Presentation on theme: "Need for detailed study to establish all contributing factors, and to propose solutions. Study in Iraq and other Middle Eastern countries should also be."— Presentation transcript:
Need for detailed study to establish all contributing factors, and to propose solutions. Study in Iraq and other Middle Eastern countries should also be considered to establish real current prevalence and incidence, and associated causal factors in the region. The above studies needs to include the socio-political factors and not just overt clinical governance. It has to be acknowledged that there are other healthcare demands for funding as the financial and working practice issues are not unique to Ophthalmic surgery, these wider demands may require international aid. The Neglect of Surgical Care of Cataracts in the Al-Najaf Governorate, Iraq Authors : Haidar A. W. Al-Hakim 1,2, H. Mohammed J. Hassan 1, Z Shukur 2, Hala Hassan 3, Peter A Cudd 4 Affiliations : 1 - Dept. of Ophthalmology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK; 2 - Medical College, Kufa University, Iraq; 3 - Department of Optometry and Visual Sciences, City University, London, EC1V 0HB; 4 - Dept. of Medical Physics & Clinical Engineering, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK Al-Najaf Governorate Al –Najaf is located on the edge of the western plateau of Iraq, 160 km to the southwest of Baghdad. It is considered to have a desert climate extremely hot during the summer and relatively cold in winter. Al-Najaf is the administration centre of the Al-Najaf Governorate, one of 18 governorates in Iraq. Introduction It has been observed that in Al-Najaf, Iraq, the numbers of people with untreated cataracts is steadily increasing year on year. The causes for this were unknown, but, because of the desert climate, ultraviolet rays of the sun were speculated as a cause. At the time of the study there was no response from NGOs, and, almost nothing from Government or the public. The aim of this study was to identify the likely causes to highlight this as an area worthy of further investigation and to propose some potential solutions. Approach Clinical Governance and epidemiology were used as starting points. The poster presents preliminary information on both. Specifically over a year (2005-2006) data was collected on : - the financial investment in health care across Middle Eastern countries and for comparison, the UK; - the reality of Al-Najaf healthcare working practises; - Estimated Prevalence/Incidence across Middle Eastern countries for comparison with the reality in Al-Najaf; - And, treatment rates within Al-Najaf Financial comparison Clearly the amount of investment per capita on health care can greatly impact Clinical Governance and treatment rates – Iraq is at the bottom in the region (Figures assume 20% spent on health services everywhere). But, a comparison of GDP would put Iraq in the middle of these countries! And it would appear its not as simple as being oil rich CountryHealth Spend per Capita US$ 1 Kuwait1981 Turkey959 Saudi Arabia896 Iran764 Jordan639 Syria406 Iraq177 UK4594 Al-Najaf Health Service Conditions Basic operating difficulties on a regular basis, e.g. : a light bulb of the operating microscope in Al -Forat Al-Awsat Hospital needed 2 weeks to be replaced, at which time not a single cataract operation was performed; equipment availability and maintenance is very poor, e.g. only one surgical set is available, so patients have to wait for the sterilisation cycle to end before starting again; staff shortages, e.g. no ophthalmic scrub nurses, no female nurses. There are 8 ophthalmologists : 5 operate, 3 carry 90% of the case load and 3 do not operate on cataracts. Most of the cataract operations are done by ECCE, 28% left aphakic, rather than Phacoemulsification with intraocular lens implants – due to lack of training. No expectation that all this is different in other large conurbations in Iraq. Results – Prevalence/Incidence 2004 2,3 CountryPrevalenceIncidencePopulation Iraq513,09137,31525,374,691 Iran1,360,00099,26967,503,000 Jordan113,4618,2515,611,202 Kuwait45,6483,3192,257,549 Saudi Arabia521,60937,93525,795,000 Syria364,31126,49518,016,000 Turkey1,415,320103,53470,413,958 UK1,218,70988,63360,270,708 Results – Al-Najaf prevalence & treatment rates The figures in the above table are based on 2% prevalence and 0.15% incidence 2,3 they have been shown to demonstrate the large populations involved. However estimates of the prevalence for untreated cataracts in Al-Najaf is 10%. Currently its unknown whether this is primarily due to greater incidence or insufficient treatment rates. The number of Ophthalmic consultants in Al-Najaf is 8, but only 3 of them do health service operations per week. There is an average of 15 operations per week in total (private operations – i.e. those funded from the private finances of individuals – are not included) Results - Projections of treatment rates Discussions – specific to Al-Najaf The working conditions of Ophthalmic care in Al-Najaf is very inadequate to meet the needed level of care. One possible solution is more staff and resources – from the projections this would require more than 50% increase of staff working with current practices and similar caseloads. A 10 year solution would require the same numbers of staff but also require better training, resourcing and motivation for all staff. In effect both solutions are suggesting more resources and/or more efficient clinical governance in some form to achieve resolution of the current problem. The faster routes to decreasing prevalence shown in the graph clearly involve greater investment. Discussion – wider context It is unlikely that the Iraqi government in the short term would be able to invest the levels of funding needed to implement the 10 year solution based on UK practice. One solution to consider would be to seek specific international aid to achieve healthcare goals. However a solution using existing numbers of staff with resources enough to allow more than 5 operations per week per consultant would greatly improve the situation. It is possible in other countries in the region where investment is higher per capita in health services, that they do not see the same or scale of problems, this should be investigated in future studies. Conclusions – Al-Najaf and Iraq Conclusions – Wider Context If the status quo remains in Al-Najaf the outlook for the majority of people who have or get cataracts is poor – with limited prospect for maintained sight. The solution will require a collective will from health, government and NGOs as well as the Al-Najaf population to improve the situation. In Iraq a greater investment of GDP needs to be applied to health care to stand any chance of controlling spiralling cataract prevalence Until progress is made with the all above, the Al-Hasan Foundation has recently been formed to fund and manage an Ophthalmic Clinic in Al-Najaf for diagnostic and after care of surgical cases, and, fund equipment and consumables for the Ophthalmic theatre in Al-Forat Al-Aswat Hospital. References 1. Central Intelligence Agency, The World Fact Book 2006. Available at: http//www.cia.worldfactbook.org, accessed September 2006. 2. World Health Organisation, The World Health Report 2006. Available at: http//www.who.int/whr/2006/annex/en, accessed September 2006 3. Iraq Living Conditions Survey 2004. Available at: http//www.iq.undp.org/ilcs/overview, accessed September 2006 Ophthalmic tray in 2006 in Al-Furat Al-Awsat hospital in Al-Kufa district of the Al-Najaf Governorate
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