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Background Buruli ulcer disease (BUD) is a neglected tropical disease of the skin, subcutaneous tissue and bone caused by Mycobacterium ulcerans , with various disabling and stigmatising sequelae. Patients face a range of adverse impacts owing to the disease as most are unable to relate effectively with their communities, battling stigma and fear of discrimination. This study aimed to explore the stigma associated with the lived experiences of BUD in patients in Nigeria. Methods This was a cross-sectional qualitative study that employed a focus group discussion (FGD) and key informant interviews in Enugu State, Nigeria. A random sampling of communities was followed by a purposive selection of FGD participants and key informants. A total of six key informants and eight FGD participants took part in the study. Data were collected over 6 wk from December 2022 to February 2023. The NVivo application was used to analyse transcripts and compute themes of quotes. Results Patients experienced stigma owing to the condition. The most reported experiences by participants were shame and culpability, isolation and social exclusion, including maltreatment from family members. Conclusions Identifying the stigma experienced by patients owing to BUD helps in the provision of psychosocial management services and support for patients. [ABSTRACT FROM AUTHOR]

Background: The Greater Lawndale Healthy Work project is a sequential mixed methods community based participatory research project that examines work as a structural determinant of health and builds community capacity for healthy work in a predominantly Black and Latinx community in Chicago known as Greater Lawndale (GL). Objectives: We interviewed community leaders in GL as key informants to understand the barriers to healthy work and inform intervention development. Methods: We conducted a directed content analysis of transcripts from 20 key informants and coded the social ecology and type of intervention. Results: Every key informant mentioned at least one asset in GL, showing an opportunity to employ a capacity-oriented approach to intervention development. Key informants suggested a variety of interventions to address precarious work across levels of the social ecology, with individual and community level interventions being the most salient. Conclusion: Through this approach, we were able to navigate tensions and challenges in conducting research for community-wide change. Key informant stakeholder interviews can be leveraged to meaningfully inform intervention development and support the development of multi-level, sustainable, and culturally acceptable interventions that advance health equity. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) infection is an important public health concern, with nearly 2,900 cases of HPV-related cancers reported in New York State (NYS) each year. Despite concerted efforts to enhance vaccine uptake in NYS, HPV vaccination rates among 13–15-year-olds failed to meet the 2020 healthy People target, and continue to lag behind the 2030 goal, of 80%. In counties with low immunization levels, understanding factors influencing decision-making among unvaccinated adolescents is crucial. This study aimed to identify barriers, facilitators, and potential interventions to improve HPV vaccine uptake. Qualitative semi-structured interviews were conducted with key informants in 15 NYS counties within the lowest quartile of HPV vaccine coverage among 13-year-old adolescents. Public health representatives, including Immunization Quality Improvement for Providers (IQIP) consultants, vaccine coordinators, medical directors, and primary care providers, were identified through purposive and snowball sampling. Interviews explored vaccination coverage knowledge, barriers and facilitating factors, and recommended strategies for improvement. All conversations were audio-recorded, transcribed, and analyzed using ATLAS.ti. Forty-four interviews were conducted, revealing barriers to HPV vaccination such as limited vaccine knowledge, vaccine misinformation, and accessibility. Key informants asserted barriers could be primarily addressed through education efforts, such increased public awareness, improved parent–doctor conversations, additional provider education on vaccine benefits, and supplementary education in patient spaces. Targeted education efforts and improved provider communication strategies have the potential to bolster HPV vaccination rates in NYS. These findings offer valuable insights for guiding future initiatives in communities facing significant barriers to vaccination.

Background: Population mortality is an important metric that sums information from different public health risk factors into a single indicator of health. However, the impact of COVID-19 on population mortality in low-income and crisis-affected countries like Sudan remains difficult to measure. Using a community-led approach, we estimated excess mortality during the COVID-19 epidemic in two Sudanese communities. Methods: Three sets of key informants in two study locations, identified by community-based research teams, were administered a standardised questionnaire to list all known decedents from January 2017 to February 2021. Based on key variables, we linked the records before analysing the data using a capture-recapture statistical technique that models the overlap among lists to estimate the true number of deaths. Results: We estimated that deaths per day were 5.5 times higher between March 2020 and February 2021 compared to the pre-pandemic period in East Gezira, while in El Obeid City, the rate was 1.6 times higher. Conclusion: This study suggests that using a community-led capture-recapture methodology to measure excess mortality is a feasible approach in Sudan and similar settings. Deploying similar community-led estimation methodologies should be considered wherever crises and weak health infrastructure prevent an accurate and timely real-time understanding of epidemics' mortality impact in real-time. [ABSTRACT FROM AUTHOR]

Identifying and recruiting key informants is a widely used sampling strategy in applied qualitative health research. Key informants were first conceptualized within ethnography, but there is little methodological guidance about how to use this technique outside of that research tradition. The objective of this article is to offer practical suggestions about how existing methods for data collection with key informants could be translated to methodologies commonly used in applied qualitative health research. This article delineates how key informants could be conceptualized and sampled and how data sufficiency can be approached. The article prompts deeper consideration of the politics of representation and epistemic power that are inherent to the use of key informants in applied qualitative health research. [ABSTRACT FROM AUTHOR]

Background: The onset of the COVID-19 pandemic challenged healthcare providers to adapt their models of care and leverage technology to continue to provide necessary care while reducing the likelihood of exposure. One setting that faced a unique set of challenges and opportunities was free and charitable clinics. In response to the emerging pandemic, The North Carolina Association for Free and Charitable Clinics (NCAFCC) offered their 66 member clinics access to a telehealth platform, free of charge. Objective: This paper explores the varied perspectives of leaders in the NCAFCC member clinics regarding the implementation of telehealth services to facilitate continuity of care for patients during the height of the pandemic. Design: This qualitative study is part of a broader research effort to understand and contextualize the experience of implementing and using telehealth services by North Carolina free and charitable clinics during and after the COVID-19 pandemic. The research team conducted 13 key informant interviews and employed thematic analysis and grounded theory to explore critical themes and construct a model based on the CFIR to describe the use of telehealth in free and charitable clinics. Results: Twelve clinic managers and executive directors from free and charitable clinics across the state participated in the key informant interviews providing their unique perspective on the experience of implementing telehealth services in a free and charitable clinic environment during the COVID-19 pandemic. When examined within the lens of the consolidated framework for implementation research (CFIR), 3 key themes emerged from the key informant interviews: mission driven patient centered care, resilience and resourcefulness, and immediate implementation. Conclusions: This study aligns with existing literature regarding telehealth implementation across other safety net provider settings and highlights the key implementation factors, organizational elements, provider perspectives, and patient needs that must collectively be considered when implementing new technologies, especially in a low-resource, high need healthcare setting. The study showcases the implementation climate, resourcefulness, and mission driven approach that allowed many NCAFCC clinics to respond to an emergent situation by adopting and implementing a telehealth platform in a period of 2 weeks or less. [ABSTRACT FROM AUTHOR]

