Fred Hollows Foundation New Zealand

Napier, New Zealand

Fred Hollows Foundation New Zealand

Napier, New Zealand
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Lee L.,Fred Hollows Foundation New Zealand | Ramke J.,Fred Hollows Foundation New Zealand | Ramke J.,University of New South Wales | Blignault I.,University of New South Wales | Casson R.J.,University of Adelaide
Ophthalmic Epidemiology | Year: 2013

Purpose: To determine barriers to seeking eye care services in Timor-Leste in 2010, and compare this to similar analyses undertaken 5 years previously. Methods: An interview-based questionnaire used in a 2005 survey was re-administered as part of a population-based cross-sectional survey of adults selected by multistage random sampling from those aged ≥ 40 years in Timor-Leste in 2010. Results: The participation rate for the 2010 survey was 89.5% (n = 2014). The sex-age-domicile-adjusted prevalence of a history of at least one previous or current ophthalmic problem in the population aged ≥ 40 years was 92.6% (95% confidence interval [CI], 91.4-93.7%). Of these, 75.4% (95% CI 73.4-77.3%) had not consulted a care provider. In multivariate analysis, rural domicile, illiteracy and subsistence farming were associated with having not sought care for an eye problem. The most frequently cited reasons were "service too far away" (36.3%), "no time/other priorities" (21.7%) and "unaware of eye care service" (20.7%). More people reported a history of an eye problem in 2010 than in 2005, but the proportion seeking care was no different. Social barriers became more prevalent for urban dwellers in 2010, while attitudinal barriers decreased. For rural residents, social and service-related barriers increased and awareness and attitudinal barriers decreased. Conclusion: Barriers to eye health service use in Timor-Leste are not universal or static. Monitoring the extent and nature of barriers, as well as the prevalence and causes of vision impairment, will help plan appropriate interventions for vulnerable groups. © 2013 Informa UK Ltd All rights reserved.


Brian G.,Fred Hollows Foundation New Zealand | Ramke J.,Fred Hollows Foundation New Zealand | Maher L.,Fred Hollows Foundation New Zealand | Page A.,Fred Hollows Foundation New Zealand | Szetu J.,Fred Hollows Foundation New Zealand
New Zealand Medical Journal | Year: 2010

Aim To estimate the prevalence of diabetes among adults aged ≥40 years in Fiji, and determine the demographic characteristics associated with this diagnosis. Method During a population-based survey, participant glycosylated haemoglobin (HbA1c) was determined and physician diagnosis of diabetes self-reported. HbA1c≥6.5% or claimed previous diagnosis, independent of HbA1c, defined presence of diabetes. Results were extrapolated to the whole population. Predictors of risk for diabetes were investigated using logistic regression models. Results Of those enumerated, 1381 participated (73.0%). For 1353 with either a history of diabetes or valid HbA1c, prevalence of diabetes was 44.8% (95%CI 42.2- 47.5). Adjusting for age and domicile, Indians had significantly higher risk of diabetes than Melanesians among males (OR 2.02, 95%CI 1.37-2.97, p<0.001) and females (OR 1.99, 95%CI 1.44-2.73, p<0.001). Females were at greater risk than males among Melanesians (OR 1.75, 95%CI 1.30-2.36, p<0.001) and Indians (OR 1.94, 95%CI 1.33-2.84, p<0.001). Risk increased with age for both genders and ethnicities, adjusting for ethnicity and domicile, then gender and domicile. The ethnicity-genderage- domicile adjusted prevalence of diabetes among adults aged ≥40 years in Fiji was 41.0% (95%CI 38.4-43.6): 99,000 people. Conclusion As identified in 1970, diabetes continues to be a substantial population health problem in Fiji. © NZMA.


