Table 3.
Distribution of personnel, workload, and diabetic retinopathy treatment services in Ghana
| Variable | Setting | Facility type | Regions | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Rural | Urban | Public | CHAG | Private | GAR | AR | NR | BAR | VR | |
| n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | |
| Health professionals treating DR | ||||||||||
| Vitreoretinal surgeon | 0 (0.0) | 11 (100.0) | 4 (36.36) | 1 (9.09) | 6 (54.55) | 10 (90.9) | 1 (9.1) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Ophthalmologist | 4 (21.1) | 15 (78.9) | 6 (31.6) | 3 (15.8) | 10 (52.6) | 10 (52.63) | 4 (21.05) | 3 (15.79) | 1 (5.26) | 1 (5.26) |
| Optometrist | 0 (0.0) | 1 (100.0) | 0 (0.0) | 0 (0.0) | 1 (100) | 1 (100.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Ophthalmic nurse | 3 (37.5) | 5 (62.5) | 0 (0.0) | 3 (37.5) | 5 (62.5) | 5 (62.5) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 3 (37.5) |
| DRT | ||||||||||
| Retinal laser photocoagulation | 3 (30.0) | 7 (70.0) | 2 (20.0) | 3 (30.0) | 5 (50.0) | 6 (60.0) | 1 (10.0) | 1 (10.0) | 1 (10.0) | 1 (10.0) |
| Anti-VEGF | 1 (9.1) | 11 (90.9) | 4 (33.33) | 1 (8.33) | 7 (58.33) | 7 (58.3) | 3 (25.0) | 2 (16.7) | 0 (0.0) | 0 (0.0) |
| Vitreoretinal surgery | 0 (0.0) | 6 (100.0) | 2 (33.3) | 0 (0.0) | 4 (66.7) | 5 (83.3) | 1 (16.7) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Guidelines for DRT | 3 (33.3) | |||||||||
| ICO guidelines | 1 (16.7) | 5 (83.3) | 2 (33.3) | 1 (16.7) | 3 (50.0) | 2 (33.3) | 2 (33.3) | 1 (16.7) | 1 (16.7) | 0 (0.0) |
| Clinical expertise | 3 (25.0) | 9 (75.0) | 4 (33.3) | 3 (25.0) | 5 (41.7) | 5 (41.7) | 3 (25.0) | 2 (16.7) | 1 (8.3) | 1 (8.3) |
| Routine diabetic examination | 2 (28.6) | 5 (71.4) | 3 (42.86) | 2 (28.57) | 2 (28.57) | 4 (57.14) | 0 (0.0) | 1 (14.29) | 1 (14.29) | 1 (14.3) |
| Referral pathway | ||||||||||
| One-way | 0 (0.0) | 5 (100.0) | 1 (20.0) | 1 (20.0) | 3 (60.0) | 4 (80.0) | 1 (20.00) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Reciprocal | 3 (33.3) | 6 (66.7) | 3 (33.33) | 2 (22.22) | 4 (44.44) | 3 (33.33) | 2 (22.22) | 2 (22.22) | 1 (11.11) | 1 (11.1) |
| Records availability | 3 (27.3) | 8 (72.7) | 2 (18.18) | 3 (27.27) | 6 (54.55) | 5 (45.45) | 2 (18.18) | 2 (18.18) | 1 (9.09) | 1 (9.09) |
| Number of people treated | ||||||||||
| Retinal laser | 33 (1.9) | 1669 (98.1) | 293 (17.22) | 117 (6.87) | 1292 (75.91) | 1461 (85.84) | 208 (12.22) | 5 (0.29) | 10 (0.59) | 18 (1.1) |
| Anti-VEGF | 15 (0.8) | 1953 (99.2) | 268 (13.62) | 124 (6.30) | 1576 (80.08) | 1716 (87.20) | 229 (11.64) | 23 (1.17) | 0 (0.0) | 0 (0.0) |
| Vitreoretinal surgery | 0 (0.0) | 407 (100.0) | 22 (5.41) | 21 (5.16) | 364 (89.43) | 407 (100.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Number of eyes treated | ||||||||||
| Retinal laser photocoagulation | 37 (1.3) | 2910 (98.7) | 406 (13.78) | 117 (3.97) | 2424 (82.25) | 2589 (87.85) | 321 (10.89) | 9 (0.31) | 10 (0.34) | 18 (0.6) |
| Anti-VEGF | 21 (0.6) | 3435 (99.4) | 338 (9.78) | 124 (3.59) | 2994 (86.63) | 3103 (89.79) | 318 (9.20) | 35 (1.01) | 0 (0.0) | 0 (0.0) |
| Vitreoretinal surgery | 0 (0.0) | 533 (100.0) | 22 (4.13) | 21 (3.94) | 490 (91.93) | 533 (100.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Checklist for DRT services | ||||||||||
| Screening protocols for DM | 2 (28.6) | 5 (71.4) | 4 (57.14) | 1 (14.29) | 2 (28.57) | 3 (42.86) | 1 (14.29) | 2 (28.57) | 1 (14.29) | 0 (0.00 |
