Table 2. Baseline and post-intervention surveys in Mopani District to assess the impact of a health system strengthening support package to improve primary eye care.
| Intervention Sites | Control Sites | ||||
|---|---|---|---|---|---|
| Baseline | Post | Baseline | Post | pa | |
| Organisation of Care | |||||
| nb | 20 | 20 | 16 | 16 | |
| Staff member responsible for ophthalmic care | 10.0% | 40.0% | 18.8% | 12.5% | 0.02 |
| Designated ophthalmic consulting room | 0.0% | 5.0% | 0.0% | 0.0% | 1.00 |
| Sufficient space to perform VA | 40.0% | 55.0% | 37.5% | 43.8% | 1.00 |
| Ability to create a dark environment | 65.0% | 73.7% | 62.5% | 81.3% | 0.48 |
| Have guidelines for eye screening | 20.0% | 75.0% | 31.3% | 0.0% | <0.01 |
| Meetings with hospitals about eye care | 0.0% | 15.0% | 18.8% | 0.0% | 0.04 |
| Transport of referred patients with acute ophthalmic conditions | 50.0% | 70.0% | 56.3% | 0.0% | <0.01 |
| Transport of referred patients with chronic ophthalmic conditions | 45.0% | 40.0% | 43.8% | 0.0% | 0.17 |
| Returns from hospital with written feedback, median (range) | 0.0% (0.0–1.0) | 1.0% (0.0–100) | 0.0% (0.0–20.0) | 5.0% (0.0–20.0) | 0.74 |
| Eye teams visit the facility | 75.0% | 75.0% | 75.0% | 62.5% | 0.88 |
| Essential Resources & Drugs | |||||
| nb | 20 | 20 | 16 | 16 | |
| Distance VA chart available | 75.0% | 100% | 87.5% | 56.3% | <0.01 |
| Correct distance from patient to VA chart | 26.7% | 72.2% | 21.4% | 33.3% | 0.19 |
| Pen torch available | 0.0% | 70.0% | 18.8% | 0.0% | <0.01 |
| Direct ophthalmoscope available | 50.0% | 47.4% | 62.5% | 12.5% | 0.10 |
| Essential drugs available, median (range)c | 55.6% (22.2–66.7) | 55.6% (22.2–77.8) | 55.6% (22.2–77.8) | 55.6% (33.3–88.9) | 0.47 |
| Stock-outs of essential drugs in previous 3 months | 55.0% | 33.3% | 43.8% | 53.3% | 0.21 |
| Clinical Practice | |||||
| nb | 57 | 60 | 45 | 48 | |
| Saw an ophthalmic patient <6 months ago | 100% | 93.1% | 95.6% | 97.9% | 0.08 |
| Estimated ophthalmic patients seen per month, median (range) | 12.0 (3.0–50.0) | 10.0 (0.0–80.0) | 15.0 (2.0–99.0) | 15.0 (2.0–80.0) | 0.16 |
| Enjoy serving ophthalmic patientsd | 49.1% | 50.8% | 48.9% | 25.5% | 0.08 |
| Comfortable managing ophthalmic patientsd | 36.8% | 43.1% | 31.1% | 25.0% | 0.28 |
| Consider ophthalmic knowledge adequated | 7.0% | 18.6% | 4.4% | 12.5% | 0.53 |
| Know how to perform VAd | 33.3% | 63.3% | 37.8% | 14.6% | <0.01 |
| Know how to assess the pupillary light reflexd | 7.0% | 36.7% | 17.8% | 14.6% | <0.01 |
| Know how to use an ophthalmoscoped | 5.3% | 18.3% | 17.8% | 8.3% | 0.02 |
| Know how to administer topical eye drugsd | 33.3% | 57.9% | 40.0% | 37.5% | 0.03 |
| Aware of referral criteria for ophthalmic patients | 59.6% | 88.1% | 57.8% | 72.9% | 0.33 |
| Knowledge of referral criteria: objectively evaluatede | 56.1% | 80.0% | 55.6% | 33.3% | <0.01 |
| Clinical knowledge: objectively evaluatedf | 14.0% | 16.7% | 11.1% | 8.3% | 0.76 |
All variables are self-reported unless otherwise indicated. VA, visual acuity.
a p for change in intervention sites versus change in control sites. Statistically significant differences are shown in bold.
b Assessments evaluating Organisation of Care and Essential Resources & Drugs were administered at facility level (n = facilities); Questionnaires evaluating Clinical Practice were administered at an individual level (n = individuals) and then aggregated to facility level for analysis.
c Percentage of the following nine drugs that were available in each facility: topical anaesthetics, sodium chloride, oral pain killers, topical anti-allergic drops, oral anti-allergic medication, topical antibiotics, oral or intra-muscular antibiotics, oral anti-glaucoma drugs and topical miotics.
d Self-reported using a scale of 1 to 5, where 1 = not at all, 3 = fine and 5 = very much. Percentage represents the number of ratings of 4 or 5 out of the total number of ratings.
e Percentage who answered 2 or more questions regarding referral criteria correctly out of 3.
f Percentage who answered 6 or more clinical questions correctly out of 11, namely scored >50%.