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改善白内障手术后儿童随访的策略:撒哈拉以南非洲和南亚儿童眼科三级医疗机构的研究结果

Strategies to improve follow-up of children after surgery for cataract: findings from Child Eye Health Tertiary Facilities in sub-Saharan Africa and South Asia.

作者信息

Kishiki E, van Dijk K, Courtright P

机构信息

Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania.

Light for the World, Veenendaal, The Netherlands.

出版信息

Eye (Lond). 2016 Sep;30(9):1234-41. doi: 10.1038/eye.2016.169. Epub 2016 Jul 29.

Abstract

PurposeWe sought to conduct a systematic literature review on follow-up of children with ocular surgical management (primarily childhood cataract) in developing countries. Second, we sought to determine the current practices regarding follow-up for clinical, optical, low vision, rehabilitation, and educational placement among children receiving surgical services at Child Eye Health Tertiary Facilities (CEHTF) in sub-Saharan Africa (SSA) and South Asia.MethodsA systematic literature review was conducted. Separately, we conducted a cross-sectional study among CEHTF in SSA and South Asia (India, Nepal, and Bangladesh) to assess current capacities and practices related to follow-up and educational placement.ResultsThe articles that met the systematic review eligibility criteria could be grouped into two areas: factors and strategies to improve post-operative follow-up and educational placement of children after surgery. Among the 106 CEHTF in SSA and South Asia, responses were provided by 75 CEHTF. Only 59% of CEHTF reported having a Childhood Blindness and Low Vision Coordinator; having a coordinator was associated with having appropriate follow-up mechanisms in place. Educational referral practices were associated with having a low-vision technician, having low-vision devices, and having donor support for these services.ConclusionsThe systematic literature review revealed evidence of poor follow-up after surgical interventions for cataract and other conditions, but also showed that follow-up could be improved significantly if specific strategies were adopted. Approaches to follow-up are generally inadequate at most facilities and there is little external support for follow-up. Findings suggest that funding and supporting a coordinator would assist in ensuring that good practices for follow-up (cell phone reminders, patient tracking, and reimbursement of transport) were followed.

摘要

目的

我们试图对发展中国家接受眼部手术治疗(主要是儿童白内障)的儿童的随访情况进行系统的文献综述。其次,我们试图确定撒哈拉以南非洲(SSA)和南亚的儿童眼健康三级设施(CEHTF)中,接受手术治疗的儿童在临床、验光、低视力、康复及教育安置方面的随访现状。

方法

进行了一项系统的文献综述。另外,我们在SSA和南亚(印度、尼泊尔和孟加拉国)的CEHTF中开展了一项横断面研究,以评估与随访及教育安置相关的现有能力和做法。

结果

符合系统综述纳入标准的文章可分为两个领域

改善术后随访及手术患儿教育安置的因素和策略。在SSA和南亚的106家CEHTF中,75家提供了回复。只有59%的CEHTF报告设有儿童失明和低视力协调员;设有协调员与具备适当的随访机制相关。教育转诊做法与配备低视力技术员、拥有低视力设备以及获得这些服务的捐赠支持有关。

结论

系统的文献综述表明,白内障及其他病症手术干预后的随访情况不佳,但也表明,如果采取特定策略,随访情况可显著改善。大多数机构的随访方法普遍不足,且随访几乎没有外部支持。研究结果表明,资助并支持一名协调员将有助于确保遵循良好的随访做法(手机提醒、患者跟踪及交通费用报销)。

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