Advance Care Planning (ACP) relates to the process of thinking about, discussing, and potentially documenting future wishes and preferences relating to personal and health matters. Existing literature has explored ACP from the perspective of health care professionals and older people. However, data exploring the broader process of Advance Personal Planning (APP), which also accounts for plans relating to legal and financial matters, are limited. This article reports on an interview study that explored barriers to APP engagement, factors influencing the quality and future use of instruments, and opportunities for improving APP processes for older adults from the perspectives of key informants working in the fields of law, health, and aged care. Data were coded in NVivo and analysed thematically. Opportunities for improvement include education, normalising conversations, integration into usual practice, and reform. Recommendations are made at professional, community, and structural levels, with the aim of improving APP outcomes for all involved. [ABSTRACT FROM AUTHOR]

This study examines stakeholder perceptions of environmental, economic, and social indicators for selecting Polyethylene terephthalate recycling technologies in India, Pakistan, Sri Lanka, and Thailand. An online survey was conducted with 154 stakeholders from these countries. The survey data were analyzed using descriptive and inferential statistical methods. The results showed that global warming potential and total energy demand were the most important environmental indicators across all countries. Capital costs and profits from main recycling businesses were of utmost importance economically. Social indicators such as working environment and job creation opportunities were also deemed significant. However, the study found differences across countries. For instance, water consumption and solid waste generation were more important for Pakistan than for Thailand, while acidification potential and photochemical oxidant formation were more important for Thailand. Moreover, electricity cost was more significant in Sri Lanka, while job creation opportunity was more important in India, Pakistan, and Sri Lanka than in Thailand. The findings of this study can inform decisionmaking processes for policymakers and industry leaders in the plastic recycling field, aiding them in the transition toward a circular economy. [ABSTRACT FROM AUTHOR]

The achievement of higher productivity in various sectors has been influenced by human resources that can provide quality services in order to meet the needs of customers. It is the right moment to adapt to some changes in human resources for the tourism sector. Due to the growth of the tourism industry, this study is intended to determine human resources compliance in selected large tour companies in Arusha, Tanzania. The study employs a qualitative research approach. The saturation point was reached using purposive and simple random sampling techniques. The interviews and focus group discussions (FGDs) were employed for primary data collection from the 8 key informants, representing 8 large tour companies, and 5 FGDs composed of tour guides and administrative staff from similar companies. In content analysis, the obtained data is then analyzed and thematically interpreted. The results revealed various uncomfortable human resource practices and other areas that need the restructuring of the system in place to benefit both employers and employees. Therefore, to make this successful, the study recommends that the government and potential tourism stakeholders advocate tourism development on human resources and the entire working conditions for improving the operations of tour companies.

There are increasing global concerns about women's participation in gambling, and their risk of gambling-related harm. Limited attention has been given to the range of specific and tailored strategies that may be used to prevent and reduce women's risk of gambling-related harm. This study aimed to understand how key informants in Australia conceptualised the risks facing women who gamble, and the range of tailored strategies that could be used to respond. Online focus groups were conducted with n = 15 key informants working in gambling research, policy, prevention, treatment services, and five women with lived experience of gambling harm (as Experts by Experience). A reflexive approach to thematic analysis was used to guide the data interpretation. Gambling harm was recognised as a hidden problem for women. There were a number of knowledge gaps that key informants acknowledged they had about women, with participants suggesting that older rather than younger women were most at risk of experiencing gambling harm. Participants recommended a range of de-normalisation strategies that could specifically target women – including strategies to address the barriers for women attending recreational and social alternatives, co-producing public health messages with women for public education initiatives, and providing anonymous pathways for women to participate in advocacy for gambling reform. [ABSTRACT FROM AUTHOR]

Introduction: Widespread armed conflict has affected Yemen since 2014. To date, the mortality toll of seven years of crisis, and any excess due to the COVID-19 pandemic, are not well quantified. We attempted to estimate population mortality during the pre-pandemic and pandemic periods in nine purposively selected urban and rural communities of southern and central Yemen (Aden and Ta'iz governorates), totalling > 100,000 people. Methods: Within each study site, we collected lists of decedents between January 2014–March 2021 by interviewing different categories of key community informants, including community leaders, imams, healthcare workers, senior citizens and others. After linking records across lists based on key variables, we applied two-, three- or four-list capture-recapture analysis to estimate total death tolls. We also computed death rates by combining these estimates with population denominators, themselves subject to estimation. Results: After interviewing 138 disproportionately (74.6%) male informants, we identified 2445 unique decedents. While informants recalled deaths throughout the study period, reported deaths among children were sparse: we thus restricted analysis to persons aged ≥ 15 years old. We noted a peak in reported deaths during May–July 2020, plausibly coinciding with the first COVID-19 wave. Death rate estimates featured uninformatively large confidence intervals, but appeared elevated compared to the non-crisis baseline, particularly in two sites where a large proportion of deaths were attributed to war injuries. There was no clear-cut evidence of excess mortality during the pandemic period. Conclusions: We found some evidence of a peak in mortality during the early phase of the pandemic, but death rate estimates were otherwise too imprecise to enable strong inference on trends. Estimates suggested substantial mortality elevations from baseline during the crisis period, but are subject to serious potential biases. The study highlighted challenges of data collection in this insecure, politically contested environment. [ABSTRACT FROM AUTHOR]

