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Leaving no one behind: Equity and Eye Health

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 August 2019) | Viewed by 27784

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Special Issue Editors

Dr. Jacqueline Ramke

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Guest Editor

1. International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
2. Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
Interests: health equity; access to health services; epidemiology; routinely collected data/health information systems; evidence synthesis; knowledge to action
Special Issues, Collections and Topics in MDPI journals

Dr. Nyawira Mwangi

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Guest Editor

1. Kenya Medical Training College P.O Box 30195 -00100 Nairobi
2. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, WC1E 7HT, UK
Interests: health systems; public eye-health; diabetic retinopathy; complex interventions

Dr. Jennifer Evans

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Guest Editor

International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Interests: evidence synthesis; epidemiology; age-related eye disease; neglected tropical diseases

Special Issue Information

Dear Colleagues,

There are an estimated 250 million people living with blindness or visual impairment, 80% of whom have avoidable or treatable conditions. Ensuring everyone, everywhere can access the eye care they need without suffering financial hardship would contribute to the aim of the Sustainable Development Goals to leave no one behind. As such, the World Health Organization considers comprehensive eye-care as an integral component of Universal Health Coverage.

To a large extent, having avoidable or treatable visual impairment is socially determined. For example, women, people living in poverty, and people living in remote areas are more likely to experience conditions such as trachoma and are less likely to overcome the myriad of barriers to access treatment for conditions such as cataract or diabetic retinopathy. For those who do obtain eye care, they may not experience the same level of quality delivered to more advantaged population groups. People who experience multiple levels of disadvantage—for example poor, rural women—are particularly vulnerable to poor eye-health.

While low- and middle-income countries have the highest burden of vision loss, high income countries are not immune to eye health inequalities—in different wealthy countries, indigenous populations, ethnic minorities, people living in aged care, and uninsured people experience worse eye-health than their more socially advantaged counterparts.

In this Special Issue, we will consider submissions on any aspect of equity and eye health in low- and middle-income settings, or submissions targeted towards disadvantaged groups in any setting. Our understanding of the problem of inequalities in eye health is growing, but there is very little evidence on solutions to eliminate these inequalities. Therefore, we are particularly interested in solution-based research on strategies to address inequalities, which can include health systems, implementation or operational research, experimental or quasi-experimental studies, and systematic reviews. We also welcome submissions that report novel methods of measuring or conceptualising eye-health inequality.

We look forward to reading your submissions and assembling an interesting and impactful Special Issue.

Dr. Jacqueline Ramke
Dr. Nyawira Mwangi
Dr. Jennifer Evans
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

health equity
comprehensive eye care
prevention of visual impairment and blindness
universal eye health
health services
health systems
global health
Universal Health Coverage
SDGs

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Published Papers (7 papers)

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12 pages, 1671 KiB

Open AccessArticle

Continuous Knowledge Translation in Action: Designing a Programmatic Research Trial for Equitable Eye Health for Rural Nepalese Women

by Yadira Perez Hazel, Cathy Malla, Anita Afford, Tessa Hillgrove, Reeta Gurung, Anjila Dahal, Sarita Shah, Mohan Krishna Shrestha and Anu Manandhar

Int. J. Environ. Res. Public Health 2020, 17(1), 345; https://doi.org/10.3390/ijerph17010345 - 3 Jan 2020

Cited by 5 | Viewed by 3822

Abstract

Reaching vulnerable populations through programmatic eye health interventions requires a focus on not only the intervention strategies, but the adaptability of the program design process itself. Knowing who is left behind and why solutions that will be effective on the ground at the time of implementation are not necessarily generated. There is a need for eye health programmatic design processes that can trial interventions and allow for continuous knowledge translation along the way. In rural Nepal, women are impacted by multiple and interconnected determinants of health, as well as unique barriers to accessing information and services, requiring targeted programming strategies. This article describes a programmatic design and knowledge translation process that aims to increase women’s uptake of eye health services in rural Nepal. The article outlines key learnings of this knowledge translation process, and how this may contribute to addressing gender equity in eye health. Full article

