RESUMO
BACKGROUND: The COVID-19 pandemic had a profound impact on healthcare and ophthalmology services globally. Numerous studies amongst various medical and surgical specialties showed a reduction in patient attendance and surgical procedures performed. Prior published ophthalmic literature focused on specific types of procedures and were usually single centre. The current study attempts to quantify the impact on a larger scale, namely that of sub-Saharan Africa, and to include all ophthalmic subspecialties. METHODS: This is a retrospective analysis of the surgical records from 17 ophthalmology centres in seven countries located in East, Central, West and Southern Africa. The date of declaration of the first lockdown was used as the beginning of the pandemic and the pivot point to compare theatre records one year prior to the pandemic and the first year of the pandemic. We examined the total number of surgical procedures over the two year period and categorized them according to ophthalmic subspecialty and type of procedure performed. We then compared the pre-pandemic and pandemic surgical numbers over the two year period. RESULTS: There were 26,357 ophthalmic surgical procedures performed with a significant decrease in the first year of the pandemic (n = 8942) compared to the year prior to the pandemic (n = 17,415). The number of surgical procedures performed was lower in the first year of the pandemic compared to the year prior to the pandemic by 49% [Incidence rate ratio (IRR) 0.51, 95% CI 0.41-0.64), 27% (0.73, 0.55-0.99), 46% (0.54, 0.30-0.99), 40% (0.60, 0.39-0.92) and 59% (0.41, 0.29-0.57) in sub-Saharan Africa (4 regions combined), West, Central, East and Southern Africa, respectively]. The number of surgical procedures in the different sub-specialty categories in sub-Saharan Africa (4 regions combined) was significantly lower in the first year of the pandemic compared to the year prior to the pandemic, except for glaucoma (IRR 0.72, 95% CI 0.52-1.01), oncology (0.71, 0.48-1.05), trauma (0.90, 0.63-1.28) and vitreoretinal (0.67, 0.42-1.08) categories. CONCLUSION: This study provides insight into the impact of the COVID-19 pandemic in multiple regions and countries on the African continent. The identification of which surgical subspecialty was most affected by the COVID-19 pandemic in each region allows for better planning and resource allocation to address these backlogs.
RESUMO
Background: Low/middle-income countries have the highest burden of blindeness and visual impairment, which directly affects the children and indirectly affects their community. Furthermore, the number of blind years suffered by children with low vision or blindness creates a self-perpetuating ripple effect on their development, health and the socio-economic development of their communities. This systematic review aims to interrogate the existing evidence on the prevalence and causes of blindness and visual impairment in Nigerian children to provide evidence to drive health policy. Methods: This was a systematic review without meta-analysis (SwiM) using a narrative synthesis of the evidence reported using the PRISMA guidelines. All primary cross-sectional studies (in English) reporting the prevalence and causes of visual impairment among Nigerian children under 20 years old between 2003 and 2022 were included in this review. PUBMED, AJOL, BASE and ProQuest databases were searched for eligible studies between 6 June and 15 July 2023. The quality of the included studies was assessed using the AXIS tool. Results were extracted and summarised using descriptive statistics. Visual impairment and blindness using the presenting visual acuity in the better eye were reported using the WHO classification. Results: Seventeen studies, involving 16,924 children from 13 states across five geo-political zones in Nigeria, were included in the final analysis of this review. The prevalence of visual impairment was 3.9%, 2.7% and 0.3% for mild, moderate and severe visual impairments, respectively, due to ametropia, cataracts, glaucoma, etc. The prevalence of blindness was 0.2% due to cataracts, corneal scars and optic atrophy. Conclusion: Blindness and visual impairment is still a significant clinical and public health burden among Nigerian children. Hence, there is still a need for clinicians, especially opthalmologists, public health specialists, policy-makers, and other relevant stakeholders to intensify efforts towards the prevention and control of this burden.