The achievement of higher productivity in various sectors has been influenced by human resources that can provide quality services in order to meet the needs of customers. It is the right moment to adapt to some changes in human resources for the tourism sector. Due to the growth of the tourism industry, this study is intended to determine human resources compliance in selected large tour companies in Arusha, Tanzania. The study employs a qualitative research approach. The saturation point was reached using purposive and simple random sampling techniques. The interviews and focus group discussions (FGDs) were employed for primary data collection from the 8 key informants, representing 8 large tour companies, and 5 FGDs composed of tour guides and administrative staff from similar companies. In content analysis, the obtained data is then analyzed and thematically interpreted. The results revealed various uncomfortable human resource practices and other areas that need the restructuring of the system in place to benefit both employers and employees. Therefore, to make this successful, the study recommends that the government and potential tourism stakeholders advocate tourism development on human resources and the entire working conditions for improving the operations of tour companies. [ABSTRACT FROM AUTHOR]

When developing a novel conservation assessment, tradeoffs between generality and precision, and between realism and simplicity, will inevitably need to be made. Engaging potential end-users during development can help developers navigate these tradeoffs to maximise uptake. End-user engagement can also produce feedback about external perceptions, allowing changes to be made prior to the final design. Here, we report on end-user consultations about the species recovery assessment method introduced by the International Union for Conservation of Nature (IUCN), which is a new component of the IUCN Red List of Threatened Species. This species recovery assessment was originally called the 'Green List of Species.' We conducted two types of end-user consultation over a two-year period—1) key informant interviews, and 2) technical consultations about the details of the assessment method, including identification of factors that increased the amount of time required to conduct an assessment. A main finding from the key informant interviews was that the name 'Green List of Species' was inappropriate for the assessment, given the potential for misunderstanding the scope of the assessment and potential confusion with the IUCN Green List of Protected and Conserved Areas. We therefore proposed the name 'Green Status of Species', a suggestion accepted by IUCN. A repeated concern in key informant interviews was the perception that the species recovery assessments were complex, indicating a potential tradeoff between scientific rigour and simplicity. To address this concern, we used feedback from the technical consultations to identify assessment steps which were most in need of refinement, and implemented solutions and made recommendations to streamline those steps (e.g., we found that the number of spatial units used in an assessment was positively correlated with assessment time, and increased greatly when more than 15 spatial units were used). This process of end-user engagement makes it much more likely that the Green Status of Species will be used in conservation communication, monitoring, and decision-making—helping achieve the ultimate goal of biodiversity recovery.

Human papillomavirus (HPV) infection is an important public health concern, with nearly 2,900 cases of HPV-related cancers reported in New York State (NYS) each year. Despite concerted efforts to enhance vaccine uptake in NYS, HPV vaccination rates among 13-15-year-olds failed to meet the 2020 healthy People target, and continue to lag behind the 2030 goal, of 80%. In counties with low immunization levels, understanding factors influencing decision-making among unvaccinated adolescents is crucial. This study aimed to identify barriers, facilitators, and potential interventions to improve HPV vaccine uptake. Qualitative semi-structured interviews were conducted with key informants in 15 NYS counties within the lowest quartile of HPV vaccine coverage among 13-year-old adolescents. Public health representatives, including Immunization Quality Improvement for Providers (IQIP) consultants, vaccine coordinators, medical directors, and primary care providers, were identified through purposive and snowball sampling. Interviews explored vaccination coverage knowledge, barriers and facilitating factors, and recommended strategies for improvement. All conversations were audio-recorded, transcribed, and analyzed using ATLAS.ti. Forty-four interviews were conducted, revealing barriers to HPV vaccination such as limited vaccine knowledge, vaccine misinformation, and accessibility. Key informants asserted barriers could be primarily addressed through education efforts, such increased public awareness, improved parent-doctor conversations, additional provider education on vaccine benefits, and supplementary education in patient spaces. Targeted education efforts and improved provider communication strategies have the potential to bolster HPV vaccination rates in NYS. These findings offer valuable insights for guiding future initiatives in communities facing significant barriers to vaccination.

One of the most important reasons for the inefficiency of rural development programs in developing countries such as Iran is the lack of attention to local needs and capabilities, especially in the field of rural economy, and the dictating of the same program for all the villages in the country. The purpose of this study is to provide an exploratory analysis of the economic needs of rural communities based on the views of key informants. The research is applied in terms of purpose and descriptive-analytical in terms of the data collection and analysis. The data were obtained from questionnaires and semi-structured interviews. The statistical population of the study consisted of local agents in Yazd Province including managers and the elite as well as rural households. The data analysis was done in two qualitative and quantitative sections. Content analysis method was used in the qualitative part using the MAXQUDA software, and a t-test and Friedman and W. Kendall test in the quantitative part. Based on the results in the qualitative section, 34 economic needs were identified in the form of 9 indicators. The percentage of the repetition of these indices indicates that the employment index (17.89%) is the most frequent need in the province. The results of the quantitative part of the research also show that the employment index with a statistic of 8.33 and the income index with a statistic of 7.66 are the most important needs of the rural economy in the province, which should be given a priority in development plans.

Banana (Musa sp.) leaf is widely used as a food contact material (FCM) in the Philippine foodservice industry. In spite of its usage in serving and wrapping various raw and cooked foods, the Association of Southeast Asian Nations (ASEAN) general guidelines on FCMs exempted its application to banana leaf (BL) and other natural materials that have not undergone chemical modification. This study documented the knowledge and practices in the utilization of BL in foodservice establishments within the top five local government units (LGUs) in Metropolitan Manila, Philippines. Key informant interviews using a semi-structured questionnaire and participant observation were employed in data collection. Data were analyzed using the constant comparison method. Results showed that despite technological and scientific advancement, the BL has remained a functional FCM in the foodservice industry due to its perceived ethnic, sensory, and environmental impacts. The BL specifications -- including leaf maturity, dimensions, integrity, cleanliness, and varietal source -- are related to its functionalities as FCM. Generally, preparation methods employed by foodservice establishments include wiping, washing, and heating. These methods of preparation were found to be significantly associated with types of food products. The efficacy of these preparation methods needs to be evaluated due to possible leaf contamination and deterioration due to improper handling and storage prior to usage. Furthermore, the foodservice industry identified BL supply, price, and quality issues that should be properly addressed. As an FCM, BL influences final food product quality and safety. Thus, the utilization of BL by other actors within the foodservice supply chain should be further studied to provide baseline information for the establishment of Philippine standards for BL as an FCM. [ABSTRACT FROM AUTHOR]

