Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A randomised controlled trial to investigate effects of enhanced supervision on primary eye care services at health centres in Kenya, Malawi and Tanzania
BMC Health Services Research, Volume 14, No. SUPPL.1, Article S6, Year 2014
Notification
URL copied to clipboard!
Description
Background: Knowledge and skills of primary health care workers (PHCWs) in primary eye care have been demonstrated to be inadequate in several districts of Kenya, Malawi, and Tanzania. We tested whether enhanced supervision, focused on improving practical skills over two years, would raise the scores of these workers on a test of basic knowledge and skills. Methods. This was a randomised controlled trial. All primary health care (PHC) facilities within two districts of each country were enrolled and randomly assigned by district (Kenya, Malawi) or by health care facility (Tanzania) to receive quarterly skills-based supervision by a district eye coordinator or to continue existing routine supervision. At baseline, a test of basic knowledge and skills in five key areas was administered to PHCWs, and visual acuity (VA) charts and working torches were provided. After two years the test was administered again. Changes in test scores were compared between the intervention (enhanced supervision) and the non-intervention (routine supervision) facilities. Results: All 137 facilities in the six districts were enrolled including 343 PHCWs. At baseline, no facility had a visual acuity chart and 18 (13%) had a working torch; the average total skills scores were 6.04 and 6.38 (maximum of 12) in the non-intervention and the intervention facilities, respectively. After two years, 16 intervention facilities (23.2%) had a visual acuity chart correctly placed and 19 (27.5%) had a working torch, compared to 4 (5.9%) and 6 (8.8%), respectively, in the routine supervision facilities. At the facility level, the change in overall test scores was +1.84 points in the intervention sites compared to +0.42 points in the non-intervention sites (p<0.001). Staff turnover included about 75% of the staff by the end of the study. Conclusion: The improvements in the enhanced supervision facilities were very modest and of questionable clinical significance. The low impact of the intervention may be due to the high turnover of PHCWs or high absenteeism. A better understanding of the quality of eye care at PHC facilities and influencing factors are urgently needed before continuing to invest resources in the scale up of this model of task shifting in Africa. © 2014 Kalua et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Kalua, Khumbo M.
Malawi, Zomba
University of Malawi
Malawi, Blantyre
Lions Sight First Eye Hospital
Gichangi, Michael Mbee
Kenya, Nairobi
Ministry of Health Nairobi
Barassa, Ernest
Kenya, Nairobi
Ministry of Health Nairobi
Eliah, Edson
Tanzania
Kilimanjaro Centre for Community Ophthalmology Tanzania
Lewallen, Susan
Tanzania
Kilimanjaro Centre for Community Ophthalmology Tanzania
South Africa, Cape Town
University of Cape Town
Courtright, Paul D.
Tanzania
Kilimanjaro Centre for Community Ophthalmology Tanzania
South Africa, Cape Town
University of Cape Town
Statistics
Citations: 30
Authors: 6
Affiliations: 5
Identifiers
Doi:
10.1186/1472-6963-14-S1-S6
e-ISSN:
14726963
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Study Locations
Kenya
Malawi
Tanzania