(This article belongs to the Special Issue Leaving no one behind: Equity and Eye Health)

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11 pages, 2874 KiB

Open AccessArticle

Integrating Geospatial Data and Measures of Disability and Wealth to Assess Inequalities in an Eye Health Survey: An Example from the Indian Sunderbans

by Soumya Mohanty, Emma Jolley, RN Mohanty, Sandeep Buttan and Elena Schmidt

Int. J. Environ. Res. Public Health 2019, 16(23), 4869; https://doi.org/10.3390/ijerph16234869 - 3 Dec 2019

Cited by 2 | Viewed by 2780

Abstract

The Sunderbans are a group of delta islands that straddle the border between India and Bangladesh. For people living on the Indian side, health services are scarce and the terrain makes access to what is available difficult. In 2018, the international non-governmental organisation Sightsavers and their partners conducted a population-based survey of visual impairment and coverage of cataract and spectacle services, supplemented with tools to measure equity in eye health by wealth, disability, and geographical location. Two-stage cluster sampling was undertaken to randomly select 3868 individuals aged 40+ years, of whom 3410 were examined. Results were calculated using standard statistical processes and geospatial approaches were used to visualise the data. The age–sex adjusted prevalence of blindness was 0.8%, with higher prevalence among women (1.1%). Cataract Surgical Coverage for eyes at visual acuity (VA) 3/60 was 86.3%. The study did not find any association between visual impairment and wealth, however there were significant differences by additional (non-visual) disabilities at all levels of visual impairment. Geospatial mapping highlighted blocks where higher prevalence of visual impairment was identified. Integrating additional tools in population-based surveys is critical for measuring eye health inequalities and identifying population groups and locations that are at risk of being left behind. Full article

(This article belongs to the Special Issue Leaving no one behind: Equity and Eye Health)

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11 pages, 1610 KiB

Open AccessArticle

Cataract Services are Leaving Widows Behind: Examples from National Cross-Sectional Surveys in Nigeria and Sri Lanka

by Jacqueline Ramke, Fatima Kyari, Nyawira Mwangi, MMPN Piyasena, GVS Murthy and Clare E Gilbert

Int. J. Environ. Res. Public Health 2019, 16(20), 3854; https://doi.org/10.3390/ijerph16203854 - 12 Oct 2019

Cited by 22 | Viewed by 4621

Abstract

The Sustainable Development Goals aim to leave no one behind. We explored the hypothesis that women without a living spouse—including those who are widowed, divorced, separated, and never married—are a vulnerable group being left behind by cataract services. Using national cross-sectional blindness surveys from Nigeria (2005–2007; n = 13,591) and Sri Lanka (2012–2014; n = 5779) we categorized women and men by marital status (married/not-married) and place of residence (urban/rural) concurrently. For each of the eight subgroups we calculated cataract blindness, cataract surgical coverage (CSC), and effective cataract surgical coverage (eCSC). Not-married women, who were predominantly widows, experienced disproportionate cataract blindness—in Nigeria they were 19% of the population yet represented 56% of those with cataract blindness; in Sri Lanka they were 18% of the population and accounted for 54% of those with cataract blindness. Not-married rural women fared worst in access to services—in Nigeria their CSC of 25.2% (95% confidence interval, CI 17.8–33.8%) was far lower than the best-off subgroup (married urban men, CSC 80.0% 95% CI 56.3–94.3); in Sri Lanka they also lagged behind (CSC 68.5% 95% CI 56.6–78.9 compared to 100% in the best-off subgroup). Service quality was also comparably poor for rural not-married women—eCSC was 8.9% (95% CI 4.5–15.4) in Nigeria and 37.0% (95% CI 26.0–49.1) in Sri Lanka. Women who are not married are a vulnerable group who experience poor access to cataract services and high cataract blindness. To “leave no one behind”, multi-faceted strategies are needed to address their needs. Full article

(This article belongs to the Special Issue Leaving no one behind: Equity and Eye Health)

