabajadores de salud, que eran capaces de aplicarlo en la atención de rutina (128).…”

Section: Otras Consideracionesunclassified

Recomendaciones de la OMS sobre cuidados maternos y neonatales para una experiencia posnatal positiva

2022

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En consonancia con los ODS y la Estrategia mundial para la salud de la mujer, el niño y el adolescente, y aplicando un enfoque basado en los derechos humanos, las iniciativas de atención posnatal deben ampliarse más allá de la cobertura y la simple supervivencia de modo que incluyan la calidad de la atención. Estas directrices tienen como objetivo mejorar la calidad de la atención posnatal esencial y de rutina que se brinda a las mujeres y los recién nacidos, con el objetivo final de mejorar la salud y el bienestar materno y neonatal. En ellas se considera que una "experiencia posnatal positiva" es un resultado importante para todas las mujeres que dan a luz y sus recién nacidos, que sienta las bases para mejorar la salud y el bienestar a corto y largo plazo. Una experiencia posnatal positiva se define como aquella en la que las mujeres, los recién nacidos, las parejas, los padres, los cuidadores y las familias reciben información, tranquilidad y apoyo de manera constante de parte de trabajadores de salud motivados; y en la que un sistema de salud flexible y con recursos reconoce las necesidades de las mujeres y los bebés, y respeta su contexto cultural. En estas directrices unificadas se presentan algunas recomendaciones nuevas y otras ya existentes sobre la atención posnatal de rutina para las mujeres y los recién nacidos que reciben atención posnatal en centros de salud o en la comunidad, independientemente de los recursos disponibles. Se proporciona un conjunto integral de recomendaciones para los cuidados durante el período posnatal, con énfasis en los cuidados esenciales que todas las mujeres y los recién nacidos deben recibir, y prestando la debida atención a la calidad de la atención; es decir, la prestación y la experiencia de la atención recibida. Estas directrices actualizan y amplían las recomendaciones de la OMS del 2014 sobre la atención posnatal de la madre y el recién nacido, y complementan las directrices actuales de la OMS sobre el manejo de las complicaciones posnatales.

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Section: Otras Consideracionesunclassified

Recomendaciones de la OMS sobre cuidados maternos y neonatales para una experiencia posnatal positiva

2022

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“…In Tanzania, following a study that evaluated an eye care training module that included red reflex testing by primary child health care workers, eye screening was included in the curriculum of the Integrated Management of Childhood Illness. More than 3000 staff have since been trained to perform eye screening in newborns and young children [37]. Another study in Tanzania assessed the feasibility of different devices for red reflex screening, including a novel, low-cost direct ophthalmoscope [38].…”

Section: Discussionmentioning

confidence: 99%

Universal newborn eye screening: a systematic review of the literature and review of international guidelines

et al. 2022

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Background This systematic review assessed the effectiveness of universal screening for newborn eye abnormalities compared with no screening in improving infant vision and health outcomes. MethodsWe searched CENTRAL (Cochrane Library), MEDLINE, Embase, Global Health, Global Index Medicus, clinical trials databases, and bibliographies of relevant articles. We included randomized and observational studies of all newborns, regardless of illness or risk factors, that compared universal screening for any eye abnormality by eight weeks of age with no universal screening. Two authors independently selected studies, extracted data, and evaluated the risk of bias. We used GRADE to assess the certainty of evidence. We also reviewed available recommendations on newborn eye screening. ResultsFourteen studies were identified but only three compared universal red reflex screening with no screening. Findings suggest that universal red reflex testing in maternity wards (MWs) may increase the number of newborns with congenital cataracts referred for eye care from MWs or well-baby clinics (WBCs) in the first year of life (risk ratio (RR) = 9.83, 95% confidence interval (CI) = 1.36-71.20; low certainty evidence). However, the effect of screening in WBC is uncertain (RR = 6.62, 95% CI = 0.87-50.09). The effect of MW or WBC screening on referral from any health care facility (MWs, WBCs, paediatrician clinic, other) in the first year is uncertain (MW screening: RR = 1.22, 95% CI = 0.63-2.39; WBC screening: RR = 0.97, 95% CI = 0.46-2.05). However, referral or surgery by 6 weeks of age may be higher with universal MW screening (early referral: RR = 4.61, 95% CI = 1.12-19.01; early surgery: RR = 8.23, 95% CI = 1.13-59.80; low certainty evidence). The effect of WBC screening on early referral and surgery is uncertain (early referral: RR = 1.98, 95% CI = 0.43-9.19; early surgery: RR = 3.97, 95% CI = 0.50-31.33; very low certainty evidence). Universal red reflex testing may increase clinical conjunctivitis (OR = 1.22, 95% CI = 1.01-1.47; low certainty evidence) but the effect on confirmed bacterial conjunctivitis is uncertain (OR = 1.20, 95% CI = 0.76-1.90; very low-certainty evidence). Nine guidelines recommended universal newborn eye screening using red reflex testing.Conclusions Evidence supports the role of red reflex testing shortly after birth to increase early identification, referral, and surgery for congenital cataracts. Registration PROSPERO (reference CRD42020180524).In 2020, 1.44 million children aged 0-14 years were estimated to be blind or severely visually impaired [1]. Most blind children are either born blind from congenital conditions or become blind before the age of 5 years from acquired conditions [2,3].