BackgroundGrowing evidence suggests that maternal prepregnancy weight and gestational weight gain are risk factors for perinatal complications and subsequent maternal and child health. Postpartum weight retention is also associated with adverse birth outcomes and maternal obesity. Clinical guidelines addressing healthy weight before, during, and after pregnancy have been introduced in some countries, but at present a systematic accounting for these policies has not been conducted. The objective of the present study was to conduct a cross-national comparison of maternal weight guidelines.MethodsThis cross sectional survey administered a questionnaire online to key informants with expertise on the subject of maternal weight to assess the presence and content of preconceptional, pregnancy and postpartum maternal weight guidelines, their rationale and availability. We searched 195 countries, identified potential informants in 80 and received surveys representing 66 countries. We estimated the proportion of countries with guidelines by region, income, and formal or informal policy, and described and compared guideline content, including a rubric to assess presence or absence of 4 guidelines: encourage healthy preconceptional weight, antenatal weighing, encourage appropriate gestational gain, and encourage attainment of healthy postpartum weight.ResultsFifty-three countries reported either a formal or informal policy regarding maternal weight. The majority of these policies included guidelines to assess maternal weight at the first prenatal visit (90%), to monitor gestational weight gain during pregnancy (81%), and to provide recommendations to women about healthy gestational weight gain (62%). Guidelines related to preconceptional (42%) and postpartum (13%) weight were less common. Only 8% of countries reported policies that included all 4 fundamental guidelines. Guideline content and rationale varied considerably between countries, and respondents perceived that within their country, policies were not widely known.ConclusionsThese results suggest that maternal weight is a concern throughout the world. However, we found a lack of international consensus on the content of guidelines. Further research is needed to understand which recommendations or interventions work best with respect to maternal weight in different country settings, and how pregnancy weight policies impact clinical practices and health outcomes for the mother and child.

The aim was to explore issues in relation to accessing cancer care for the Australian trans and gender diverse community through key informant interviews to inform a larger study on the topic. Semi-structured interviews were conducted with key informants who either had clinical and/or research experience with trans and gender diverse populations or were members of the community who act as advocates (total n = 14). Participants had diverse genders, including three transwomen, one transman, three non-binary people, six cis woman and one cis man. Thematic analysis was used to analyse the transcripts. Four themes were identified in the data: 'More Important Issues' than Cancer Concern, Experiences of Cancer Care, Barriers to Cancer Care and (Potential) Facilitating Factors to Access Cancer Care. The findings show the inconsistencies in awareness of cancer in the trans and gender diverse population, both within the community itself and in healthcare. There are issues concerning underutilization of screening services, healthcare workers lacking knowledge and an invisibility within organizations and systems. Education is needed in cancer care, as are partnerships with community organizations, inclusive policies, improved data collection on gender, targeted health promotion and research. [ABSTRACT FROM AUTHOR]

When developing a novel conservation assessment, tradeoffs between generality and precision, and between realism and simplicity, will inevitably need to be made. Engaging potential end-users during development can help developers navigate these tradeoffs to maximise uptake. End-user engagement can also produce feedback about external perceptions, allowing changes to be made prior to the final design. Here, we report on end-user consultations about the species recovery assessment method introduced by the International Union for Conservation of Nature (IUCN), which is a new component of the IUCN Red List of Threatened Species. This species recovery assessment was originally called the 'Green List of Species.' We conducted two types of end-user consultation over a two-year period—1) key informant interviews, and 2) technical consultations about the details of the assessment method, including identification of factors that increased the amount of time required to conduct an assessment. A main finding from the key informant interviews was that the name 'Green List of Species' was inappropriate for the assessment, given the potential for misunderstanding the scope of the assessment and potential confusion with the IUCN Green List of Protected and Conserved Areas. We therefore proposed the name 'Green Status of Species', a suggestion accepted by IUCN. A repeated concern in key informant interviews was the perception that the species recovery assessments were complex, indicating a potential tradeoff between scientific rigour and simplicity. To address this concern, we used feedback from the technical consultations to identify assessment steps which were most in need of refinement, and implemented solutions and made recommendations to streamline those steps (e.g., we found that the number of spatial units used in an assessment was positively correlated with assessment time, and increased greatly when more than 15 spatial units were used). This process of end-user engagement makes it much more likely that the Green Status of Species will be used in conservation communication, monitoring, and decision-making—helping achieve the ultimate goal of biodiversity recovery. [ABSTRACT FROM AUTHOR]

In this paper, we address the assessment of community readiness (CR) for the prevention of child maltreatment in the context of a community survey. A mail survey was administered to 222 service providers and 54 supervisors and managers from 35 different organizations serving children and their families in four Canadian communities. Eleven items from the short version of the Readiness Assessment for the Prevention of Child Maltreatment (RAP-CM) were used, in combination with questions assessing knowledge of family support programs offered in the community and a measure of inter-agency collaboration. Findings show that a consistent and valid indicator of "Lack of knowledge of the environment" can be derived from the RAP-CM items and used for screening key informants. Overall, CR appears mixed in the communities studied, the weakest dimensions of which are the will to address the problem and the dynamism of informal social resources. Leadership emerges as a major gap that needs to be addressed. [ABSTRACT FROM AUTHOR]

To assess the readiness to implement child maltreatment (CM) prevention programs at a national level. This is a cross-sectional study. This study was completed alongside similar studies undertaken by the rest of the Gulf Cooperation Council (GCC) countries and led by Kingdom of Saudi Arabia (KSA). The study will allow further understanding of possible obstacles that may be encountered while implementing a nationwide prevention program. The 10-dimensional model of readiness had been developed by the World Health Organization (WHO) in collaboration with five countries (Brazil, The Former Yugoslav Republic of Macedonia, Malaysia, Saudi Arabia, and South Africa) through a five-stage process. Stakeholders and decision makers were invited to participate. Scores for each dimension were compared with those for the rest of the GCC countries. The overall score of Kuwait was 39.17 out of 100. This was below the mean average score for the GCC countries (47.83). Out of the 10 dimensions, key informants scored the highest on legislation, mandates and policies (6.61). The lowest score was reported on attitudes towards CM prevention (1.94). Informal social resources (5.72) ranked the highest as compared to the rest of the GCC countries. The readiness of Kuwait is weak on several dimensions and needs to be strengthened. Despite that, the country is moderately ready to implement large-scale evidence-based CM prevention programs because it is strong in the infrastructure of knowledge, legislation, mandates, and policies and informal social resources. • The overall score of the 10 dimensions was 39.17. • The highest score was reported on legislation, mandates, and policies. • The lowest score was reported on attitudes towards child maltreatment prevention. [ABSTRACT FROM AUTHOR]

