Retinal photographic screening in a diabetic clinic versus ophthalmologist screening in an eye clinic; Task-sharing to increase diabetic retinopathy screening in Tanzania

Abstract

Background: We compared two methods of screening for diabetic retinopathy in a diabetic clinic by a technician using a digital retinal camera, and in an eye clinic by an ophthalmologist.
Objective: To find out if task-sharing might result in more screening uptake.
Methods: The study site was a tertiary referral hospital in North Tanzania. All patients aged 18 years and above attending the adult diabetic clinic during this period, living in Kilimanjaro Region and diagnosed with type-2 diabetes were invited to participate. After attending their regular diabetes check-ups, the participants in the study either remained in the diabetic clinic to be screened by a technician using the retinal camera or moved through a fast-track system and were screened for diabetic retinopathy in the eye clinic by an ophthalmologist.
One hundred and thirty six participants were screened in the diabetic clinic group and 137 in the eye clinic group.
Results: Diabetic retinopathy was detected at 52.4% in the diabetic clinic, with 3.2% requiring treatment. In the eye clinic detection was 36.9% with 4.1% requiring treatment.
Conclusion: Diabetic retinopathy screening with a retinal camera operated by a trained technician is an effective and efficient method of diabetic retinopathy screening, to detect diabetic retinopathy and maculopathy, and a good use of task-sharing. This research suggests the implementation of comprehensive community-based programmes with the aim of providing knowledge-based teaching, clinical support, resources and action plans that health care workers can use to empower people with diabetes to be healthy living with diabetes and be proactive in preventing the complications of diabetes.