Skills of general health workers in primary eye care in Kenya, Malawi and Tanzania.

Khumbo Kalua,Ernest Barassa,Edson Eliah,Susan Lewallen,Paul Courtright,Michael Gichangi

doi:10.1186/1478-4491-12-s1-s2

Abstract

BackgroundPrimary eye care (PEC) in sub-Saharan Africa usually means the diagnosis, treatment, and referral of eye conditions at the most basic level of the health system by primary health care workers (PHCWs), who receive minimal training in eye care as part of their curricula. We undertook this study with the aim to evaluate basic PEC knowledge and ophthalmologic skills of PHCWs, as well as the factors associated with these in selected districts in Kenya, Malawi, and Tanzania.MethodsA standardized (26 items) questionnaire was administered to PHCWs in all primary health care (PHC) facilities of 2 districts in each country. Demographic information was collected and an examination aimed to measure competency in 5 key areas (recognition and management of advanced cataract, conjunctivitis, presbyopia, and severe trauma plus demonstrated ability to measure visual acuity) was administered.ResultsThree-hundred-forty-three PHCWs were enrolled (100, 107, and 136 in Tanzania, Kenya, and Malawi, respectively). The competency scores of PHCW varied by area, with 55.7%, 61.2%, 31.2%, and 66.1% scoring at the competency level in advanced cataract, conjunctivitis, presbyopia, and trauma, respectively. Only 8.2% could measure visual acuity. Combining all scores, only 9 (2.6%) demonstrated competence in all areas.ConclusionThe current skills of health workers in PEC are low, with a large per cent below the basic competency level. There is an urgent need to reconsider the expectations of PEC and the content of training.

Highlights

Primary eye care (PEC) in sub-Saharan Africa usually means the diagnosis, treatment, and referral of eye conditions at the most basic level of the health system by primary health care workers (PHCWs), who receive minimal training in eye care as part of their curricula
The average number of patients recorded in log books who presented with eye complaints among the centres in 2010 was 52, 108, and 278 in Tanzania, Kenya, and Malawi, respectively
These differences are consistent with the fact that in Tanzania the PHC facility has a catchment population of 2,000-5,000; in Kenya it serves around 10,000, and in Malawi it serves around 8,00020,000

Summary

Introduction

Primary eye care (PEC) in sub-Saharan Africa usually means the diagnosis, treatment, and referral of eye conditions at the most basic level of the health system by primary health care workers (PHCWs), who receive minimal training in eye care as part of their curricula. We undertook this study with the aim to evaluate basic PEC knowledge and ophthalmologic skills of PHCWs, as well as the factors associated with these in selected districts in Kenya, Malawi, and Tanzania. There is a growing body of literature documenting problems in the quality of care in primary health care (PHC) systems in eastern Africa. A study there of 502 cases at 62 facilities documented the fact that primary health care workers (PHCW) failed to use standard guidelines in treating about half of severely ill children [3]. With respect to the delivery of eye care, problems have been documented in the management of urgent eye conditions in PHC facilities [4]. A pilot study in Tanzania tested knowledge of priority eye conditions among PHCW and found it inadequate to deal with those [5]

Methods

Results

Discussion

Conclusion