Decreasing delay in pediatric g y p presentation to CEHTF - - PowerPoint PPT Presentation

Decreasing delay in pediatric g y p presentation to CEHTF

Fortunate Shija Susan Lewallen Asiwome Seneadza Chileshe Mboni Susan Lewallen Paul Courtright Chileshe Mboni Gerald Msukwa Ariel Phiri Tionenji Ng’ongola

KCCO in brief

• Established in 2001 in Moshi, TZ
• Work throughout eastern Africa

d h l f

• Leading technical agency for

paediatric eye disease in Africa: courses, research & publications courses, research & publications

Pic buliding

Sites for current study

How do we get from here… to here?

Provide high quality surgery Identify early and refer Ensure proper follow up

This requires a program

Background‐ why this study?

• Evidence from schools

for blind for blind

• Previous AED project

indicated that trainin indicated that training PHCW alone was not effective effective

• Interest in expanding

pediatric programs requires information

• n costs

Objectives

• 1. Document delay & reasons

Objectives

for delay in presentation to 3 CEHTF

• 2. Measure knowledge and

skills of MCH workers at recognizing and referring childhood cataract

• 3. Test whether training &

supervision will increase supervision will increase referrals by MCH workers 4 Estimate cost of establishing

• 4. Estimate cost of establishing

CEHTF in Africa

Study design‐ objective #1‐ l i i d l i t ti explaining delay in presentation

Standardized interviews with caretakers presenting to CEHTF with significant surgical with significant surgical problem

• cataract, glaucoma,

cataract, glaucoma, squint, RB, orbital tumour

• who recognized
• who recognized

problem

• steps taken to access

service

• barriers encountered

Study design‐objective #2‐ what do k k d ? MCH workers know and practice?

• Administered a simple test and questionnaire to MCH
• Administered a simple test and questionnaire to MCH

workers from 1 district each site

Study design‐ objective #3 ‐ will trained & i d MCH k k supervised MCH workers make more referrals?

• 1 day training on recognizing and referring children
• Regular phone contact from CEHTF, monitor referrals

and compare to neighboring district

Preliminary results… Preliminary results…

Number of children with selected d d d h diagnoses admitted over 6 months

Malawi Tanzania Zambia total Congenital cataract 51 30 28 109 Developmental cataract 21 6 3 30 Developmental cataract 21 6 3 30 Congenital glaucoma 16 8 5 29 Squint 1 3 17 21 Retinoblastoma 8 3 7 18 Secondary glaucoma 3 3 Orbital tumour 1 1 2 Total 98 53 61 212

Months of delay from recognition at h l home to arrival at CEHTF (means, 95% CI)

Initial delay 2’dary delay Total y (recognition‐ 1st contact) y y (1st contact‐ CEHTF delay (mos) C i l 17 (10 23) 19 (13 24) 36 (28 43) Congenital cataract (109) 17 (10‐23) 19 (13‐24) 36 (28‐43) Developmental 12 (4 20) 16 (9 24) 29 (18 40) Developmental cataract (30) 12 (4‐20) 16 (9‐24) 29 (18‐40) Congenital glaucoma 1 (0‐3) 8 (0‐15) 9 (2‐16) Congenital glaucoma (29) 1 (0 3) 8 (0 15) 9 (2 16) Squint (21) 3 (0‐7) 27 (14‐41) 30 (17‐43) q ( ) ( ) ( ) ( ) Retinoblastoma (18) 2 (1‐3) 10 (6‐15) 12 (8‐17)

Cataract: months of delay from i i h i l CEHTF recognition at home to arrival at CEHTF

(means, 95% CI)

Initial delay (recognition‐ 1st ) 2’dary delay (1st contact‐ CEHTF Total delay % > 12 months 1st contact) CEHTF Malawi ( ) 19 (10‐28) 19 (12‐26) 38 (28‐47) 57 (n=72) Tanzania (n 36) 18 (8‐28) 18 (11‐24) 36 (24‐47) 64 (n=36) Zambia (n=31) 7 (2‐11) 18 (10‐26) 25 (18‐33) 59 (n=31)

Cataract: reasons for delay Cataract: reasons for delay

Tanzania Zambia Rx’d by primary health worker 4 5 No money/transportation 10 13 Didn’t recognize problem/think serious 10 8 Multiple diseases in child 3 Didn’t know where to go 4 Didn t know where to go 4 Other 4 1

How many hours from home is the CEHTF?

vel who trav % w

No association found between h t CEHTF d d l hours to CEHTF and delay

Health workers’ knowledge‐ pre training

Mentioned cataract as cataract as possible diagnosis g Malawi 21/48=44% Tanzania

2/25=8%

Zambia

20/38=53%

Health workers' knowledge: at what age ( h ) h ld h (months) can a child have eye surgery?

Health workers’ knowledge‐ pre training

Mentioned scar as possible diagnosis Malawi 34/55=62% Tanzania 2/25=8% Zambia 13/38=38%

Did health workers (pre training) examine h f hild i i i ? the eyes of children at immunization?

always some‐ never if mother asks How many y times Malawi 9 ( %) 42 ( %) 1 ( %) 5 ( %) y have a torch 5/52=9% (17%) (81%) (2%) (10%) Tanzania 5 (20%) 15 (60%) 1 (4%) 4 (16%) 5/25=20% (20%) (60%) (4%) (16%) Zambia 2 (5%) 28 (74%) 7 (18%) 1 (3%) 3/38=8%

Did training help increase referrals? Did training help increase referrals? Comparison between referrals from d d d d trained and untrained districts

Country Referrals from trained districts Referrals from non trained districts Malawi 15 12 Tanzania 10 2

Discussion

• Preliminary data indicate that we are still not getting

kids in early enough. This issue is equally important as training and equipping CEHTF

• Delay occurs both before and after contact with

health system

• Existing MCH workers have very limited skills and

knowledge‐ can they help if better trained & supervised?? A i f diff h d ill b d d d

• A variety of different methods will be needed and we

need evidence for which work and which do not in different settings different settings

Still to do

• Continue collecting data on children through

end of the year

• Longer follow up on the referrals‐ ongoing for

g p g g next year to see whether the training actually improved referrals p

• Complete analysis of costs – data have been

collected collected

• Advocacy to be discussed