Browsing by Author "Ruvuma, 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.
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    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.