Globally working age population worldwide 13. Diabetic Retinopathy

Globally prevalence of
diabetic mellitus has increased from 108 million in 1980 to 422 million in 2014
1, 2, with the age-standardized prevalence of
diabetes has doubling from 4.7% to 8.5% since 1980 3. In Sub-Saharan Africa and other
developing countries , diabetes prevalence has risen more rapidly than expected
4. Rapid
urbanization, globalisation and unhealthy lifestyle has contributed to the
growing epidemic of diabetes around the world5. A case in point,
is a developing country such as Ghana experiencing
prevalence rise in diabetes i.e. from 0.2% in 1964 6 to 1.9% in 2010 7 in recent years,
with attributing factors associated to overweight (25.4%) and obesity (17%) of
the adult population 8. Though services
for diabetic management and services have improved in recent years 9, screening and
management for diabetic retinopathy is not fully incorporated into the national
diabetes program10. Integrating eye
care services into the general health system helps in strengthening the system
for effective planning and development 11, 12. Vision loss due
to diabetic retinopathy is an important cause of visual impairment in the
working population of any country.

One of the major
complications from diabetes mellitus is the development of diabetic retinopathy
13; a retinal vascular disease that results
as a complication of poor DM management 14. Previous studies show that approximately one
third of people living with diabetes will develop diabetic retinopathy and a
further one third will develop vision threatening diabetic retinopathy 13. Moreover, the
number of people with DR is projected to grow from 126.6 million in 2010 to 191.0
million by 2030, whilst global estimate shows the number with
vision-threatening diabetic retinopathy will increase from 37.3
million to 56.3 million if prompt action is not taken 15. . DR is the leading cause of vision loss in
working age population worldwide 13.  

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Retinopathy Overview

Diabetic retinopathy (DR), is a retinal vascular
disease that occurs as a complication of diabetes mellitus 14. Diabetic
retinopathy is characterised by signs of ischemia, microaneurysms, cotton wool
spots, neovascularisation, haemorrhages, macular oedema and retinal detachment 16. The early stages
of the disease are mostly asymptomatic but gradually become more serious as the
disease progresses leading to vision loss and blindness. Diabetic retinopathy
begins as mild and progresses to moderate and severe non-proliferative diabetic
retinopathy (NPDR) and then proliferative diabetic retinopathy (PDR). Macular oedema
can develop at any time in the progression of diabetic retinopathy 17



is a lower middle income country in West Africa located on the coast of the
Gulf of Guinea. The country is divided into ten administrative regions with
Accra as the capital. With a population of 24,658,823 and a growth rate of 2.5%
according to the 2010 census18, Ghana has one of
the fastest growing populations in Africa19. The country has
a GDP of 1426 USD and total expenditure on health is 3.6% of GDP as at 201420. Life expectancy
is estimated at 62 years and the country has an under five mortality rate of 7821.




Retinopathy in Ghana

to the international diabetes federation, 93,170 people in Ghana are living
with DR and 26,620 have vision threatening diabetic retinopathy. The burden of
increasing number of diabetics is set to double by the year 2040 22. However, the
‘vision 2020 links program aims to facilitate knowledge and skills transfer
between a training Eye hospital in a developing country (e.g. Ghana) and a
training Eye institution in U.K (e.g. Moorefield’s Eye hospital) to plan and
develop services to improve quality of life of people living with diabetes 10.

study conducted by Poore et al reported that DR screening was inclusive in
holistic routine diabetes check in some hospitals in Ghana, though people
referred for screening test frequently failed to turn up at the eye department.
It was reported that one of the main reasons for low turn up was the prospect
of long queues and lengthy waiting time 10

System in Ghana

Ministry of health who was the sole sector providing direction, policies and
guidelines concerning the health in the country changed its policies to
decentralise functions of the health system23. The national
health policy developed in 2007 aimed at improving health outcomes by offering
financial protection and to ensure that the system was sustainable, responsive,
equitable and efficient. To achieve these goals, policy making, service
delivery, financing and regulatory functions were allocated to autonomous
agencies (e.g. Ghana Health Service, National Health Insurance Scheme, teaching
hospitals and others) 23. Ghana is one of
the few countries in Africa with an operational health insurance system gearing
towards a universal health coverage 24. As a result,
primary health care has become an embodied part of the health system in Ghana.

Care in Ghana

The objective of the
Ghana National Eye Health Programme is
to reduce avoidable blindness through the strengthening of capacities that
ensure affordable and available eye care services to all people living in the
country. This includes the mobilization of communities to participate actively
in eye health. The lack of requisite human resource is, however, a major
challenge to the work of the programme. Presently, there are about 97
ophthalmologists25 in Ghana, some of whom are either in administrative
positions or no longer in active practice. Majority of those in service
delivery are in the capital cities, leaving the rural areas underserved.
Ophthalmic nurses (288) and optometrists (300)26 are the main personnel who work in eye units at
the district hospitals or in urban polyclinics. Eye health services are
delivered by other health service providers who have been trained in Primary
Eye Care


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