Illustrations as a patient education tool to improve recall of postoperative cataract medication regimens in the developing world.

PURPOSE: To assess the impact of medication frequency illustrations in patient education for use in the developing world. METHODS: This was a randomized controlled trial of a study population of patients undergoing cataract surgery in St/Louis du Nord, Haiti. Patients and accompanying family members were randomized prior to surgery to receive either standard oral post/operative instructions or oral instructions with detailed illustrations regarding the morning, noon, evening, and bedtime use of topical antibiotic and steroid drops. On postoperative day 1, patients and enrolled family members were questioned regarding when and how often the patient was to use his or her eye drops by a blinded examiner, and results were compiled. RESULTS: Of the 65 patients enrolled in the study 32 patients were randomized to the oral group, 33 were randomized to the illustration group. The morning recall was 76% in the illustration group and 50% in the oral group without illustrations (p = 0.0259). Bedtime recall was 67% in the illustration group and 38% in the oral group (p = 0.0139). There was a statistically significant improvement in recall for the illustration group with the morning and bedtime doses. There was a trend in favor of the illustration group on the afternoon and evening doses; however this was not statistically significant. CONCLUSION: Illustrations appear to be a useful adjunct in explaining complex medication regimens to patients in the developing world where cultural and language barriers can be difficult to bridge. This better understanding could translate into improved medication compliance and outcomes.

Mapping the prevalence of sickle cell and beta thalassaemia in England: estimating and validating ethnic-specific rates.

A range of estimates for sickle cell and beta thalassaemia have been derived for the different ethnic groups living in the U.K., reflecting uncertainty over the true population value in certain countries and the heterogeneity within and between countries of origin comprising the same ethnic group. These were validated against six community screening programmes, with the estimated range correctly predicting the number of affected births observed by the programmes. In England approximately 3000 affected babies (0.47%) carry sickle cell trait and 2800 (0.44%) carry beta thalassaemia trait annually: with approximately 178 (0.28 per 1000 conceptions) affected by sickle cell disease (SCD) and 43 (0.07 per 1000) by beta thalassaemia major/intermedia. Allowing for termination, about 140-175 (0.22-0.28 per 1000) affected infants are born annually with SCD and from 10 to 25 (0.02-0.04 per 1000) with beta thalassaemia major/intermedia. These are the first evidence-based rates for sickle cell and beta thalassaemia for use in the U.K., and should underpin the future planning of services. The long-term solution to monitoring changes in the rates of trait and disease in the population is to introduce a standardized instrument for collecting ethnicity for all community screening programmes.