Importance Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed. Objective To describe the key outcomes of the PECI development. Evidence Review A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review. Findings Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI. Conclusions and Relevance This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.
During the present investigation, Henosepilachna vigintioctopunctata adults were treated against different concentration of verbenaceous products viz. leaves of Clerodendron siphonanthus, Lantana camara, Lippia geminate and Vitex negundo. The concentrations were 0.25, 0.50, 0.75, 1.0, 1.5, 2.0, 2.5 and 3.0% (v/v), respectively. The results showed that the H. vigintioctopunctata adults indicated the highest mortality of 73.0 at 3.0% concentration of V. negundo. The mortality decreased in the concentrations of all the verbenaceous extracts. Least mortality response was noted against Lippia geminate and L. camara, which was 4.0 (±1.0).
Recent global data shows that there are 36 million blind and 217 million visually impaired (VI) in the world.[1] Although there is a decline in prevalence of blindness and visual impairment (VI), the absolute numbers have increased by 17.6% and 35%, respectively.[1] The largest number of blind and VI people reside in South Asia (11.7 and 61.2 million, respectively), with majority being in India (8.8 million and 47.7 million).[1] Rapid assessment (RA) surveys done in different regions of the world provided most of the data to arrive at these global estimates; and nearly 50% of the data from India was from these RA surveys. The Rapid Assessment of avoidable blindness (RAAB) is a standard method for generating evidence on the magnitude and causes of VI and availability of eye care services to provide necessary care and achieve universal eye health.[23] RAAB 6 has an additional module that covers diabetic retinopathy (DR) which makes the survey more comprehensive. Numerous RA surveys have been done in India,[45678910111213] however, most of these surveys are from Southern India.[458111213] A majority of these are from one state,[45111213] with a few representative surveys from other parts of the country.[691014] There are hardly any surveys from North or North Eastern parts of the country. One National survey, representing 15 states but done at two different time points, showed a modest reduction in blindness and severe VI, from 8.5% to 8%.[1516] There was a gross variation in prevalence of blindness between states as well as between regions in the states. Results of RA surveys since 2001 have shown that the prevalence of blindness and severe VI varied from as low as 3.7% in Telangana region[4] to as high as 12% in Rajasthan.[6] Similarly, the VI also varied from as low as 9.4% in Prakasam district, in the state of Andhra Pradesh[11] to as high as 29.3% in Gujarat, a state with one of the highest cataract surgical coverage (CSR).[9] The reason for the variation could be due to regional differences, the time during which the survey were done, as well as service provision in these regions when the survey was conducted. Hence, there is a need for more surveys in other parts of the country, especially the North and North-Eastern states. This survey by Poddar et al. is a useful addition to literature as there are limited surveys done from this state.[17] The overall prevalence of blindness and severe VI was 5.6% which was much lower than reported in the past from another region from same state.[18] As pointed out by the authors, one of the reason for this low prevalence could be due to availability and access to better eye care services in the study area, due to the presence of a tertiary eye care facility in the adjoining district. However, the prevalence of moderate VI was high. This was also the first study from India reporting on early VI, which was found to be significantly high. In terms of causes, most of the studies have found cataract as a major cause of blindness and severe visual impairment (SVI); and refractive error as the main cause of moderate VI.[4111214] Unlike other studies, Poddar et al. found cataract as major cause of moderate VI.[17] One of the factors for this could be due to the way pinhole acuity was recorded. As far as diabetes is concerned, it is estimated that globally, there will be 439 million affected with diabetes by 2030 (with 69% in developing countries).[19] The Indian Council of Medical Research-India Diabetes study estimated that there are 62.4 million with diabetes and 77.2 million with pre-diabetes[20] With the increasing prevalence of diabetes, there will be an increase in prevalence of DR. However, population-based studies on DR are very few and these are mostly from South India.[212223242526] An urban--rural difference was also observed in prevalence of DR. The prevalence ranges from 13 to 18% in urban areas and from 9 to 10% in rural areas.[27] Most of these are population-based studies, which are expensive and time consuming. RAAB can provide fairly accurate information on the prevalence of DR in persons 50 years and above, at low cost and limited time frame. However, there is only one RAAB with DR reported in India.[28] The survey showed 21.9% to be diabetics; and the prevalence of any DR was 13% and any maculopathy was 8.9%. Approximately 2% had proliferative DR and prevalence of sight-threatening DR was 3.1%.[28] The prevalence of blindness and SVI was found to be 1.5%. In the current study by Poddar et al., the prevalence of diabetes was found to be 6.3%, higher in men.[17] The prevalence of any DR in those with diabetes was 14.9%, and any diabetic maculopathy was 12.4%. Approximately 3% had proliferative DR and overall prevalence of sight threatening DR was 6%. The prevalence blindness and SVI was 4.5%. Although the overall prevalence of diabetes in current study was low, there was higher prevalence of complications associated with diabetes suggesting poor glycemic control. Although these studies show the prevalence of diabetes and diabetic retinopathy in the population, these are very few in number; and more studies with similar methodology are required from other parts of the country in order to make a better assessment, and to develop strategies for addressing this problem.
The object of this study was to analyse the teak ( Tectona grandis ) logs prices in Orissa. It is observed that annual growth rate in prices is higher in larger girth classes and there was steep rise in price after 1974. Rise in teak price indices is much higher than the general price indices and after 1974 this gap has widened which may be due to economic causes. More emphasis on teak plantation and utilization pattern substituting secondary species, etc. is necessary for arresting the rapid increase in prices.
