Development of a diabetic retinopathy screening model for a district health system in Limpopo Province, South Africa

Zaheera Abdool,Linda Visser,Kovin Naidoo

doi:10.4102/aveh.v81i1.568

Zaheera Abdool, Linda Visser + Show 1 more

Open Access

https://doi.org/10.4102/aveh.v81i1.568

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Abstract

Background: Diabetes mellitus (DM) and diabetic retinopathy (DR) are important issues in the district health system (DHS) of South Africa (SA). Guidelines for the management of DR in SA were developed more than a decade ago but not effectively implemented.Aim: The aim of this study was to develop a suitable model for DR that could be effectively implemented by a team of healthcare practitioners (HCPs) to co-manage DM and DR in the DHS of SA.Setting: The study was conducted through Voortrekker District Hospital, Limpopo Province, SA.Methods: A saturated strategy sample study was employed, and questionnaires were distributed to 24 endocrinologists in both private and public practices in Gauteng Province and to three ophthalmologists and 10 medical officers (MOs) in ophthalmology in health institutions in Waterberg and Capricorn districts of Limpopo Province. The questionnaires distributed included questions relating to the recommended roles of primary healthcare (PHC) nurses, MOs in general practice, MOs in ophthalmology, ophthalmic nurses, optometrists, and ophthalmologists to manage patients with DM in the public sector. The Delphi technique was employed requiring experts to comment qualitatively and quantitatively to elicit the required information.Results: At PHC level, PHC nurses are to document a comprehensive patient case history and assess vitals before referring to MOs in general practice. Medical officers in general practice are to assess DM control and screen for target organ disease. All patients with DM are to be referred to optometrists for retinal photography. Optometrists and ophthalmic nurses are to detect, grade and monitor pre-proliferative stages of DR, and refer to MOs in ophthalmology or ophthalmologists at district or tertiary hospitals for surgical intervention or treatment.Conclusion: Based on the expertise of the endocrinologists and ophthalmologists concerned, a DR screening model for a DHS was proposed, reflecting the role of HCPs in the management of DM and DR in the DHS of Limpopo Province, SA.

Highlights

Diabetes mellitus (DM) is a pandemic affecting 25 million adults in the African region[1] and 2.6 million adults in South Africa (SA).[2]
Aim: The aim of this study was to develop a suitable model for diabetic retinopathy (DR) that could be effectively implemented by a team of healthcare practitioners (HCPs) to co-manage DM and DR in the district health system (DHS) of SA
All patients with DM are to be referred to optometrists for retinal photography

Summary

Introduction

Diabetes mellitus (DM) is a pandemic affecting 25 million adults (aged 20–79 years) in the African region[1] and 2.6 million adults in South Africa (SA).[2] By the year 2040, DM is projected to increase by 55% worldwide, by 140.9% in Africa and by 126.4% in sub-Saharan Africa (SSA).[3] According to the Demographic and Health Survey conducted from 1995 to 2005 in SA,[4] the self-reported prevalence of DM was higher in the Asian community followed by the mixed race community, white and black African groups. The duration of DM is an important predictor of DR development.[10]. Diabetes mellitus (DM) and diabetic retinopathy (DR) are important issues in the district health system (DHS) of South Africa (SA). Guidelines for the management of DR in SA were developed more than a decade ago but not effectively implemented

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