Purpose: The Key Informant (KI) case finding method, which trains community members to screen children for eye problems and refer them to eye services, is a common strategy to identify and refer children with blindness and visual impairment. However, studies to date have not determined the benefit and cost of adding KIs to routine outreach activities. Methods: Four eye programs in Madagascar with established outreach camps added KIs to a portion of their camps distributed equally throughout their service region over a one year period. KIs recorded children screened and their attendance at an outreach camp. Outreach personnel used standardized registration forms to gather age, sex, visual acuity, diagnosis and treatment data. Costs were gathered for the KI program and outreach camps. Results: In one year, the 4 eye programs held 138 outreach camps, 43 with KIs. The KI camps were more productive than regular camps seeing an average of 61 and 24 children and 50 and 19 children with an eye problem, for KI and regular camps, respectively. The KI camps also saw more children with moderate or severe visual impairment or blindness with 21 and 8 children (per 10 camps) for KI and regular camps, respectively. A KI camp cost $463 ($642 vs. $179) more than a regular camp and $3 ($8 vs. $11) more per child seen. Conclusion: The KI method significantly increased the number of children attending outreach camps, at all levels of visual impairment and blindness, at a modest increase in costs. [ABSTRACT FROM AUTHOR]

Abstract Background Many young women experiment with using indoor tanning beds with some becoming regular users. There is a dearth of research focused on factors related to the development of regular tanning. This study was designed to gain an in-depth understanding of the experiences of a regular indoor tanning bed user for the purpose of discovering working hypotheses related to the development of this behavior. The article thesis is that initial interactions with tanning salon employees transmit insider knowledge that serves to encourage the regular use of indoor tanning beyond experimentation. Methods We used Spradley’s ethnographic interviewing technique to conduct six iterative interviews with a key informant who was an active indoor tanning bed user and former salon employee. The research was completed in the United States in 2015. Results The informant described her experiences as a salon employee including her interactions with salon patrons. The informant was trained as a salon employee to talk about tanning as a complex process that requires multiple salon visits to achieve desired results and to develop rapport with salon patrons to be viewed as an important source of guidance and advice. In the informant’s experience, indoor tanning users who viewed tanning as a complex process and felt connected to salon employees were more receptive to purchasing larger amounts of bulk tanning sessions and committing to purchasing salon memberships. Conclusions Findings provide insights into our understanding of the development of regular tanning behavior and we propose working hypotheses about this behavior to be examined in future research. There are also implications for policy makers to reduce excessive tanning behaviors including considering point-of-sale regulations that limit sales techniques of salon employees and pricing restrictions.

This article is primarily based on field research and interview, which are the main sources of data. I carried out this field research between 2009 and 2012 in the West Bank. This fieldwork was split into three stages (in 2009, 2010 and 2012). The method of participant observation and interviewing has a wide range of supporters as well as opponents among members of the scientific community. Participant observation and interviewing as basic anthropological research methods are often criticized for the subjective and ambiguous “microcosmic” perspective from which the surveyedproblemsareapproached.Nevertheless,theseare still important methods of data collection used in anthropology, and so the controversy about their use in practice is very important. Participant observation was the basic method that I applied in my field research. Since I spent a lot of time with my informants, I won their trust, which is necessary for the successful use of this method. I participated in routine communication between members of a household, but I could watch the little quarrels, debates, disputes, etc. Thanks to the method of participant observation, I was able to discover the inner world of the surveyed communities. Which obstacles are encountered in practice in my field research, and how can participant observation and interviewing be of use in practice? This is the fundamental question I try to answer in this article.

Substance use and addiction constitute a prominent factor contributing to families becoming engaged in the child welfare system. Nine key informants, four supervisors and five front line staff, from five different child welfare organizations across Ontario, Canada provided insights into the training they have received during their careers and what additional training they would value to enhance their ability to deal with this issue. The importance of this was highlighted as the majority of service users on participants' caseloads were reported to have addiction issues. Study participants also reported that the training they had received from their organizations did not fully prepare them to work with this issue that was so prominent in their clients' lives. All nine key informants indicated that they required additional training and education to better meet the primary mandate of child welfare: to keep children safe. [ABSTRACT FROM AUTHOR]

Purpose: To report the prevalence and causes of functional low vision (FLV) in school-age children in Coimbatore District, Tamil Nadu, India and to report our experience using the key informant (KI) method in this setting. Methods: Children suspected of having low vision were identified by KIs or Aravind Eye Hospital personnel in Coimbatore District. All identified children underwent a cycloplegic refraction and full eye exam. A primary cause of decreased vision was determined for each child. The prevalence of FLV was calculated for children 6-14 years old. Spectacles and low vision devices were provided free of charge. Results: 345 children aged 6-14 years were referred and 231 had FLV. The positive-predictive value of KI referrals was 64.5%. The prevalence of FLV was 0.071% (7.1 per 10,000; 95% CI 0.062-0.080%) and ranged from 0.026% to 0.141% across the district’s blocks. Older children (age 11-14 years; OR 1.41; 95% CI 1.09-1.82) and males (OR 1.52; 95% CI 1.16-1.98) had greater odds of being diagnosed with FLV. The most common causes of FLV were retinal disorders (30.0%) and amblyopia (25.5%). Low vision devices were provided to 169 children who had a mean near and distance visual acuity improvement of 0.31 and 0.63 logMAR, respectively (p < 0.001). Conclusions: This study reports a moderate prevalence of FLV and demonstrates the ability of KIs to identify school-age children with FLV in South India. The provision of basic low vision services can improve visual outcomes in this population. [ABSTRACT FROM AUTHOR]

