Browsing by Author "Twinamasiko, A."

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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.
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    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.
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    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.