Abstract
Objective: Appropriate infrastructure and skilled personnel are essential for prevention of visual loss from
diabetic retinopathy. The study was conducted to assess the situation of diabetic retinopathy services in
Tanzania by describing the infrastructure and human resources in selected diabetes and eye clinics and to
assess the knowledge of staff in relation to diabetic retinopathy for planning purposes.
Design: A descriptive, analytical cross sectional study.
Methods: Fifteen purposefully sampled hospitals were visited to assess the infrastructure, human resources
and knowledge of staff about diabetes mellitus and diabetic retinopathy. Knowledge was assessed by
interviewing 25 and 45 staff in diabetes and eye clinics respectively using a semi-structured questionnaire.
Data were analyzed using SPSS version 17 software.
Results: Zonal hospitals had physicians and ophthalmologists while regional-referral hospitals had none.
There were two retinal specialists. All zonal-referral, specialized and four regional-referral hospitals had
dedicated space for diabetes services. Equipment for eye examination lacked while drugs and supplies were
inadequate. All hospitals had dedicated space or eye services, with three retina clinics. Two hospitals had
adequate equipment for diagnosis and treatment of diabetic retinopathy. Knowledge on when to screen
for retinopathy was correct among 33% and 32% of staff in diabetes and eye clinics respectively, while that
on yearly screening was correct among 44% and 34% diabetes and eye staff respectively. Clinical guidelines
and protocols for the management of diabetes and diabetic retinopathy were lacking.
Conclusion: Human resources and infrastructure for the diagnosis and management of diabetic retinopathy
is inadequate in Tanzania. Efforts to equip and train health personnel for comprehensive diabetes care are
required.
References
Wild S. et al. Global prevalence of diabetes:
estimates for 2000 and projections for 2030.
Diabetes care. 2004; 27: 1047-1053.
Idemyor V. Diabetes in sub-Saharan Africa: health
care perspectives, challenges, and the economic
burden of disease. Natl Med Assoc. 2010;
(7):650-653.
Hall V, Thomsen RW, Henriksen O, Lohse N.
Diabetes in sub-Saharan Africa 1999-2011:
Epidemiology and public health implications. a
systematic review. BMC Public Health. 2011; 11:
Fong DS, Aiello L, Gardner TW. American
Diabetes Association. Retinopathy in diabetes.
Diabetes Care. 2004; 11:S84–S87. doi: 10.2337/
diacare.27.2007.S84. [PubMed].
Cockburn N, Steven D, Lecuona K, Joubert F,
Rogers G, Cook C, Polack S. Prevalence, causes
and socio-economic determinants of vision loss
in Cape Town, South Africa. PLoS One. 2012;
:e30718. doi: 10.1371/journal.pone.0030718.
[PMC free article][PubMed][Cross Ref).
East African Journal of Ophthalmology July 2013
Journal of Ophthalmology of Eastern Central and Southern Africa December 2014
International Federation of Diabetes: Diabetes
in Tanzania. http://www.idf.org/membership/afr/
tanzania.
Burgess PI, Msukwa G, Beare NA. Diabetic
retinopathy in sub-Saharan Africa: meeting the
challenges of an emerging epidemic. BMC Med.
Jul 2;11:157. doi: 10.1186/1741-7015-11-157.
The United Republic of Tanzania: Tanzania
Population Distribution. National Bureau of
Statistics Dar Es Salaam 2012. http://nbs.go.tz/
nbs/sensa/PDF/2012.
Ministry of Health and Social welfare: National
Eye Care Strategic Plan 2011-2016. Ministry of
Health and Social Welfare. Dar Es Salaam. 2012.
WHO: Prevention of blindness from Diabetes
Mellitus. Report of WHO consultant in Geneva,
Switzerland, 9-11 November 2005.
WHO: Follow-up to the political Declaration
of the High-level Meeting of the general
Assembly on the prevention and Control of Non-
Communicable diseases.http://cuidadospaliativos.
org/uploads/2013/6/Asamblea%20Mundial%20
OMS-CP%20y%20ENT25-5-13.pdf
Bunjuko, T, Polack, S. A situational analysis of
diabetic retinopathy services in Ogun state of
Nigeria. MSc Community Eye Health (Dissertation)
London School of Hygiene and Tropical
Medicine. http://www.lshtm.ac.uk/library/MSc_
CEH/2009-10/491140.pdf
Ministry of Health and Social Welfare: Human
Resource for Health Strategic Plan 2008-2013.
Ministry of Health and Social Welfare. Dar Es
Salaam, 2008
Ekuwam, David Ngiligo. Situation analysis of
diabetic retinopathy services in Kenya. 2008.
URI:http://erepository.uonbi.ac.ke:8080/xmlui/
handle/123456789/24653
World Diabetes Foundation. Diabetes practice
guidelines 2009. www.globaldiabetes walk.net/
composite-93.htm.
Levitt NS. Diabetes in Africa: Epidemiology,
management and healthcare challenges. Heart.
; 94:1376–82. [PubMed].
Sperl-Hillen J, Beaton S, Fernandes O, Von
Worley A, Vazquez-Benitez G, et al. Comparative
effectiveness of patient education methods for type
diabetes: a randomized controlled trial. Arch
Intern Med. 2011; 171(22):2001-10. doi: 10.1001.