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14 pages, 290 KiB

Open AccessArticle

A Multiform, Group-Based Rehabilitation Program for Visually Impaired Young People to Promote Activity and Participation. A Pilot Study

by Anna-Liisa Salminen, Tuija Heiskanen and Tiina Suomela-Markkanen

Int. J. Environ. Res. Public Health 2019, 16(19), 3682; https://doi.org/10.3390/ijerph16193682 - 30 Sep 2019

Cited by 1 | Viewed by 2754

Abstract

Young people with visual impairment (YPWVI) face several challenges in their everyday lives. However, little is known about interventions that focus on promoting their participation that contributes to health and well-being and is considered the most relevant outcome in rehabilitation. Objectives: This study investigated the clinical outcomes and acceptability of a new one-year, multiform, group-based rehabilitation program for YPWVI. The aim of the pilot program was to support them becoming more independent and to promote their participation. Rehabilitation consisted of group-meetings in an institutional setting, online group meetings, individually tailored one-on-one guidance, individual online discussions and parents’ group meetings. Fifteen young persons with visual impairment were recruited and 14 completed the intervention, six of whom were blind or had severe visual impairment and eight had mild visual loss. Methodology: The study utilized a mixed methods triangulation design. Clinical outcome measures were goal attainment scaling (GAS) and occupational performance (COPM) completed with qualitative interview data. Focus group interviews with participants and parents were used to evaluate the acceptability of the program. Results: GAS-rated personal goals were widely achieved and the scores of both performance and satisfaction scales of COPM improved. Overall, the rehabilitation program proved to be acceptable. Group-based rehabilitation was deemed very important and it enabled peer support. However, two-day periods of inpatient rehabilitation, proved to be too short, whereas five-day periods were considered to disturb schoolwork. Conclusions: Group-based multi-form rehabilitation for YPWVI can have a positive impact on activity and participation of the participants. The program can support independence and the achievement of rehabilitation goals. The group format was applauded for providing social support and company. The program required some structural modifications. Full article

(This article belongs to the Special Issue Leaving no one behind: Equity and Eye Health)

13 pages, 1128 KiB

Open AccessArticle

Utilization of Secondary Eye Care Services in Western Kenya

by Hillary K Rono MMed, David Macleod, Andrew Bastawrous, Emmanuel Wanjala, Michael Gichangi and Matthew J. Burton

Int. J. Environ. Res. Public Health 2019, 16(18), 3371; https://doi.org/10.3390/ijerph16183371 - 12 Sep 2019

Cited by 11 | Viewed by 5290

Abstract

Background: Eye care provision is currently insufficient to meet the population’s eye health needs in Kenya. Many people remain unnecessarily visually impaired or at risk of becoming so due to treatable or preventable conditions. A lack of access and awareness of services are key barriers, in large part due to their being too few eye care providers in the health system for this unmet need. Methods: A hospital-based, retrospective analysis of patients who attended Kitale eye unit, Trans Nzoia County, Kenya from 1st January 2013 to 31st December 2015. Age and sex standardized hospital attendance rates by residence, age group, and sex were calculated for Trans Nzoia county and each subcounty. The changing trends in attendance rates were estimated by calculating the difference between base year and last year. Incidence rate ratios for attendance for each age-group, sex, and residence were estimated using a multivariable regression model. Results: 20,695 patients from the county were seen in Kitale Eye Unit in 2013, 2014 and 2015. In that period, 8.3% had either uncorrected refractive error, cataracts or glaucoma, the priority VISION2020 diseases, and 61.0% had allergic or other conjunctivitis or normal eyes, which could potentially be managed at primary eye care. During the study period, overall average annual attendance rate increased from 609 to 792 per 100, 000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26–1.35). Attendance rates increased more in females than males (34.7% vs. 25.1%, respectively), IRR 1.07 (1.04–1.10). Attendance rates increased with increasing age, (highest among the elderly compared to the young). We found that in extreme age groups (>75 years and <15years) females were less likely to attend than males and there was reduced utilization from those based furthest from the hospital. Conclusion: Specialist eye services are heavily utilized by people with conditions that could be managed at the primary health care level. Barriers to accessing eye services were distance and gender, especially among the most vulnerable groups (young and the elderly). Integration of primary and secondary eye care services could lower barriers to essential eye care services to the population whilst lowering pressure on the limited specialist services by ensuring more appropriate utilization. Full article