Du Toit R.,Fred Hollows Foundation New Zealand | Palagyi A.,Fred Hollows Foundation New Zealand | Ramke J.,Fred Hollows Foundation New Zealand | Brian G.,Fred Hollows Foundation New Zealand | And 2 more authors.
Ophthalmology | Year: 2010

Purpose: To determine the independent, relative, and combined impact of reduced distance and near vision on the vision-specific quality of life (VS QOL) of adults in Timor-Leste. Design: A population-based cross-sectional eye health survey was conducted in urban and rural areas in Timor-Leste. Participants: Participants were 40 years or older. Those with better eye presenting distance vision worse than 6/18, and every third participant with 6/18 or better vision, completed the VS QOL questionnaire: in total 704 of the 1414 participants. Methods: Distance and near visual acuities were measured and eye health was assessed. The VS QOL questionnaire administered by interview was analyzed using Rasch analysis, univariate analysis, and linear regression to determine associations between VS QOL, demographic factors, and levels of visual impairment. Main Outcome Measures: The Timor-Leste VS QOL questionnaire results. Results: Rasch analysis confirmed that for participants both with and without visual impairment, the Timor-Leste VS QOL questionnaire provided a valid and reliable measure, was unidimensional, and had appropriate response categories. There was a consistent pattern of deterioration in VS QOL as vision worsened: for each category of distance- and near-vision impairment, there was an independent and significant change in Timor-Leste VS QOL scores between no visual impairment and either mild, moderate, or severe impairment (P<0.05). Combined distance- and near-vision impairment was associated with a greater impact on VS QOL than categories separately, the impact of severe distance- and near-vision impairment being the greatest and clinically significant: -3.05 (95% confidence interval [CI], -3.60 to -2.49; P<0.05; and 95% CI, <-1.0). Distance vision (37.2%) contributed relatively more than near vision (4.7%) to the total variance in VS QOL (41.9%). Older people, those not married, not literate, and rural dwellers had significantly worse Timor-Leste VS QOL scores (P<0.05). Conclusions: This study provides evidence of independent dose-response relationships between distance- and near-vision impairment and poorer VS QOL. Distance-vision impairment had a relatively larger impact on VS QOL than near-vision impairment. Combined distance- and near-vision impairment was associated with a greater impact on VS QOL compared with the independent impact of distance- or near-vision impairment at similar levels. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2010 American Academy of Ophthalmology.


Tousignant B.,Fred Hollows Foundation New Zealand | Tousignant B.,Divine Word University | Brian G.,Fred Hollows Foundation New Zealand | Brian G.,University of Otago | And 5 more authors.
Ophthalmic Epidemiology | Year: 2013

Purpose: To estimate the prevalence of optic neuropathy (ON) among prisoners in a provincial prison in Papua New Guinea, and to explore risk factors for this condition among this population. Methods: Cross-sectional observation study of 148 male prisoners aged ≥ 18 years using an interview-based questionnaire, assessment of visual and nervous system function, ocular examination, and blood analysis (α-tocopherol, β-carotene, lutein, folate, homocysteine, holotranscobalamin II, riboflavin, selenium, thiamin, and vitamins A, B12 and C). Likelihood of the presence of ON was based on ordered groups determined by weighted combination of optic nerve head appearance and visual dysfunction (acuity, field, color perception). Main outcome measures were prevalence and associations of ON. Results: Sample prevalence of clinical ON was 10.4% (95% confidence interval [CI], 6.2-16.8). No cases were found of unexplained non-visual nervous system dysfunction, including peripheral neuropathy. Increasing age (p = 0.001), length of current (p = 0.002) and lifetime (p = 0.03) incarceration, and duration of smoking by current smokers (p = 0.001) were associated with increased ON likelihood. However, when age-controlled, the smoking duration association was not maintained (p = 0.6). Prisoners were folate deficient. Adjusting for age and duration of current incarceration, whole blood (p = 0.02) and red blood cell (p = 0.04) folate concentrations were inversely associated with ON likelihood. No association was found for any other assessed demographic, lifestyle or biochemical measure. Conclusions: A cluster of ON associated with folate deficiency has been identified. Recommendations for dietary change and micronutrient supplementation have been made. © 2013 Informa UK Ltd All rights reserved.


