National approaches to trichiasis surgical follow-up, outcome assessment and surgeon audit in trachoma-endemic countries in Africa.
Africa
/ epidemiology
Cross-Sectional Studies
Endemic Diseases
Female
Follow-Up Studies
Health Care Surveys
Health Policy
/ trends
Humans
Male
Monitoring, Physiologic
Outcome Assessment, Health Care
Postoperative Period
Prevalence
Surveys and Questionnaires
Trachoma
/ epidemiology
Trichiasis
/ physiopathology
Eye (Globe)
Public health
Journal
The British journal of ophthalmology
ISSN: 1468-2079
Titre abrégé: Br J Ophthalmol
Pays: England
ID NLM: 0421041
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
14
02
2020
revised:
02
04
2020
accepted:
25
06
2020
pubmed:
28
7
2020
medline:
25
9
2021
entrez:
28
7
2020
Statut:
ppublish
Résumé
Poor outcomes of trichiasis surgery, including postoperative trichiasis, are common in many trachoma-endemic countries in Africa. To improve outcomes, WHO recommends regular follow-up and outcome assessment of surgical cases plus audit of trichiasis surgeons. To assess national approaches to trichiasis surgical follow-up, outcome assessment and audit, and identify national targets for good surgical outcome (defined as the percentage of patients undergoing surgery for trichiasis remaining free of post-operative trichiasis for a defined interval after surgery). A cross-sectional survey was carried out between May and July 2018, involving all 29 known-trachoma-endemic countries in Africa. An emailed questionnaire was used to collect information on national targets for surgical outcomes, policies, monitoring and strategies to address underperformance by surgeons. All national programmes provided information; 2 of the 29 had not yet implemented trichiasis surgery as part of their trachoma elimination programme. Findings from 27 countries are therefore reported. Only four countries reported having a national policy for trichiasis surgery follow-up and outcome assessment and only two had a national policy for conducting audits of trichiasis surgeons. Only 9 of the 27 countries had a cut-off point at which poorly performing surgeons would be instructed to discontinue surgery until retraining or other interventions had been undertaken. To address the challenge of post-operative trichiasis and other poor outcomes, national trachoma programmes should create and implement policies and systems to follow up patients, assess surgical outcomes and monitor the performance of individual surgeons through post-surgical audits.
Sections du résumé
BACKGROUND
Poor outcomes of trichiasis surgery, including postoperative trichiasis, are common in many trachoma-endemic countries in Africa. To improve outcomes, WHO recommends regular follow-up and outcome assessment of surgical cases plus audit of trichiasis surgeons.
AIMS
To assess national approaches to trichiasis surgical follow-up, outcome assessment and audit, and identify national targets for good surgical outcome (defined as the percentage of patients undergoing surgery for trichiasis remaining free of post-operative trichiasis for a defined interval after surgery).
METHODS
A cross-sectional survey was carried out between May and July 2018, involving all 29 known-trachoma-endemic countries in Africa. An emailed questionnaire was used to collect information on national targets for surgical outcomes, policies, monitoring and strategies to address underperformance by surgeons.
RESULTS
All national programmes provided information; 2 of the 29 had not yet implemented trichiasis surgery as part of their trachoma elimination programme. Findings from 27 countries are therefore reported. Only four countries reported having a national policy for trichiasis surgery follow-up and outcome assessment and only two had a national policy for conducting audits of trichiasis surgeons. Only 9 of the 27 countries had a cut-off point at which poorly performing surgeons would be instructed to discontinue surgery until retraining or other interventions had been undertaken.
DISCUSSION
To address the challenge of post-operative trichiasis and other poor outcomes, national trachoma programmes should create and implement policies and systems to follow up patients, assess surgical outcomes and monitor the performance of individual surgeons through post-surgical audits.
Identifiants
pubmed: 32713838
pii: bjophthalmol-2019-315777
doi: 10.1136/bjophthalmol-2019-315777
pmc: PMC7611077
mid: EMS106910
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
904-908Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Informations de copyright
© World Health Organization 2021. Licensee BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Invest Ophthalmol Vis Sci. 2011 Apr 25;52(5):2704-11
pubmed: 21051704
PLoS Med. 2011 Dec;8(12):e1001137
pubmed: 22180732
PLoS Negl Trop Dis. 2011 Apr 05;5(4):e1014
pubmed: 21483713
Br J Ophthalmol. 2018 Oct;102(10):1324-1327
pubmed: 29907634
Ophthalmic Epidemiol. 2015;22(3):214-25
pubmed: 26158580
BMC Ophthalmol. 2020 Nov 17;20(1):451
pubmed: 33203380
Br J Ophthalmol. 2007 Feb;91(2):143-5
pubmed: 16973662
Community Eye Health. 2014;27(85):18
pubmed: 24966461
Am J Trop Med Hyg. 2018 Oct;99(4):858-863
pubmed: 30039782
Infect Dis Poverty. 2017 Apr 4;6(1):73
pubmed: 28372566
Community Eye Health. 2012;25(78):38
pubmed: 23139455
Br J Ophthalmol. 2011 Mar;95(3):331-4
pubmed: 20881027
Community Eye Health. 2014;27(87):58
pubmed: 25918472
Lancet. 2005 Sep 17-23;366(9490):1026-35
pubmed: 16168785