Cet article vise à explorer plus avant une certaine façon de pratiquer l’ethnographie, que j’ai développée au cours des deux dernières décennies. Elle consiste, sur la base du principe de commune humanité, à créer des relations de longue durée avec le public enquêté, en l’occurrence des « SDF ». Ceci ne va sans soulever certaines contradictions, voire tensions, dès lors que la recherche suppose aussi un principe d’efficacité. J’ai ainsi été conduit à mettre en œuvre des usages qui peuvent prêter à polémique, dont une certaine dose de secret dans le prélèvement des données. Dans la première partie du texte, je critique notamment la centralité de l’observation et le recours aux entretiens classiques dans la pratique voire la représentation de l’ethnographie, dans des termes généralisables à différents terrains ; dans la seconde partie, je reviens en détail sur ma pratique pour mieux faire valoir ma conception de l’éthique, laquelle s’inscrit dans mon engagement plus global au service du changement social en faveur des (sous)-prolétaires. [ABSTRACT FROM AUTHOR]

Background The use of smokeless tobacco (SLT) is very common in India and leads to well established adverse health effects, particularly oral cancers. Aim To understand the perceptions of SLT users and health care providers regarding the prevalence of SLT in the community, awareness about its adverse effects and challenges for cessation Methods Key Informant (KI) interviews with SLT users; Focus group discussions (FGDs) with female and male tobacco users and health care providers Results KI perceptions among users and service providers were more or less similar regarding the extent of SLT use in the community. There was inadequate knowledge of the harm from SLT use, both among SLT users and health care providers. FGD’s revealed high positive expectancies from SLT use and low risk perception. Shift from one to the other form of tobacco and a very early age of initiation, particularly among women, was observed. There was a low demand for assistance to quit. Conclusions SLT cessation efforts in the country must take cognizance of user perspectives and focus on strategies for demand reduction in all populations, including adolescents. Health care providers need to be trained in SLT cessation. [ABSTRACT FROM AUTHOR]

Survey research is appropriate and necessary to address certain types of research questions. In this paper, we acknowledge the ongoing debate about survey research and focus specifically on examining the conditions under which a study might validly utilize data provided by a single respondent. To this end, we summarize the main challenges that survey research in supply chain management faces when dealing with single respondents and later argue that having multiple respondents does not necessarily represent a cure-all solution. Next, we discuss the concept of alignment in survey research and explore the characteristics of research questions that can be addressed through single key informants. We conclude the paper by suggesting that researchers should carefully consider the appropriateness of single key informants in light of the type of research question and also clearly support such choice when describing the method adopted. [ABSTRACT FROM AUTHOR]

Purpose: An estimated 19 million children are visually impaired; of these, 1.4 million are irreversibly blind. A key challenge is to identify them early in life to benefit maximally from visual rehabilitation, and/or treatment. This aggregative review and structured literature analysis summarizes evidence of what it is about the key informant (KI) approach that works to identify children with blindness or severe visual impairment (B/SVI) in the community (for whom, to what extent, in what circumstances, in what respect, how and why). Methods: Peer-reviewed (PubMed, hand search) and grey literature (Google, World Health Organization website, academic theses, direct requests) were included, and methods and criteria used for identification, productivity (number of children referred per KI), accuracy of referrals (positive predictive value, PPV), age of children with B/SVI, KI definition, sex, information about cost and comparisons aggregated. Results: We included 31 documents describing 22 unique KI programs. Mostly KIs identified children with B/SVI in 1–3 weeks, i.e. “campaign mode.” In 60%, KIs were community volunteers, others formal health sector workers (FHSW). Around 0.02–1.56 children per KI (median = 0.25) were successfully recruited. PPV ranged from 12 to 66%. In two studies comparing FHSWs and community KIs, the latter were 8 and 10 times more productive. Conclusion: KIs working in campaign mode may provide an effective approach to identifying children with B/SVI in communities. Including identification of ocular problems and/or other impairments has been recommended. Research on factors that influence effectiveness and on whether KIs continue to contribute could inform programs. [ABSTRACT FROM AUTHOR]

The effectiveness of eye care service delivery is often dependant on how the different stakeholders are aligned. These stakeholders range from the ministries of health who have the capacity to grant government subsidies for eye care, down to the primary healthcare workers who can be enrolled to screen for basic eye diseases. Advocacy is a tool that can help service providers draw the attention of key stakeholders to a particular area of concern. By enlisting the support, endorsement and participation of a wider circle of players, advocacy can help to improve the penetration and effectiveness of the services provided. There are several factors in the external environmental that influence the eye care services - such as the availability of trained manpower, supply of eye care consumables, government rules and regulations. There are several instances where successful advocacy has helped to create an enabling environment for eye care service delivery. Providing eye care services in developing countries requires the support - either for direct patient care or for support services such as producing trained manpower or for research and dissemination. Such support, in the form of financial or other resources, can be garnered through advocacy.

The objective of this review is to discuss the available data on the prevalence and causes of global blindness, and some of the associated trends and limitations seen. A literature search was conducted using the terms "global AND blindness" and "global AND vision AND impairment", resulting in seven appropriate articles for this review. Since 1990 the estimate of global prevalence of blindness has gradually decreased when considering the best corrected visual acuity definition: 0.71% in 1990, 0.59% in 2002, and 0.55% in 2010, corresponding to a 0.73% reduction per year over the 2002-2010 period. Significant limitations were found in the comparability between the global estimates in prevalence or causes of blindness or visual impairment. These limitations arise from various factors such as uncertainties about the true cause of the impairment, the use of different definitions and methods, and the absence of data from a number of geographical areas, leading to various extrapolation methods, which in turn seriously limit comparability. Seminal to this discussion on limitations in the comparability of studies and data, is that blindness has historically been defined using best corrected visual acuity.

Two-thirds of the world′s population with low vision resides in the Asia-Pacific region. Provision of comprehensive low vision services is important to improve vision-related quality of life (QoL) for people with this condition. This review outlines the critical issues and challenges facing the provision of low vision services in the Asia-Pacific region. The review offers possible strategies to tackle these issues and challenges facing service providers and policy makers in lieu of Vision 2020 strategies in this area. Pertinent findings from the global survey of low vision services and extensive ground work conducted in the region are used; in addition, a discussion on the availability of services, human resources and training, and funding and the future sustainability of low vision care will be covered. In summary, current issues and challenges facing the region are the lack of specific evidence-based data, access, appropriate equipment and facilities, human resources, funding, and sustainability. These issues are inextricably interlinked and thus cannot be addressed in isolation. The solutions proposed cover all areas of the VISION 2020 strategy that include service delivery, human resources, infrastructure and equipment, advocacy and partnership; and include provision of comprehensive care via vertical and horizontal integration; strengthening primary level care in the community; providing formal and informal training to enable task shifting and capacity building; and promoting strong government and private sector partnership to achieve long-term service financial sustainability.

