NRU :: Browsing by Author "Arunga, S."

Browsing by Author "Arunga, S."

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Diabetic retinopathy screening program in Southwestern Uganda
(The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2020) Arunga, S.; Tran, T.; Tusingwire, P.; Kwaga, T.; Kanji, R.; Kageni, R.; Hortense, L. N.; Ruvuma, S.; Twinamasiko, A.; Kakuhikire, B.; Kataate, B.; Kilberg, K.; Gibbs, G.; Kakinda, M.; Harrie, R.; Onyango, J.
Between 2019 and 2045, the prevalence of Diabetes Mellitus (DM) will double; associated with this, the burden of Diabetic Retinopathy (DR) is also expected to increase, especially in low-resourced settings. To prevent avoidable visual impairment and blindness, early detection through screening and early treatment are necessary. To enable access to these services, we developed the Lions Diabetic Retinopathy Project for southwestern Uganda to serve the region including 17 Districts with eight million inhabitants. Methods: A three-pronged strategy for mass screenings levering the existing general health system and opportunistic screening of higher-risk population. Capacity building involved training a vitreoretinal surgeon and allied eye care providers, installing critical infrastructure at the referral eye hospital, and acquiring equipment for primary health centres. Results: In 1.5 years, 60 DR screening camps were implemented; this led to screening of 9,991 high risk individuals for DM and 5,730 DM patients for DR. We referred 1,218 individuals with DR for further management at the referral eye hospital, but only 220 (18%) attended referral. The main barrier for not attending referral was long travel distance and the associated direct and indirect costs. Human resources trained included 34 ophthalmic nurses, five midlevel providers, and one vitreoretinal surgeon. Major equipment acquired included a vitrectomy system, an outreach vehicle, and non-mydriatic fundus cameras. Conclusions: DR screening can be implemented in a resource-limited setting by integrating with the general primary healthcare system. However, geographic barriers stymie delivery of therapeutic services and we need to establish models to bring these services closer to areas with poorer access.
Diurnal intraocular pressure fluctuation in black adult primary open angle glaucoma patients attending Ruharo Eye Centre, South- Western Uganda
(East African Journal of Ophthalmol Central and Southern Africa, 2014) Arunga, S.; Bwetsia, F. M.; Aliraki, L.
To study the general diurnal intraocular pressure (IOP) fluctuation in black adult patients with Primary Open Angle Glaucoma attending Ruharo Eye Centre; to determine their IOP fluctuation range and determine their 24 hour IOP fluctuation pattern. Design: Descriptive cross sectional study. Methods: This was a hospital based, descriptive cross sectional study. Fifty one patients with glaucoma on different treatment options (No treatment, medical treatment and post trabeculectomy) were enrolled and intraocular pressure measured every 2 hours for 24 hours. The mean fluctuation ranges, peak and trough times of intraocular pressure were recorded for each group and 24 hour fluctuation curve patterns were drawn. Results: Primary Open Angle Glaucoma (POAG) patients who were not on treatment had the highest mean intraocular pressure fluctuation range 11.1mmHg (95% CI 8.3-14) followed patients on medical treatment who had the second highest mean fluctuation range 9.3mmHg (95% CI 7.5-11.1), while patients who had received trabeculectomy had the lowest mean IOP fluctuation ranges 5.3 (95% CI 3.5-7.0). The general average peak intraocular pressure time was between 11am-1pm. Conclusion: Trabeculectomy was found to have the best control of IOP fluctuation in patients with POAG compared to medical treatment (timolol, pilocarpine and acetazolamide) and those not on treatment. The best time for measuring IOP in patients with POAG was found to be between 11am-1pm because most of the peaks IOPs were captured during this time.
Factors associated with poor presenting vision among patients with microbial keratitis In Uganda
(The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2020) Arunga, S.; Atto, G.; Ayebazibwe, B.; Onyango, J.; Macleod, D.; Hu, V. H.; Burton, M. J.
