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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
AIM: To evaluate systems and services for management of diabetes and diabetic retinopathy. METHODOLOGY: The National Program for Blindness Control conducted a nationwide descriptive study from 1st February to 31st October 2016. Data was collected using WHO's:"Tool Assessment of Diabetic Retinopathy and Diabetes Management Systems" adapted to the context. Using direct interviews, all previously identified stakeholders, were involved from all levels of management and throughout the territory. The IBM version 20 software permitted analysis. RESULTS: Out of the 48 individuals selected, 46 agreed to participate in the survey. Four participants (8.7%) worked at the central level of the Ministry of Public Health, 2 (4.4%) were NGOs partners, 6 (13%) diabetic patients, and 34 (73.9%) health staff. According to the answers of participants, diabetes stands among priorities in the national health policy. Diabetic care services have been integrated into the National action plan for Chronic Non-Communicable Diseases, but a specific program for control of diabetes has not been created neither are national guidelines recommended by the Ministry available. Some health facilities provide care for diabetes and its complications. Modern technologies for evaluation and follow-up of diabetes of its complications are available only in tertiary level hospitals and in some private clinics. The cost of care obtained is the responsibility of the patients and families. CONCLUSION: The political will to manage diabetes and diabetic retinopathy is recognized by stakeholders and beneficiaries but not translated into an effective program. A suitable implementation strategy is necessary.
