Astrid Leck

London School of Hygiene & Tropical Medicine

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Matthew J. Burton

London School of Hygiene & Tropical Medicine

Simon Arunga

Mbarara University of Science and Technology

Victor H. Hu

London School of Hygiene & Tropical Medicine

David Macleod

London School of Hygiene & Tropical Medicine

Jeremy Hoffman

Moorfields Eye Hospital NHS Foundation Trust

John Onyango

Mbarara University of Science and Technology

Sandip Das Sanyam

Aravind Eye Hospital

Reena Yadav

Lady Hardinge Medical College

Sanjay Kumar Singh

Aravind Eye Hospital

Abhishek Roshan

Aravind Eye Hospital

Cooperative Institutions

London School of Hygiene & Tropical Medicine

Mbarara University of Science and Technology

University of London

Aravind Eye Hospital

University College London

University of Edinburgh

University of Ghana

Institute of Ophthalmology

Centre for Sight

Korle Bu Teaching Hospital

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Candidate Number: 105888 MSc: Public Health for Eye Care Title: Patent medicine Vendors and Eye Care in Cross River State, Nigeria

Astrid Leck Clare Gilbert

Eye care

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Management of microbial keratitis by private pharmacies in Uganda: a study of knowledge, attitude, and practice.

Wellcome Open Research (2025)

Abel Ebong Simon Arunga Tara Mtuy Angela Meric Birungi John Onyango

Purpose To determine the knowledge, attitude, and practice of pharmacy attendants in the management of microbial keratitis. Methods This mixed-methods study was conducted in selected pharmacies and drug shops located in Mbarara City between March and May 2022. We administered questionnaires assessing the knowledge, attitudes, and practices (KAP) related to microbial keratitis (MK) to 140 pharmacy attendants (PAs) in the drug shops and pharmacies. We also conducted 40 in-depth interviews (IDI) and three focus group discussions (FGD) with pharmacy attendants to discuss practices, challenges, and opportunities to improve the management of MK. Results Of the 140 pharmacy attendants, almost half (49.29%) reported that they were not confident when making diagnoses in patients with eye problems, and 19.29% were uncertain of which drug to prescribe. In the IDIs and FGDs, the pharmacy attendants reported that they receive and manage patients with MK. Some immediately refer any patients they receive with eye complaints without prescribing any medication while others only refer those who are not responding to medication. The challenges faced in managing patients with MK included inadequate knowledge of managing eye diseases including MK, patients presenting with severe diseases because of delays in seeking healthcare, and the use of traditional eye medicine. The pharmacy attendants suggested ways of improving the management of MK and other eye diseases in the community including community sensitisation on eye diseases and conducting continued professional development lecture sessions on MK in pharmacies, drug shops, and clinics. Conclusion The study showed that probable MK was a common presentation among patients seeking to buy drugs from pharmacies and drug shops. Pharmacies are key stakeholders in the health seeking journey of patients and hence need to be supported through capacity building and strengthening the referral network to improve the outcomes of patients with eye diseases and MK.

Fungal Keratitis

10.12688/wellcomeopenres.22594.1

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Preparation of lactophenol cotton blue slide mounts.

PubMed (1999)

Astrid Leck

The lactophenol cotton blue (LPCB) wet mount preparation is the most widely used method of staining and observing fungi and is simple to prepare. The preparation has three components: phenol, which will kill any live organisms; lactic acid which preserves fungal structures, and cotton blue which stains the chitin in the fungal cell walls.

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Mooren’s Ulcer in Uganda: A Prospective Observational Case Series

Denise Kavuma Simon Arunga John Onyango Astrid Leck Jeremy Hoffman

Purpose: Mooren’s ulcer is an aggressive, chronic, and painful ulceration of the cornea, commonly seen in adult men. It is difficult to treat, often resulting in poor visual outcomes. There is limited published evidence on its management. Our aim was to describe the presentation, treatment and outcomes of patients presenting with Mooren’s ulcer in Mbarara, Uganda over a defined time period. Methods: A prospective observational case series conducted over 3 months from August 2017 to November 2017, with scheduled reviews up to 3 months. Participants’ history, presentation, management and clinical course were captured. Laboratory investigations for underlying systemic diseases were performed, in addition to corneal microbiology testing. Results: We enrolled a total of 8 patients (6 males). The median age was 26 years (IQR 22-27.5, full range 16-32). A history of trauma was present in 3 (38%) of cases. The earliest presenting time was 1 month after start of symptoms. At presentation, 2 (25%) patients had normal vision, 3 (38%) had moderate vision impairment (VI), 1 (12%) had severe VI, and 2 (25%) were blind. There was no systemic disease diagnosed on investigation, but corneal microbiology revealed 3 (38%) ulcers had fungal co-infections. At 3 months, 4 (50%) patients had normal vision, 1 (12%) had moderate VI, and 3 (38%) were blind. No patients required evisceration or enucleation. Conclusion: Mooren’s ulcer is difficult to treat and further studies to assess risk factors would be beneficial in providing evidence for better management of this condition, particularly in resource limited settings.