To determine factors associated with poor presenting vision among patients with microbial keratitis in Uganda. Design: Retrospective audit study. Methods: This was a study of patients presenting with microbial keratitis at the two main eye units in Southern Uganda in the year 2015. Information on time to presentation, treatment history, use of traditional eye medicine, trauma and presenting final visual acuity was collected. Factors associated with a poor presenting vision in a regression model were analysed. Results: There were 273 cases during the year 2015. The median presentation time was 7 days from onset (IQR 2-21, total range 0-366 days). Trauma was reported in 59/88 (67%) patients and 69/162 (43%) reported using traditional eye medicine. Visual acuity was reported in only 216/273 cases at presention. Visual acuity at presentation of less than 6/60 (severe visual impairment) was strongly associated with the use of traditional eye medicine (OR 5.13, 95%CI 2.17–12.1, p=0.001) and distance from the eye hospital (OR 1.02, 95% CI 1.01-1.03, p=0.002). Conclusion: This audit highlighted the role of use of traditional eye medicine and long distance from the eye hospital in contributing to poor presentation among patients with microbial keratitis in Uganda.
The ingredients and microbiology studies of traditional eye medicine in a teaching hospital in Southwest Uganda
(The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2020) Lee, C. P.; Aggarwal, S.; Arunga, S.; Johnson, S.
The aim of this study was to investigate the usage, ingredients, and microbiological profile of Traditional Eye Medicine (TEM) at a teaching hospital in southwest Uganda. Methods: This was a single-center prospective pilot study that included 11 individuals who used TEM before presenting to a tertiary eye center of the Mbarara University of Science and Technology (MUST) between February 15th, 2017, and February 24th, 2017. We noted the patients’ demographics, chief complaints, reasons for using TEM, and duration of treatment. We obtained the 19 samples of TEM and reviewed botanical contents and the microbiologic profile via gram staining, KOH staining, and cultures on blood-heart infusion agar, blood agar, chocolate agar, and potato dextrose agar. Results: The most common reason for using TEM was cultural belief, followed by the cost of western medications and distance to the eye clinic. Cataracts and allergic conjunctivitis were the most common diagnoses made. The major contents were botanical sources. Sixteen out of 19 samples (84%) showed positive microbial culture; 6 samples were polymicrobial, and 10 were monomicrobial. Klebsiella species was the most common microorganism, being isolated from 13 samples. Other bacterial organisms included Staphylococcus aureus and Bacillus species. Fungal species such as candida and aspergillus species were isolated as well. Conclusion: Most of our patients used TEM due to cultural beliefs. Eighty-five percent of the TEM samples showed positive microbiology culture, predominantly with Klebsiella species. Further microbiologic studies are warranted to identify the correlation between the use of TEM, corneal contamination, and corneal ulcers.
Mooren’s ulcer in Uganda: A prospective observational case series
(The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2020) Kavuma, D.; Arunga, S.; Onyango, J.; Leck, A.; Hoffman, J. J.; Hu, V. H.; Burton, M.
Mooren’s ulcer is a progressive, chronic, and painful peripheral ulceration of the cornea, commonly seen in adult men. In our set up, it has been observed to be aggressive and difficult to treat, often resulting in poor visual outcomes. There is limited published evidence on its management. Objective: 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 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: A total of eight patients (6 males and 2 females) were enrolled. 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 one 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: Most patients were below 30 years and presented late to the hospital, with advanced ulcers, leading to outcomes ranging from good to poor. 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.
Outcomes of trabeculectomy among glaucoma patients in Uganda: A 4-year hospital based audit
(The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2018) Mbumba, F. B.; Hirnschall, N.; Arunga, S.; Kwaga, T.; Onyango, J.; Rigal, K.