| Screening protocols for DR | 1 (11.1) | 8 (88.9) | 4 (44.44) | 1 (11.11) | 4 (44.44) | 6 (66.67) | 1 (11.11) | 2 (22.22) | 0 (0.0) | 0 (0.0) |
| Grading protocols for DR | 1 (11.1) | 8 (88.9) | 4 (44.44) | 1 (11.11) | 4 (44.44) | 6 (66.67) | 1 (11.11) | 2 (22.22) | 0 (0.0) | 0 (0.0) |
| Treatment protocols for DR | 1 (11.1) | 8 (88.9) | 4 (44.44) | 1 (11.11) | 4 (44.44) | 6 (66.67) | 1 (11.11) | 2 (22.22) | 0 (0.0) | 0 (0.0) |
| DR treatment registry/records | 2 (18.2) | 9 (81.8) | 3 (27.27) | 2 (18.18) | 6 (54.55) | 7 (63.64) | 1 (9.09) | 2 (18.18) | 1 (9.09) | 0 (0.0) |
| Anti-VEGF drugs | 1 (8.3) | 11 (91.7) | 4 (33.33) | 1 (8.33) | 7 (58.33) | 7 (58.33) | 3 (25.00) | 2 (16.67) | 0 (0.0) | 0 (0.0) |
| 27 needle and 1 ml syringe | 2 (15.4) | 11 (84.6) | 4 (30.77) | 2 (15.38) | 7 (53.85) | 7 (53.85) | 3 (23.08) | 2 (15.38) | 0 (0.0) | 1 (7.69) |
| Operating microscope | 3 (21.4) | 11 (78.6) | 4 (28.57) | 3 (21.43) | 7 (50.00) | 7 (50.00) | 3 (21.43) | 2 (14.29) | 1 (7.14) | 1 (7.14) |
| Retinal Laser machine | 2 (20.0) | 8 (80.0) | 3 (30.00) | 3 (30.00) | 4 (40.00) | 7 (70.00) | 1 (10.0) | 0 (0.0) | 1 (10.00) | 1 (10.0) |
| Vitrectomy machine | 1 (12.5) | 7 (87.5) | 2 (25.00) | 2 (25.00) | 4 (50.00) | 6 (75.00) | 1 (12.5) | 0 (0.0) | 0 (0.0) | 1 (12.5) |
| Fundus/retinal camera | 2 (22.2) | 7 (77.8) | 2 (22.22) | 2 (22.22) | 5 (55.56) | 5 (55.56) | 2 (22.22) | 1 (11.11) | 1 (11.11) | 0 (0.0) |
| OCT machine | 0 (0.0) | 7 (100.0) | 3 (42.86) | 1 (14.29) | 3 (42.86) | 6 (85.7) | 1 (14.3) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Pan retinal photocoagulation lens | 1 (10.0) | 9 (90.0) | 3 (30.0) | 2 (20.0) | 5 (50.0) | 7 (70.00) | 2 (20.00) | 0 (0.0) | 0 (0.0) | 1 (10.0) |
| FFA/ICG angiography | 1 (16.7) | 5 (83.3) | 2 (33.3) | 1 (16.7) | 3 (50.0) | 4 (66.67) | 1 (16.67) | 0 (0.0) | 0 (0.0) | 1 (16.7) |
| Slit lamp biomicroscope | 3 (21.4) | 11 (78.6) | 4 (28.6) | 3 (21.4) | 7 (50.0) | 7 (50.0) | 3 (21.43) | 2 (14.29) | 1 (7.14) | 1 (7.14) |
| Direct ophthalmoscope | 3 (21.4) | 11 (78.6) | 4 (28.6) | 3 (21.4) | 7 (50.0) | 7 (50.00) | 3 (21.43) | 2 (14.29) | 1 (7.14) | 1 (7.14) |
| Indirect ophthalmoscope | 3 (21.4) | 11 (78.6) | 4 (28.6) | 3 (21.4) | 7 (50.0) | 7 (50.00) | 3 (21.43) | 2 (14.29) | 1 (7.14) | 1 (7.14) |
| 90 D lens | 3 (23.08) | 10 (76.92) | 4 (30.77) | 3 (23.08) | 6 (46.15) | 7 (53.85) | 2 (15.38) | 2 (15.38) | 1 (7.69) | 1 (7.69) |
| 78 D lens | 2 (15.4) | 11 (84.6) | 4 (30.77) | 2 (15.38) | 7 (53.85) | 7 (53.85) | 3 (23.08) | 2 (15.38) | 1 (7.69) | 0 (0.0) |
| 20 D lens | 3 (21.4) | 11 (78.6) | 4 (28.57) | 3 (21.43) | 7 (50.0) | 7 (50.0) | 3 (21.43) | 2 (14.29) | 1 (7.14) | 1 (7.14) |
| Three-mirror contact lens | 2 (16.7) | 10 (83.3) | 4 (33.3) | 2 (16.7) | 6 (50.0) | 7 (58.33) | 2 (16.67) | 2 (16.67) | 0 (0.0) | 1 (8.33) |
| Visual acuity chart | 3 (21.4) | 11 (78.6) | 4 (28.6) | 3 (21.4) | 7 (50.0) | 7 (50.0) | 3 (21.43) | 2 (14.29) | 1 (7.14) | 1 (7.14) |
n frequency, % percentage frequency, CHAG Christian Health Association of Ghana, GAR Greater Accra Region, AR Ashanti Region, NR Northern Region, BAR Brong Ahafo Region, VR Volta Region, DRT Diabetic Retinopathy Treatments, Anti-VEGF Anti-vascular endothelial growth factor therapy, DM Diabetes mellitus, DR Diabetic retinopathy, OCT Optical Coherence Tomography, FFA Fluorescein Angiography, ICG Indocyanine Green, D Dioptres; Workload is defined as the total number of eyes treated for DR using retinal lasers, Anti-VEGF or by VR surgery