Evisceration (ophthalmology)

Presentation (obstetrics)

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Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study

Wellcome Open Research (2019)

Simon Arunga Allen Asiimwe Eunice Apio Olet Grace Kagoro‐Rugunda Bosco Ayebazibwe

Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large prospective study to determine how TEM use impacts presentation and outcome of MK and to explore reasons why people use TEM for treatment in Uganda. Methods: In a mixed method prospective cohort study, we enrolled patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018 and collected information on history, TEM use, microbiology and 3-month outcomes. We conducted qualitative interviews with patients, carers traditional healers on reasons why people use TEM. Outcome measures included presenting vision and at 3-months, comparing TEM Users versus Non-Users. A thematic coding framework was deployed to explore reasons for use of TEM. Results: 188 out of 313 participants reported TEM use. TEM Users had a delayed presentation; median presenting time 18 days versus 14 days, p= 0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse presenting visual acuity median logarithm of the minimum angle of resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at 3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable logistic regression model, distance from the eye hospital and delayed presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system breakdown, poverty, fear of the eye hospital, cultural belief in TEM, influence from traditional healers, personal circumstances and ignorance. Conclusion: TEM users had poorer clinical presentation and outcomes. Capacity building of the primary health centres to improve access to eye care and community behavioural change initiatives against TEM use should be encouraged.

Eye care

10.12688/wellcomeopenres.15259.1

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Traditional eye medicine use in microbial keratitis in Uganda: a mixed methods study

Wellcome Open Research (2019)

Simon Arunga Allen Asiimwe Eunice Apio Olet Grace Kagoro‐Rugunda Bosco Ayebazibwe

Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large prospective study to determine how TEM use impacts presentation and outcome of MK and to explore reasons why people use TEM for treatment in Uganda. Methods: In a mixed method prospective cohort study, we enrolled patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018 and collected information on history, TEM use, microbiology and 3-month outcomes. We conducted qualitative interviews with patients, carers traditional healers on reasons why people use TEM. Outcome measures included presenting vision and at 3-months, comparing TEM Users versus Non-Users. A thematic coding framework was deployed to explore reasons for use of TEM. Results: Out of 313 participants enrolled, 188 reported TEM use. TEM Users had a delayed presentation; median presenting time 18 days versus 14 days, p= 0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse presenting visual acuity median logarithm of the minimum angle of resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at 3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable logistic regression model, distance from the eye hospital and delayed presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system breakdown, poverty, fear of the eye hospital, cultural belief in TEM, influence from traditional healers, personal circumstances and ignorance. Conclusion: TEM users had poorer clinical presentation and outcomes. Capacity building of the primary health centres to improve access to eye care and community behavioural change initiatives against TEM use should be encouraged.

10.12688/wellcomeopenres.15259.2

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Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study

BMJ Open Ophthalmology (2021)

Simon Arunga Tumu Mbarak Abel Ebong James Mwesigye Dan Kuguminkiriza

Fungal keratitis is a major ophthalmic public health problem, particularly in low-income and middle-income countries. The options for treating fungal keratitis are limited. Our study aimed to describe the outcomes of using chlorhexidine 0.2% eye-drops as additional treatment in the management of patients with recalcitrant fungal keratitis.

Fungal Keratitis

Natamycin

corneal ulcer

10.1136/bmjophth-2020-000698

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Role of traditional healers in the management of microbial keratitis in eastern Nepal

Wellcome Open Research (2024)

Sandip Das Sanyam Reena Yadav Abeer H. A. Mohamed-Ahmed Simon Arunga Astrid Leck

Background Microbial Keratitis (MK) is a leading cause of corneal blindness due to infection and its consequences, with a higher incidence in resource-limited nations. Hospital-based patient records from different parts of Nepal suggest patients often use traditional eye medicine to treat MK. Traditional healers (TH) within the community are often the first point of care for MK management. Little is known of their practice, perceptions, and knowledge around MK management. We aimed to understand the role of traditional healers in the management of MK in south-eastern Nepal. Methods A cross-sectional, mixed method, descriptive study was conducted in the Siraha district of Nepal. A total of 109 traditional healers consented to participate in a survey of knowledge, attitude, and practices. Some participants were also invited to participate in in-depth interviews and focus group discussions. Interviews and focus groups were conducted and recorded in the Maithili language by a native speaking interviewer and transcribed into English. Descriptive analysis was performed for the survey. Data saturation was considered the endpoint for qualitative data collection, and a thematic was analysis applied. Results Traditional healers believe that infection of the eye can be caused by trauma, conjunctivitis, or evil spirits. They were unclear about differentiating MK from other eye conditions. They provided various types of treatment. Some were confident that they could treat severe ulcers that had not responded to medical therapy, while others thought treating larger diameter ulcers would be difficult. Although there were mixed responses in referring patients with MK, the majority of TH were willing to refer. Conclusion In a weak health system, traditional healers may help address barriers to healthcare access and reduce delays to definitive care, upon integration into the formal health system and referral pathway.

Thematic Analysis

Eye care

10.12688/wellcomeopenres.21241.2

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Safe management of ophthalmic health care waste.

PubMed (2021)

Astrid Leck

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Acanthamoeba keratitis in Ghana

British Journal of Ophthalmology (2002)

Astrid Leck

Suppurative keratitis due to Acanthamoeba spp is most commonly associated with poor contact lens hygiene. However, recently there have been reports of keratitis caused by Acanthamoeba spp in the tropics in non-contact lens wearers.1 We report one such case of Acanthamoeba keratitis in Ghana, west Africa. A 25 year old male driver (from Accra) reported to a hospital in Bawku, northern Ghana. He presented with symptoms of chronic corneal ulceration (duration of symptoms 31 days) and visual acuity in his affected eye was reduced to perception of hand movements only. The patient did not recall experiencing any trauma to his eye before symptoms. The patient had already taken antibiotics before primary presentation at the …

Acanthamoeba keratitis

10.1136/bjo.86.10.1187-a

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