More than eight million people suffer with trichiasis due to trachoma globally, but less than 160,000 receive surgery per year even though “S” is a key aspect of the elimination of blindness due to trachoma as part of the WHO “SAFE” approach. In order to meet the shortfall, general nurses have been trained to perform this surgery in a term known as task shifting. This study sought to determine the productivity and attrition of such general nurses trained in trachomatous trichiasis surgery in three East African countries. The team took the approach of a three year cohort study of trichiasis surgeons. The response rate by the surgeons to the questionnaire was good: 86%. Only 16.1% of the 222 surgeons performed more than 50 such operations per year. Twenty-eight percent had left their area and no longer performed the surgery over three years – a high attrition rate. The authors found that having been trained by an experienced trainer, being supervised and having an outreach programme with more than three surgical sets were all associated with high productivity and low attrition. The authors concluded that overall productivity was too low and attrition too high to warrant training of general nurses for trachomatous trichiasis surgery. Instead they suggest that a different approach must be sought to address the surgical need presented by trachoma and suggest that this might include a complete plan for provision of surgery. This might include multiple surgical packs, outreach programmes, continuous support, supervision and training. There remains currently, a large and unmet need for the WHO to achieve its 2020 goals of elimination of blindness due to trachoma.

Task shifting for eye care in Eastern Africa: general nurses as trichiasis surgeons in Kenya, Malawi and Tanzania.
Gichangi M, Kalua K, Barassa E et al.
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Jonathan CP Roos

Harvard, Cambridge & Moorfields-trained Consultant Oculoplastic Surgeon and academic based in London at Publishes in the world’s leading medical journals and lectures internationally on aesthetics, eyelid diseases and thyroid eyes.

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