Objective: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries. Materials and Methods: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations. Results: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available. Conclusions: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.

Corneal diseases represent the second leading cause of blindness in most developing world countries. Worldwide, major investments in public health infrastructure and primary eye care services have built a strong foundation for preventing future corneal blindness. However, there are an estimated 4.9 million bilaterally corneal blind persons worldwide who could potentially have their sight restored through corneal transplantation. Traditionally, barriers to increased corneal transplantation have been daunting, with limited tissue availability and lack of trained corneal surgeons making widespread keratoplasty services cost prohibitive and logistically unfeasible. The ascendancy of cataract surgical rates and more robust eye care infrastructure of several Asian and African countries now provide a solid base from which to dramatically expand corneal transplantation rates. India emerges as a clear global priority as it has the world′s largest corneal blind population and strong infrastructural readiness to rapidly scale its keratoplasty numbers. Technological modernization of the eye bank infrastructure must follow suit. Two key factors are the development of professional eye bank managers and the establishment of Hospital Cornea Recovery Programs. Recent adaptation of these modern eye banking models in India have led to corresponding high growth rates in the procurement of transplantable tissues, improved utilization rates, operating efficiency realization, and increased financial sustainability. The widespread adaptation of lamellar keratoplasty techniques also holds promise to improve corneal transplant success rates. The global ophthalmic community is now poised to scale up widespread access to corneal transplantation to meet the needs of the millions who are currently blind.

State and nonstate health programs in developing countries are often influenced by priorities that are defined in the Millennium Development Goals (MDGs). In the wake of recessionary pressures, policy makers in the health sector are often seen to divert significant budgets to some specific health programs and make only token allocations for other health problems that are important but do not fall under the traditional MDG box of health priorities. This paper illustrates the economic argument for investment in one such program: The eye health program and employs a country case study of Pakistan to demonstrate that there are significant economic gains that are being foregone by not addressing the needs of the blind in poverty reduction strategies. By applying appropriate growth and discounting factors and using the average wage rate, the paper estimates the total productivity gains that are realizable over a period of 10 years if the blind population in Pakistan is rehabilitated and their carers released to participate in the mainstream economic activity. Our findings indicate that significant productivity gains accumulated over 10 years, range from Rs. 61 billion (US$ 709 million) to Rs. 421 billion (US$ 4.9 billion) depending upon whether the entire blind population or only those affected by a specific cause are rehabilitated. The per annum productivity gains of rehabilitating the entire blind population represents 0.74% of the current gross domestic product of Pakistan, which is higher than the total public spending on health. In order to reap these benefits, the subsequent absorption of the rehabilitated blind and their carers into mainstream economic activity is as important as their effective rehabilitation.

Since the year 2000, the amount written about the economics of blindness and visual impairment has increased substantially. In some cases, the studies listed under this heading are calculations of the costs related to vision impairment and blindness at a national or global level; in other cases the studies examine the cost-effectiveness of strategies to prevent or modify visual impairment or blindness that are intended to be applied as a guide to treatment recommendations and coverage decisions. In each case the references are just examples of many that could be cited. These important studies have helped advocates, policy makers, practitioners, educators, and others interested in eye and vision health to understand the magnitude of the impact that visual impairment and blindness have on the world, regions, nations, and individuals and the tradeoffs that need to be made to limit the impact. However, these studies only begin to tap into the insights that economic logic might offer to those interested in this field. This paper presents multiple case studies that demonstrate that the economics of blindness and visual impairment encompasses much more than simply measures of the burden of the condition. Case studies demonstrating the usefulness of economic insight include analysis of the prevention of conditions that lead to impairment, decisions about refractive error and presbyopia, decisions about disease and injury treatment, decisions about behavior among those with uncorrectable impairment, and decisions about how to regulate the market all have important economic inputs.

Global estimates indicate that more than 2.3 billion people in the world suffer from poor vision due to refractive error; of which 670 million people are considered visually impaired because they do not have access to corrective treatment. Refractive errors, if uncorrected, results in an impaired quality of life for millions of people worldwide, irrespective of their age, sex and ethnicity. Over the past decade, a series of studies using a survey methodology, referred to as Refractive Error Study in Children (RESC), were performed in populations with different ethnic origins and cultural settings. These studies confirmed that the prevalence of uncorrected refractive errors is considerably high for children in low-and-middle-income countries. Furthermore, uncorrected refractive error has been noted to have extensive social and economic impacts, such as limiting educational and employment opportunities of economically active persons, healthy individuals and communities. The key public health challenges presented by uncorrected refractive errors, the leading cause of vision impairment across the world, require urgent attention. To address these issues, it is critical to focus on the development of human resources and sustainable methods of service delivery. This paper discusses three core pillars to addressing the challenges posed by uncorrected refractive errors: Human Resource (HR) Development, Service Development and Social Entrepreneurship.

Background: In the final push toward the elimination of avoidable blindness, cataract occupies a position of eminence for the success of the Right to Sight initiative. Aims: Review existing situation and assess what monitoring indicators may be useful to chart progress towards attaining the goals of Vision 2020. Settings and Design: Review of published papers from low and middle income countries since 2000. Materials and Methods: Published population-based data on prevalence of cataract blindness/visual impairment were accessed and prevalence of cataract blindness/visual impairment computed, where not reported. Data on prevalence of cataract blindness, cataract surgical coverage at different visual acuity cut offs, surgical outcomes, and prevalence of cataract surgery were analyzed. Scatter plots were used to look at relationships of some variables, with Human Development Index (HDI) rank. Available data on Cataract Surgical Rate (CSR) was plotted against prevalence of cataract surgery reported from surveys. Results: Worse HDI Ranks were associated with higher prevalence of cataract blindness. Most studies showed that a significant proportion of the blind were covered by surgery, while a fifth showed that a significant proportion, were operated before they went blind. A good visual outcome after surgery was positively correlated with higher surgical coverage. CSR was positively correlated with cataract surgical coverage. Conclusions: Cataract surgical coverage is increasing in most countries at vision