To determine the outcomes of trabeculectomy surgery and predictors of post-operative Intra Ocular Pressure (IOP) among glaucoma patients attending Ruharo Eye Centre. Materials and Methods: In a clinical audit conducted from January to June 2016, we reviewed records of all patients who had undergone trabeculectomy at Ruharo Eye Centre (REC), at least in one eye prior to recruitment. We made phone calls to patients inviting them for a clinical examination. For the patients who turned up, we recorded their Best Corrected Visual Acuity (BCVA), Visual Fields (VFs), Intra Ocular Pressure (IOP), Cup-Disc Ratio (CDR), and any post-operative complications. We also asked patients about their general satisfaction with both the operation and vision. We did a before and after comparison analysis on several outcome measures using STATA v14. These included: visual acuity, intra ocular pressure, cup disc ratio and visual field. We defined treatment success as a post-operative IOP reduction of 40% from baseline and analyzed for its predictors in a multivariate regression model. Results: Sixty-two eyes of 38 patients were included in this study. Median age was 66 years (range 24 to 91 years). Median observation time was 2.8 years (range 0.2-4.6 years). Overall treatment success rate was 95%. Mean IOP pre-and post-operatively was 32 mmHg (95% CI 29.3-34.7) and 12.9 mmHg (11.7-14.2) respectively, P=0.001; there was no significant worsening of visual acuity and visual field loss. Mean visual acuity Log MAR pre and post-operatively was 0.58 (95% CI 0.48-0.68) and 0.65 (95% CI 0.52-0.78), P=0.21. Mean visual field defect was 23.4 (95% CI 21.4-25.5) and 22.9 (95% CI 20-9-25.0), P=0.44. Conclusion: Trabeculectomy in our setting seemed to have a good success rate and provided good IOP control, preservation of vision and visual fields.
Prevalence and causes of blindness and severe visual impairment (BL/SVI) among children in Ntungamo district, Southwestern Uganda: A key informant cross-sectional population survey
(The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2016) Arunga, S.; Onyango, J.; Ruvuma, S.; Twinamasiko, A.
To estimate the prevalence and causes of blindness and severe visual impairment among children in Ntungamo district South-western, Uganda.Methods: This was a cross sectional community survey using the key informant method; approximately 200 village health team members were carefully selected and trained to screen for severe visual impairment using a torch, 6 meter string and a 6/60 E chart. They did house to house screening for severe visual impairment and blindness among children below 16 years in the whole district. Identified children were referred to a rendezvous point within the community to be examined further by the ophthalmologist. Data was collected using the standardized WHO childhood blindness data collection form. Proportions and causes of severe visual impairment and blindness were determined. Clinical and social characteristics were described.Results: A total of 59 children were identified, 15 with severe visual impairment and 44 with blindness. Mean age was 6.5 years (95% CI 5.3-7.4) and 59% of the children were male. The prevalence of blindness and severe visual impairment was 0.02% (95% CI 0.01-0.03). Causes were analysed by anatomical site, aetiology and specific diagnosis. Majority of the anatomical causes were due to cornea (18%) and lens (17%) abnormalities. With respect to specific diagnosis, 30% was cataract and cataract surgery complications and corneal scar. Overall, 72% of the blindness and severe visual impairment was due to avoidable causes.Conclusion: Prevalence of severe visual impairment and blindness was relatively low in this population. Lens and corneal abnormalities were the leading cause of blindness. Most of the cases of visual impairment and blindness were avoidable.
Prevalence, risk factors and causes of visual impairment in patients with diabetes at Mbarara Regional Referral Hospital, South Western Uganda; A hospital based study
(The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2015) Seba, E. G.; Arunga, S.; Bwonya, B. D.; Twinamasiko, A.
