Essay Example on Globally prevalence of diabetic mellitus has Increased

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Globally prevalence of diabetic mellitus has increased from 108 million in 1980 to 422 million in 2014 1 2 with the age standardized prevalence of diabetes has doubling from 4 7 to 8 5 since 1980 3 In Sub Saharan Africa and other developing countries diabetes prevalence has risen more rapidly than expected 4 Rapid urbanization globalisation and unhealthy lifestyle has contributed to the growing epidemic of diabetes around the world5 A case in point is a developing country such as Ghana experiencing prevalence rise in diabetes i e from 0 2 in 1964 6 to 1 9 in 2010 7 in recent years with attributing factors associated to overweight 25 4 and obesity 17 of the adult population 8 Though services for diabetic management and services have improved in recent years 9 screening and management for diabetic retinopathy is not fully incorporated into the national diabetes program10 Integrating eye care services into the general health system helps in strengthening the system for effective planning and development 11 12 Vision loss due to diabetic retinopathy is an important cause of visual impairment in the working population of any country

One of the major complications from diabetes mellitus is the development of diabetic retinopathy 13 a retinal vascular disease that results as a complication of poor DM management 14 Previous studies show that approximately one third of people living with diabetes will develop diabetic retinopathy and a further one third will develop vision threatening diabetic retinopathy 13 Moreover the number of people with DR is projected to grow from 126 6 million in 2010 to 191 0 million by 2030 whilst global estimate shows the number with vision threatening diabetic retinopathy will increase from 37 3 million to 56 3 million if prompt action is not taken 15 DR is the leading cause of vision loss in working age population worldwide 13 Diabetic Retinopathy Overview Diabetic retinopathy DR is a retinal vascular disease that occurs as a complication of diabetes mellitus 14 Diabetic retinopathy is characterised by signs of ischemia microaneurysms cotton wool spots neovascularization haemorrhages macular oedema and retinal detachment 16 The early stages of the disease are mostly asymptomatic but gradually become more serious as the disease progresses leading to vision loss and blindness Diabetic retinopathy begins as mild and progresses to moderate and severe non proliferative diabetic retinopathy NPDR and then proliferative diabetic retinopathy PDR Macular oedema can develop at any time in the progression of diabetic retinopathy 17 Country Profile Ghana is a lower middle income country in West Africa located on the coast of the Gulf of Guinea

The country is divided into ten administrative regions with Accra as the capital With a population of 24 658 823 and a growth rate of 2 5 according to the 2010 census18 Ghana has one of the fastest growing populations in Africa19 The country has a GDP of 1426 USD and total expenditure on health is 3 6 of GDP as at 201420 Life expectancy is estimated at 62 years and the country has an under five mortality rate of 7821 Diabetic Retinopathy in Ghana According to the international diabetes federation 93 170 people in Ghana are living with DR and 26 620 have vision threatening diabetic retinopathy The burden of increasing number of diabetics is set to double by the year 2040 22 However the vision 2020 links program aims to facilitate knowledge and skills transfer between a training Eye hospital in a developing country e g Ghana and a training Eye institution in U K e g Moorfields Eye hospital to plan and develop services to improve quality of life of people living with diabetes 10 A study conducted by Poore et al reported that DR screening was inclusive in holistic routine diabetes check in some hospitals in Ghana though people referred for screening test frequently failed to turn up at the eye department It was reported that one of the main reasons for low turn up was the prospect of long queues and lengthy waiting time 10 Health System in Ghana The Ministry of health who was the sole sector providing direction policies and guidelines concerning the health in the country changed its policies to decentralise functions of the health system23

The national health policy developed in 2007 aimed at improving health outcomes by offering financial protection and to ensure that the system was sustainable responsive equitable and efficient To achieve these goals policy making service delivery financing and regulatory functions were allocated to autonomous agencies e g Ghana Health Service National Health Insurance Scheme teaching hospitals and others 23 Ghana is one of the few countries in 

Africa with an operational health insurance system gearing towards a universal health coverage 24 As a result primary health care has become an embodied part of the health system in Ghana Eye Care in Ghana The objective of the Ghana National Eye Health Programme is to reduce avoidable blindness through the strengthening of capacities that ensure affordable and available eye care services to all people living in the country This includes the mobilization of communities to participate actively in eye health The lack of requisite human resource is however a major challenge to the work of the programme Presently there are about 97 ophthalmologists25 in Ghana some of whom are either in administrative positions or no longer in active practice Majority of those in service delivery are in the capital cities leaving the rural areas underserved Ophthalmic nurses 288 and optometrists 300 26 are the main personnel who work in eye units at the district hospitals or in urban polyclinics Eye health services are delivered by other health service providers who have been trained in Primary Eye Care



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