In the first 12 years of VISION 2020 sound programmatic approaches have been developed that are capable of delivering equitable eye health services to even the most remote and impoverished communities. A body of evidence around the economic arguments for investment in eye health has been developed that has fuelled successful advocacy work resulting in supportive high level policy statements. More than a 100 national plans to achieve the elimination of avoidable blindness have been developed and some notable contributions made from the corporate and government sectors to resource eye health programs. Good progress has been made to control infectious blinding diseases and at the very least there is anecdotal evidence to suggest that the global increase in the prevalence of blindness and visual impairment has been reversed in recent years, despite the ever increasing and more elderly global population. However if we are to achieve the goal of VISION 2020 we require a considerable scaling up of current efforts-this will depend on our future success in two key areas: i) Successful advocacy and engagement at individual country level to secure significantly enhanced national government commitment to financing their own VISION 2020 plans.ii) A new approach to VISION 2020 thinking that integrates eye health into health system development and develops new partnerships with wider health development initiatives.

Reliable information is required for the planning and management of eye care services. While classical research methods provide reliable estimates, they are prohibitively expensive and resource intensive. Rapid assessment (RA) methods are indispensable tools in situations where data are needed quickly and where time- or cost-related factors prohibit the use of classical epidemiological surveys. These methods have been developed and field tested, and can be applied across almost the entire gamut of health care. The 1990s witnessed the emergence of RA methods in eye care for cataract, onchocerciasis, and trachoma and, more recently, the main causes of avoidable blindness and visual impairment. The important features of RA methods include the use of local resources, simplified sampling methodology, and a simple examination protocol/data collection method that can be performed by locally available personnel. The analysis is quick and easy to interpret. The entire process is inexpensive, so the survey may be repeated once every 5-10 years to assess the changing trends in disease burden. RA survey methods are typically linked with an intervention. This article provides an overview of the RA methods commonly used in eye care, and emphasizes the selection of appropriate methods based on the local need and context.

India has a proud tradition of blindness prevention, being the first country in the world to implement a blindness control programme which focused on a model to address blinding eye disease. However, with 133 million people blind or vision impaired due to the lack of an eye examination and provision of an appropriate pair of spectacles, it is imperative to establish a cadre of eye care professionals to work in conjunction with ophthalmologists to deliver comprehensive eye care. The integration of highly educated four year trained optometrists into primary health services is a practical means of correcting refractive error and detecting ocular disease, enabling co-managed care between ophthalmologists and optometrists. At present, the training of optometrists varies from two year trained ophthalmic assistants/optometrists or refractionists to four year degree trained optometrists. The profession of optometry in India is not regulated, integrated into the health care system or recognised by the majority of people in India as provider of comprehensive eye care services. In the last two years, the profession of optometry in India is beginning to take the necessary steps to gain recognition and regulation to become an independent primary health care profession. The formation of the Indian Optometry Federation as the single peak body of optometry in India and the soon to be established Optometry Council of India are key organisations working towards the development and regulation of optometry.

Since the launching of Global Initiative, VISION 2020 "the Right to Sight" many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.

In September 2000, world leaders made a commitment to build a more equitable, prosperous and safer world by 2015 and launched the Millennium Development Goals (MDGs). In the previous year, the World Health Organization and the International Agency for the Prevention of Blindness in partnership launched the global initiative to eliminate avoidable blindness by the year 2020-VISION 2020 the Right to Sight. It has focused on the prevention of a disability-blindness and recognized a health issue-sight as a human right. Both global initiatives have made considerable progress with synergy especially on MDG 1-the reduction of poverty and the reduction in numbers of the blind. A review of the MDGs has identified the need to address disparities within and between countries, quality, and disability. Noncommunicable diseases are emerging as a challenge to the MDGs and Vision 2020:0 the Right to Sight. For the future, up to and beyond 2015, there will be need for both initiatives to continue to work in synergy to address present and emerging challenges.

Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world′s health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.

Health inequities are related to social determinants based on gender, socioeconomic status, ethnicity, race, living in a specific geographic region, or having a specific health condition. Such inequities were reviewed for blindness and visual impairment by searching for studies on the subject in PubMed from 2000 to 2011 in the English and Spanish languages. The goal of this article is to provide a current review in understanding how inequities based specifically on the aforementioned social determinants on health influence the prevalence of visual impairment and blindness. With regards to gender inequality, women have a higher prevalence of visual impairment and blindness, which cannot be only reasoned based on age or access to service. Socioeconomic status measured as higher income, higher educational status, or non-manual occupational social class was inversely associated with prevalence of blindness or visual impairment. Ethnicity and race were associated with visual impairment and blindness, although there is general confusion over this socioeconomic position determinant. Geographic inequalities and visual impairment were related to income (of the region, nation or continent), living in a rural area, and an association with socioeconomic and political context was suggested. While inequalities related to blindness and visual impairment have rarely been specifically addressed in research, there is still evidence of the association of social determinants and prevalence of blindness and visual impairment. Additional research should be done on the associations with intermediary determinants and socioeconomic and political context.

Blindness is a major global public health problem and recent estimates from World Health Organization (WHO) showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS) provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP). It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI) developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion) in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.

The major causes of blindness in children encompass intrauterine and acquired infectious diseases, teratogens and developmental and molecular genetics, nutritional factors, the consequences of preterm birth, and tumors. A multidisciplinary approach is therefore needed. In terms of the major avoidable causes (i.e., those that can be prevented or treated) the available evidence shows that these vary in importance from country to country, as well as over time. This is because the underlying causes closely reflect socioeconomic development and the social determinants of health, as well as the provision of preventive and therapeutic programs and services from the community through to tertiary levels of care. The control of blindness in children therefore requires not only strategies that reflect the local epidemiology and the needs and priorities of communities, but also a well functioning, accessible health system which operates within an enabling and conducive policy environment. In this article we use cataract in children as an example and make the case for health financing systems that do not lead to ′catastrophic health expenditure′ for affected families, and the integration of eye health for children into those elements of the health system that work closely with mothers and their children.