To determine the prevalence, causes and risk factors to visual impairment among patients with diabetes at Mbarara Regional Referral Hospital (MRRH) as a baseline pilot for developing diabetic retinopathy treatment services. Design: This was a descriptive cross sectional hospital based study conducted for a period of six months. Methods: In a cross-sectional study done at Mbarara Regional Referral Hospital, 318 patients with diabetes aged 18 years and above were enrolled. Their visual acuity was determined. Those that had visual acuity of below 6/18 underwent a detailed ocular exam including refraction and a dilated fundoscopy to determine the cause of visual impairment. Results: The prevalence of visual impairment was 28.6% without correction, and 17% with correction. Cataract was the commonest cause of visual impairment (34.5%) followed by refractive error (20.8%), glaucoma (16.8%) and diabetic retinopathy (12.5%). Age was the only significant risk factor to visual impairment in this population. Conclusion: The proportion of visual impairment was high and cataract was the commonest cause of visual impairment in this population.
Radio as an effective tool for community mobilisation for eye health programs, a case study of the Mbarara University of Science and Technology, Department of Ophthalmology outreach program to Ntungamo district, rural south-western Uganda
(The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2015) Arunga, S.; Twinamasiko, A.
To determine the most effective method of mobilizing the rural community to uptake cataract outreach services in Ntungamo district, south western Uganda. Methods: This was a community based prospective survey conducted in Ntungamo district, rural south western Uganda. Different methods were used to inform the local communities in the six sub regions in Ntungamo district about an ongoing University outreach program. These included; local radio announcements, announcements at places of worship, posters, word of mouth and referral from a previous outreach. One hundred and twenty five respondents were randomly selected from a total of 600 people who turned up for the service and enrolled into the study. Interviewer administered questionnnars were administered. The main interview question was how respondents had received information about a cataract outreach service coming to their area. Results were compiled and frequency tabulations were drawn. Results: The respondents reported that they received the information through radio announcements (85.6%), by word of mouth (10%), by posters (2%) and by referral from previous outreach (1%). The results were consistent across all the six sub regions in Ntungamo district. Conclusion: Radio announcements were the most effective method for mobilizing the community for uptake of cataract outreach services. Recommendation: Radio should be encouraged as a key tool for mobilizing communities to uptake health promotion services.
Strengthening eye health research output in the region
(The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2020) Arunga, S.; Nyenze, E. M.; Wambiya, V.; Onyango, J.
In this issue of the journal, we are pleased to announce an exciting three-year partnership with ‘Eye’ Journal team of the Royal College of Ophthalmologists (RCOphth). This partnership is part of the VISION 2020 COECSA-RCOphth LINK partnership that has been in existence for the last 10 years and has led to development and strengthening of the COECSA fellowship exam and examiner training, curriculum development, ‘train the trainers’ and online CPD. The purpose of this new partnership is to leverage on the COECSA-RCOphth relationship to raise the standard and profile of JOECSA as a strong scientific ophthalmic journal sharing research results across the region by providing mentorship to the journal editorial board, reviewers, and administrators. This mentorship will be offered by the London School of Hygiene & Tropical Medicine and the ‘Eye’ Journal team of the Royal College of Ophthalmologists. This process is co funded by British Council for Prevention of Blindness (BCPB) and the RCOphth.
What is a good PhD program in ophthalmology?: Students’ perspective
(Journal of Ophthalmology of Eastern Central and Southern Africa, 2018) Mwangi, N.; Rono, H.; Arunga, S.; Mdeme, F.
Access to doctoral studies is increasing and the impact of PhD programs is generally understood to be positive. However, the lack of clarity about what a PhD entails can be a barrier to student entry into the programs. During the pre-entry period, students need to consider the reasons for choosing to take PhD and the value expected from it. In practice, this involves complex considerations related to personal, institutional, logistical and PhD program characteristics. As such, prospective students would benefit from a reflection on these factors in advance of registering for the PhD. Realising that there is a limited published literature on what makes a PhD ‘good’, in this paper we explore the factors that contribute to students’ perception of a good scholarly engagement. We use an interview format to report on some broad areas of relevant consideration. We conclude that sustained student motivation, effective supervision, adequate facilities and a supportive environment are pertinent for the learning that makes a PhD ‘good’.

Browsing by Author "Arunga, S."

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