Jane Ohuma on behalf of the Fred Hollows Foundation, Australia
Reducing the incidence of blindness and visual impairment due to diabetic retinopathy in Kenya through a systematic fundus photography-based screening program
In Kenya, approximately 100,000 individuals have sight-threatening complications associated with diabetes, and this number is increasing. Among those who seek diabetic care services from Kenyatta National Hospital alone, an estimated 10,000 are threatened with visual loss. The routine diabetes clinic at the hospital sees about 250 patients per week, and approximately 100 per week are screened in the hospital eye clinic.
Diabetes services at Kenyatta National Hospital are limited by a shortage of staff with experience in identification and management of diabetic retinopathy (DR), inadequate infrastructure and time-consuming screening procedures, low awareness and ignorance about the correlation between diabetes and blindness among patients and health workers. Systems for DR screening and follow-up are weak, with less than 20% of known diabetics having had a fundus inspection in the last 12 months, and only 60% of patients being referred from the diabetic clinic to the eye clinic for DR screening and grading. There is a critical need to upgrade screening of DR as a first step to improving diabetes services nationally.
The aim of this project is to contribute to a reduction in the incidence of blindness and visual impairment due to DR in Kenya by increasing the number of patients who are screened for eye problems. This will be achieved through implementation of an improved screening and referral process that is accurate, timely and viable for patients. Specific improvements will include upgrading equipment for DR screening, strengthening referral systems and integrating eye screening within the routine of diabetes clinics, developing clear DR clinical guidelines, and increasing knowledge and skills base of diabetes and eye clinic health workers. The ultimate intention is to develop a best practice model of training which can be subsequently rolled out to the rest of the country.