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“…Efforts to create more awareness in the community and among primary health workers are necessary to ensure early identification and referral to tertiary centres for management. The inclusion of an eye health module in the training program for the Integrated Management of Childhood Illnesses in 2018 in Tanzania allows primary health workers to improve their knowledge and skills in the diagnosis and referral of children with eye diseases including retinoblastoma [20] Results of our study show that although most parents had noted leukocoria (77.8%), a smaller proportion (66.7%) decided to seek medical care within 6 months and eventually most patients presented at the tertiary centre late, with advanced disease. Presentation at advanced stage has poor prognostic factors and contributes to the high mortality in the range of 50-70% in developing countries [12.] Seven of our patients had central nervous system involvement at first presentation and they could not be treated, and they died during the study period.…”

Section: Discussionmentioning

confidence: 99%

Clinical picture and grouping of retinoblastoma at first presentation to a tertiary Hospital in Dar es Salaam: Implications for treatment outcomes

Mafwiri¹,

Ngalula²,

Mosenene³

et al. 2021

World J. Adv. Res. Rev.

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Objectives: To assess the clinical picture and grouping of retinoblastoma at first presentation to the oncology ward at Muhimbili National Hospital. Methods: A cross sectional descriptive hospital based study was conducted from April to December 2018. Seventy two patients who presented for the first time to Muhimbili National Hospital (MNH) with a diagnosis of retinoblastoma were consecutively sampled and recruited in the study. Visual acuity, horizontal corneal diameter, intraocular pressure, anterior and posterior segments of the eye were assessed and each eye was classified according to the International Classification of Retinoblastoma (ICRB) group. Ultrasonography, neuroimaging and histology were performed. Results: A total of 72 patients comprising of 90 affected eyes were recruited and analyzed: 39(54.2%) males and 33(45.8%) females. Majority of patients were residents of the Coastal and Lake Zones. Family history of Retinoblastoma was positive in only one patient. Fifty four (75.0%) patients had unilateral disease. Leukocoria (77.8%) and proptosis (41.7%) were the commonest first clinical signs noted by the family and health workers at MNH respectively. At MNH, both bilateral and unilateral cases presented with advanced disease of group E and extra ocular extension where 84(93.3%) eyes were indicated for enucleation. The median lag time from disease onset to presentation at MNH was 4 months. Conclusion: Leukocoria was the commonest first sign of retinoblastoma presentation at home. However, despite early presentation to primary health facilities, most patients presented to the tertiary centre of MNH late with advanced disease. Efforts to raise awareness on retinoblastoma to both health workers and the community are important for early case detection, referral, diagnosis and treatment in order to improve visual outcomes and survival rates of retinoblastoma patients.

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Integrating eye health training into the primary child healthcare programme in Tanzania: a pre-training and post-training study

Cited by 7 publications

References 6 publications

Recomendaciones de la OMS sobre cuidados maternos y neonatales para una experiencia posnatal positiva

Recomendaciones de la OMS sobre cuidados maternos y neonatales para una experiencia posnatal positiva

Universal newborn eye screening: a systematic review of the literature and review of international guidelines

Clinical picture and grouping of retinoblastoma at first presentation to a tertiary Hospital in Dar es Salaam: Implications for treatment outcomes

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