Kandel Himal, Murthy G V S, Bascaran Covadonga
Department of Optometry and Vision Science, Flinders University, Australia.
International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Clin Exp Optom. 2015 Jul;98(4):335-41. doi: 10.1111/cxo.12286. Epub 2015 May 5.
Uncorrected refractive error is a public health problem globally and in Nepal. Planning of refraction services is hampered by a paucity of data. This study was conducted to determine availability and distribution of human resources for refraction, their efficiency, the type and extent of their training; the current service provision of refraction services and the unmet need in human resources for refraction in Central Nepal.
This was a descriptive cross-sectional study. All refraction facilities in the Central Region were identified through an Internet search and interviews of key informants from the professional bodies and parent organisations of primary eye centres. A stratified simple random sampling technique was used to select 50 per cent of refraction facilities. The selected facilities were visited for primary data collection. Face-to-face interviews were conducted with the managers and the refractionists available in the facilities using a semi-structured questionnaire.
Data was collected in 29 centres. All the managers (n=29; response rate 100 per cent) and 50 refractionists (Response rate 65.8 per cent) were interviewed. Optometrists and ophthalmic assistants were the main providers of refraction services (n=70, 92.11 per cent). They were unevenly distributed across the region, highly concentrated around urban areas. The median number of refractions per refractionist per year was 3,600 (IQR: 2,400 - 6,000). Interviewed refractionists stated that clients' knowledge, attitude and practice related factors such as lack of awareness of the need for refraction services and/or availability of existing services were the major barriers to the output of refraction services. The total number of refractions carried out in the Central Region per year was 653,176. An additional 170 refractionists would be needed to meet the unmet need of 1,323,234 refractions.
The study findings demand a major effort to develop appropriately trained personnel when planning refraction services in the Central Region and in Nepal as a whole. The equitable distribution of the refractionists, their community-outreach services and awareness raising activities should be emphasised.
未矫正的屈光不正问题在全球及尼泊尔都是一个公共卫生问题。屈光服务规划因数据匮乏而受阻。本研究旨在确定尼泊尔中部屈光人力资源的可获得性与分布情况、他们的工作效率、培训类型与程度；当前屈光服务的提供情况以及屈光人力资源方面未满足的需求。
这是一项描述性横断面研究。通过互联网搜索以及对专业团体和主要眼保健中心母体组织的关键信息提供者进行访谈，确定了中部地区的所有屈光设施。采用分层简单随机抽样技术选取了50%的屈光设施。对选定的设施进行走访以收集原始数据。使用半结构化问卷对设施中的管理人员和验光师进行面对面访谈。
在29个中心收集了数据。对所有管理人员（n = 29；回复率100%）和50名验光师（回复率65.8%）进行了访谈。验光师和眼科助理是屈光服务的主要提供者（n = 70，92.11%）。他们在该地区分布不均，高度集中在城市地区。每位验光师每年屈光检查的中位数为3600次（四分位间距：2400 - 6000次）。接受访谈的验光师表示，客户的知识、态度和行为相关因素，如对屈光服务需求缺乏认识和/或对现有服务知晓度低，是屈光服务产出的主要障碍。中部地区每年进行的屈光检查总数为653,176次。还需要额外170名验光师才能满足1,323,234次屈光检查的未满足需求。
研究结果表明，在规划尼泊尔中部及整个尼泊尔的屈光服务时，需要做出重大努力来培养经过适当培训的人员。应强调验光师的公平分布、他们的社区外展服务以及提高认识活动。
