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M. Gathinji, M.A. Obadiah, A.O. Eghrari, I. Achi, C. Mpyet, Z. Kwonchi, S. Ogiri, D.O. Gilbert, N.G. Congdon; Assessment of Visual Acuity and Cataract by Community–Directed Distributors of Ivermectin in Nigeria . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4139.
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Cataract is the leading cause of blindness in Africa and the world. Screening mechanisms are needed that can access poor rural areas where cataract is prevalent, and accurately identify persons requiring surgery. In Adamawa State, Nigeria, Community Directed Treatment with Ivermectin (CDTI) has been effectively utilized for onchocerciasis control and provides access to 70–80% of villages. We examined whether Community–Directed Distributors of Ivermectin(CDDs) in Adamawa State could acurately assess visual acuity and the presence of cataract.
CDDs, who had no previous formal healthcare training, and district health workers (HWs) were trained to measure visual acuity and screen for cataract among village residents. Patients were examined at the village level by CDDs or at district health clinics by HWs, acuity and diagnosis were recorded on information cards, and suspected cataract cases were referred to regional health facilities for examination in masked fashion by ophthalmologists. Measured acuity and diagnosis of cataract by CDDs and HWs were compared to those of ophthalmologists.
A total of 92 referred patients received hospital screening for visual acuity and cataract, 41 referred by CDDs and 77 by HWs (26 were seen by both sequentially). In identifying patients with low vision (presenting VA in better–seeing eye of <= 20/40), the positive predictive value (PPV) of visual acuity assessment among CDDs and HWs was 26/26 (100%) and 48/53 (91%), respectively. In detecting cataract in an eye, the PPV of CDDs was 32/56 (57%), and HWs was 50/91 (55%).
CDDs with minimal training performed comparably with HWs in their assessment of visual disability and cataract. These results suggest that ivermectin distribution may represent an effective mechanism to promote diagnosis and referral of cataract and low vision in onchocerciasis–endemic rural Africa.
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