Keywords
Diabetes
Diabetic retinopathy
Public health
Screening
Uganda
Categories
How to Cite
Abstract
Objectives: The projected near doubling of prevalence of diabetes mellitus (DM) between 2019 and 2045 is a global public health crisis; 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. However, in Uganda this was severely lacking at a population level.
Methods: We developed the Lions Diabetic Retinopathy Project for southwestern Uganda to serve a region including 17 Districts with eight million inhabitants. This included a three-pronged strategy for mass screenings, human resources development, and capacity building of the region’s referral eye hospital and 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 procured included a vitrectomy system, an outreach vehicle, and non-mydriatic fundus cameras.
Conclusions: This project provided evidence that a DR screening can be successfully implemented in a resource-limited setting and be integrated into the general health system. However, geographic barriers need to be bridged and models of care delivery bringing services closer to areas with poorer access are needed to manage the burden of DR.
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