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Developing countries often cite shortage of human resource, limited accessibility, low affordability, and asymmetric availability of health care resources as the provider end barriers to health care service utilization. Using the example of a market research project undertaken to establish an advanced surgical eye hospital in the Indian state of Uttar Pradesh, a decision-grid is constructed whereby health care providers’ can make informed decisions regarding expansion and service delivery. The comparative and interpretive logic-based approach utilizes public domain data coupled with field research and is apt for those working in developing countries and/or resource-crunch settings. The paradigms laid out and discussed, provide building blocks for decision-making, which if harnessed effectively, have broad applicability in terms of reaching the previously unreached and ultimately in improving health outcomes.

Background A vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community’s vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care. Objective Our organization is planning an awareness-cum-engagement intervention—door-to-door basic eye checkup and visual acuity screening in VCs coverage areas—to connect with the community and improve the rational use of VCs. Methods In this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ≤10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed. Results Background work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress. Conclusions Through this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability. Trial Registration ClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718 International Registered Report Identifier (IRRID) DERR1-10.2196/31951

ObjectivesTo assess COVID-19-related awareness and knowledge among truck drivers across India and report prevention practices followed, and challenges faced, by them during the COVID-19 lockdown.DesignCross-sectional study.SettingDelhi, Kanpur, Kolkata and Bangalore from July to September 2020.ParticipantsData were collected in Hindi using a structured questionnaire via telephonic interviews. Minimum 200 drivers were included from each location.Outcome measuresSociodemographic profile, awareness regarding COVID-19, knowledge regarding infection sources, disease spread and vulnerable populations, prevention practices followed and challenges faced. Information sources were also assessed.ResultsFisher’s exact test and Analysis of variance (ANOVA) test were used to check for significant differences across proportions. P value less than 0.05 was considered significant. Overall, 1246 drivers were included, with 72% response rate. Of 1246 drivers, 65% were 30–50 years of age. A majority correctly answered knowledge questions regarding communicability (95%) and fatality (66%). Fifty per cent drivers were aware of treatability of the disease, while only 43% and 24% correctly reported all signs and symptoms and routes of transmission, respectively. No driver was aware of all high-risk populations. Overall Knowledge Score is significantly associated with region. Mobile phones were the primary source of information across all regions. Over two-third drivers follow all prevention practices regularly, which differed significantly across regions. Following standard prevention practices was positively correlated with higher knowledge scores and was significantly correlated with mask use. Worry about the disease was common. Less than 40% drivers received full payment for work during this period, while 25% drivers were unable to return home due to the pandemic. Seven per cent and 26% drivers had either limited or no access to food and health services, respectively.ConclusionsAwareness activities and employer provisioned social security/health insurance might safeguard this vulnerable population till the pandemic fully abates as well as in similar situations in the future.

Aims: This study analyzes the prevalence and types of refractive errors among truck drivers, as well as their uptake of glasses. Subjects and Methods: Retrospective cross-sectional study of data collected between July 2017 and June 2018, through eye camps held across the national capital region. An optometrist conducted a comprehensive eye examination. Refractive error was defined as myopia (spherical equivalent of at least −0.5 diopter [D]), hyperopia (spherical equivalent of at least +0.5 D), or astigmatism (only cylinder of 0.5 D or more). Drivers requiring spectacles to read at a normal distance (35–40 cm) were categorized as having presbyopia. Those needing both distance and near vision correction were analyzed separately. Statistical Analysis: Data were analyzed for the prevalence of refractive errors and its types. Spectacles uptake and its association with age categories, number of affected eyes, type and severity of refractive errors were analyzed. Statistical analysis was carried out using R software version 3.1.1 and Excel 2013. Results: Refractive error (including presbyopia) was over 26% in the 4059 truck drivers screened. 8.8% needed distance correction, 24.3% needed near correction and 6.6% needed both, at least in one eye. Uptake was only 47% among those prescribed glasses and was higher among drivers requiring only near correction. Conclusions: Our study highlights the importance of eye examination among truckers. There is a need to increase the uptake of spectacles by increasing awareness and developing better models of spectacle delivery.