One of the targets set out by the United Nations, in its 2030 Agenda for Sustainable Development, is to reduce premature mortality from noncommunicable diseases.[1] Diabetes mellitus (DM), one such noncommunicable malady, is a global epidemic. It is estimated that by 2030, there will be 439 million people affected by DM, more in developing countries (especially South Asia); resulting in a heavy burden on the health system.[2] The increasing prevalence of DM has led to an alarming increase in the absolute numbers of diabetic retinopathy (DR) in Asia.[3] The increased prevalence of diabetes in the South Asian region has been attributed to regional changes in disease patterns from communicable to noncommunicable diseases.[4] To tackle the burden of DM and DR, there is a need to strengthen health systems, increase awareness about the problem, and develop adequate human resources. A well-trained team includes diabetologists, physicians, retina specialists, general ophthalmologists, optometrists, and other Allied Health Personnel (AHP). However, information is not available on the existing gaps for delivery of care in the health systems of developing countries. The World Health Organization has defined a health system as 'all organizations, people, and actions whose primary intent is to promote, restore, or maintain health'.[5] In order to develop an effective action plan to tackle DM, the different elements of the health system namely – governance, human resources, finance, health information, consumables, technology, and service delivery – have to be analyzed and understood in detail.[5] Gilbert et al. reviewed the eye care infrastructure and the human resources in 86 units located in 11 major cities of India and found that there were significant gaps in terms of infrastructure and HR, including skills and training levels.[6] Though nearly 70% had a dedicated retina unit, less than 60% had a full-time retina specialist. In terms of other HR, there was a higher proportion of nursing staff; however, availability of other personnel was inadequate.[6] Apart from this, there was a lack of engagement with physician and endocrinologist in these centers.[6] However, the results could be biased because this study included only major cities and did not include the smaller towns and villages. In a similar study, Piyasena and colleagues looked at institutions in different levels i.e. primary, secondary, and tertiary and found that most of the retina specialists and ophthalmologists are at the tertiary level in the capital cities.[7] Similarly, most of the medical officers, optometrists, and other AHP were in the capital city. The training levels were also quite different with the medical officer having the least skills. In terms of equipment, very few had facilities such as laser, fundus photography, optical coherence tomography (OCT), and ocular angiography; and where available, it was mostly in the capital cities. Both these studies point out the inadequacies in the health systems of developing countries in terms of providing care for diabetic retinopathy, including poor referral and feedback. There is an urgent need to identify gaps and strengthen health systems to provide care for diabetic retinopathy. Care for DR can be improved by taking the following steps to strengthen health systems: Involvement of key stakeholders to formulate policy for DM and DR care at primary, secondary and tertiary levels of care; which has to be reviewed periodically Allotment of adequate funds Availability of well-trained HR at each level of care. Most of the services can be delivered by the AHP and they could play a vital role in delivery of care in terms of creating awareness, ensuring periodic examination, follow-up care, and lifestyle modification. Awareness can also be increased by involving physicians and other staff who take care of patients with diabetes In a community set up, vision screening can be done by appropriately trained personnel, including general practitioners, nurses, and health care workers; with a well-defined and documented curriculum and objectives. This will increase access to eye care through adequate and timely referral of individuals with significant visual morbidity. The key lies in training and deployment of allied health personnel, who can play a significant role in the reduction of preventable blindness[8] Rapid assessment studies can be conducted every 5–10 years to collect comparable data. A program for monitoring, collecting and analyzing data associated with DR, its risk factors, and management can be established Proper use of technology such as teleophthalmology to transmit digital retinal images to trained health personnel, a retina specialist or an endocrinologist, will make care cost-effective. Screening and management of DM and its most common and dreaded sequalae DR need a different approach because of the long-term care required; unlike the approach for dealing with cataract. This review highlights the need to strengthen the health system, by developing systematic DR screening programs; strengthening human resources at all levels; and development of a sustainable infrastructure to combat visual impairment caused by DR.
Purpose To determine the association between the severity of trachomatous conjunctival scarring (TS) of the upper eyelid conjunctiva and trachomatous trichiasis (TT) severity in TT surgical patients.Methods A cross-sectional study was conducted amongst adults with TT who were referred to surgical camps in Bahi District, Tanzania, for TT surgery. Participants underwent ocular examination. The presence and severity of TS was evaluated in photographs of the everted upper eyelid. TT severity was assessed at the time of the ocular exam based on the number of lashes touching the globe and/or evidence and extent of epilation. Ordinal logistic models were used to examine the association between the severity of TS and TT severity.Results A total of 627 eyes of 388 participants were included. Mean age was 65 years (ranging from 21–98), 81% were females, and 62% had bilateral TT. 93% of eyes with any TT had at least moderate TS; 62% of eyes had severe TS. An increase in TS severity was associated with an increase in the severity of TT. Using as a reference eyes with none to mild TS, in eyes with moderate TS the odds of increased severity of TT was 1.30 (95% CI 0.67–2.51), in eyes with severe TS the odds was 4.20 (95% CI 2.23–7.92).Conclusion In cases of trachomatous trichiasis presenting for surgery, the severity of TT was significantly associated with the severity of TS with almost all cases of TT having moderate or severe scarring.
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