Spectrum and burden of ophthalmic disease at Rob Ferreira Hospital, Mpumalanga

Abstract

Purpose: The burden of eye disease in rural areas in South Africa has not been well documented. Mpumalanga is one of the rural provinces in South Africa, accounting for 7,8% of the population of the country. There are studies in South Africa that focus on particular ophthalmic diseases (e.g. cataract, glaucoma) or particular aspects of eye diseases (e.g. vision-threatening) but none thus far have provided a glimpse into the full spectrum of disease. Rob Ferreira Hospital is one of three public hospitals in Mpumalanga that provide ophthalmology services. In order to optimise care offered to this rural community, the spectrum and burden of disease needs to be understood. The purpose of this study was to assess, firstly, the burden of patients with ophthalmic disease who present to the Rob Ferreira Hospital and secondly, to identify deficiencies in the system with regard to the availability of staff, as well as the diagnostic and interventional equipment available to treat these patients. Method and materials: A retrospective, cross-sectional, descriptive study of all patients attending the Rob Ferreira ophthalmology outpatient clinic between 1 January 2012 and 31 December 2012 was conducted. Patient files were accessed to retrieve the following information: age, sex, race, comorbidities and diagnosis or diagnoses. An audit of staff as well as diagnostic and interventional equipment available at the clinic was conducted during the same time period. Results: There were 2493 patients seen between January and December 2012 at the Rob Ferreira ophthalmology outpatient clinic. Of the 2493 patient files that were searched for, 2142 were found, representing a capture rate of 85.9%. The majority of patients seen at the eye department were black African (89,3%), followed by Whites (9,1%), Indians (0,89%) and Coloureds (0,61%). Male patients made up 53.2% of the patients seen. The mean age of patients was 45,69 years. Cataracts, ocular trauma, glaucoma and diabetic retinopathy were the most

common eye problems seen at the hospital. Twenty five percent of patients who presented with cataracts had mature cataracts. Twenty percent of patients diagnosed with glaucoma were classified as advanced or end-stage disease. Ocular trauma was diagnosed in 317 patients presenting to the eye clinic. There is only 1 ophthalmologist to serve a minimum of 1,7 million people which is well below the norm for the country as well as internationally. There is also a shortage of essential equipment crucial for the correct diagnosis and management of ophthalmic patients. Conclusion: This retrospective audit provides some insights into the burden of disease at a tertiary hospital in one of the rural provinces in South Africa. Cataracts, ocular trauma, glaucoma and diabetic retinopathy were the most common eye problems seen at the hospital. A large proportion of patients present with advanced eye disease to the hospital. There is a shortage of staff and lack of equipment that would enable adequate running of the department. Certain essential services such as vitreoretinal surgery are not offered by the hospital due to the shortage of crucial diagnostic and interventional equipment.