(This article belongs to the Special Issue Leaving no one behind: Equity and Eye Health)

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16 pages, 512 KiB

Open AccessArticle

Disability-Disaggregated Data Collection: Hospital-Based Application of the Washington Group Questions in an Eye Hospital in Paraguay

by Manfred Mörchen, Olmedo Zambrano, Alexander Páez, Paola Salgado, Jason Penniecook, Andrea Brandt von Lindau and David Lewis

Int. J. Environ. Res. Public Health 2019, 16(17), 3085; https://doi.org/10.3390/ijerph16173085 - 25 Aug 2019

Cited by 4 | Viewed by 3143

Abstract

Disability-disaggregated data are increasingly considered important to monitor progress in Universal Eye Health Care. Hospital-based data are still elusive because of the cultural ambiguities of the term disability, especially in under-resourced Health Information Systems in low-and middle-income countries. The aim of this study was to estimate the hospital-based rate of disability in patients presenting at an eye department of a rural hospital in Paraguay and to discuss implications for the management of access barriers. Therefore, we introduced two standardized sets of the Washington Group (WG) Questions as a pilot project. In total, 999 patients answered the self-report WG short set (WG-SS) questionnaire with six functional domains, and 501 of these patients answered an extended set, which included additional domains for “anxiety” and “depression” (WG-ES3). Overall, 27.7% (95% Confidence Interval (CI) 24.9–30.3) were categorized as having a disability. A total of 9.6% (95% CI 7.9–11.6) were categorized as having a disability because of communication difficulties, which was second only to visual difficulties. The odds ratio for disability for patients aged 70 years and older was 8.5 (95% CI 5.0–14.4) and for male patients, it was 0.83 (95% CI 0.62–1.1). Of those patients who answered the WG-ES3, 3.4% were categorized as having a disability because of being worried, nervous or anxious and 1.4% because of feeling depressed. An analysis of the questions of the “depression” domain was impeded by a high rate of measurement errors. The results of the different domains can now be used to inform the identification and mitigation of potential access barriers to eye health services for different types of impairments. Full article

(This article belongs to the Special Issue Leaving no one behind: Equity and Eye Health)

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6 pages, 262 KiB

Open AccessCommentary

Working Towards Eye Health Equity for Indigenous Australians with Diabetes

by Jose J. Estevez, Natasha J. Howard, Jamie E. Craig and Alex Brown

Int. J. Environ. Res. Public Health 2019, 16(24), 5060; https://doi.org/10.3390/ijerph16245060 - 12 Dec 2019

Cited by 5 | Viewed by 3974

Abstract

Type 2 diabetes mellitus (T2DM) poses significant challenges to individuals and broader society, much of which is borne by disadvantaged and marginalised population groups including Indigenous people. The increasing prevalence of T2DM among Indigenous people has meant that rates of diabetes-related complications such as blindness from end-stage diabetic retinopathy (DR) continue to be important health concerns. Australia, a high-income and resource-rich country, continues to struggle to adequately respond to the health needs of its Indigenous people living with T2DM. Trends among Indigenous Australians highlight that the prevalence of DR has almost doubled over two decades, and the prevalence of diabetes-related vision impairment is consistently reported to be higher among Indigenous Australians (5.2%–26.5%) compared to non-Indigenous Australians (1.7%). While Australia has collated reliable estimates of the eye health burden owing to T2DM in its Indigenous population, there is fragmentation of existing data and limited knowledge on the underlying risk factors. Taking a systems approach that investigates the social, environmental, clinical, biological and genetic risk factors, and—importantly—integrates these data, may give valuable insights into the most important determinants contributing to the development of diabetes-related blindness. This knowledge is a crucial initial step to reducing the human and societal impacts of blindness on Indigenous Australians, other priority populations and society at large. Full article

(This article belongs to the Special Issue Leaving no one behind: Equity and Eye Health)

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