Williams S.,University of Otago | Brian G.,University of Otago | Brian G.,Fred Hollows Foundation New Zealand | Toit R.D.,Fred Hollows Foundation New Zealand
Ophthalmic Epidemiology | Year: 2012

Purpose: To evaluate an 18-item vision-specific quality-of-life questionnaire designed for use with adults in Fiji. Methods: Participants in a population-based cross-sectional survey selected by multistage random sampling from those aged ≥40 years living on Fiji's main island had distance and near visual acuity measured. Those with presenting vision impairment (<6/18) and/or presbyopia (


Brian G.,Fred Hollows Foundation New Zealand | Brian G.,University of Otago | Pearce M.G.,Pacific Eye Institute | Ramke J.,Fred Hollows Foundation New Zealand
Ophthalmic Epidemiology | Year: 2011

Purpose: To characterize refractive error, presbyopia and their correction among adults aged ≥ 40 years in Fiji, and contribute to a regional overview of these conditions. Methods: A population-based cross-sectional survey using multistage cluster random sampling. Presenting distance and near vision were measured and dilated slitlamp examination performed. Results: The survey achieved 73.0% participation (n=1381). Presenting binocular distance vision ≥ 6/18 was achieved by 1223 participants. Another 79 had vision impaired by refractive error. Three of these were blind. At threshold 6/18, 204 participants had refractive error. Among these, 125 had spectacle-corrected presenting vision ≥ 6/18 ("met refractive error need"); 79 presented wearing no (n=74) or under-correcting (n=5) distance spectacles ("unmet refractive error need"). Presenting binocular near vision ≥ N8 was achieved by 833 participants. At threshold N8, 811 participants had presbyopia. Among these, 336 attained N8 with presenting near spectacles ("met presbyopia need"); 475 presented with no (n=402) or under-correcting (n=73) near spectacles ("unmet presbyopia need"). Rural residence was predictive of unmet refractive error (p=0.040) and presbyopia (p=0.016) need. Gender and household income source were not. Ethnicity-gender-age-domicile-adjusted to the Fiji population aged ≥ 40 years, "met refractive error need" was 10.3% (95% confidence interval [CI] 8.7-11.9%), "unmet refractive error need" was 4.8% (95%CI 3.6-5.9%), "refractive error correction coverage" was 68.3% (95%CI 54.4-82.2%),"met presbyopia need" was 24.6% (95%CI 22.4-26.9%), "unmet presbyopia need" was 33.8% (95%CI 31.3-36.3%), and "presbyopia correction coverage" was 42.2% (95%CI 37.6-46.8%). Conclusion: Fiji refraction and dispensing services should encourage uptake by rural dwellers and promote presbyopia correction. Lack of comparable data from neighbouring countries prevents a regional overview. © 2011 Informa Healthcare USA, Inc.


Ramke J.,Fred Hollows Foundation New Zealand | Brian G.,Fred Hollows Foundation New Zealand | Brian G.,University of Otago | Palagyi A.,Fred Hollows Foundation New Zealand
Ophthalmic Epidemiology | Year: 2012

Purpose: To examine the financial viability of the Timor-Leste National Spectacle Program as it increases spectacle availability, affordability and uptake, particularly for Timor's poor. Methods: In rural areas, three models of ready-made spectacles were dispensed according to a tiered pricing structure of US$3.00, 1.00, 0.10 and 0.00. In addition, custom-made spectacles were available in the capital, Dili. Spectacle costs, dispensing data and income for the National Spectacle Program for 18 months from March 2007 were analyzed. Results: Rural services dispensed 3415 readymade spectacles: 47.1% to women, and 51.4% at subsidized prices, being 39.8% at US$0.10 and 11.6% free. A profit of US$1,529 was generated, mainly from the sale of US$3.00 spectacles. Women (odds ratio, OR, 1.3, 95% confidence interval, CI, 1.1-1.4) and consumers aged ≥65 years (OR 2.1; 95% CI 1.7-2.6) were more likely to receive subsidized spectacles. Urban services dispensed 2768 spectacles; mostly US$3.00 readymade (52.8%) and custom-made single vision (29.6%) units. Custom-made spectacles accounted for 36.7% of dispensing, but 73.1% of the US$12,264 urban profit. The combined rural and urban profit covered all rural costs, leaving US$2,200 to meet administration and other urban expenses. Conclusion: It is instructive and encouraging that a national spectacle dispensing program in one of the ten poorest countries of the world can use tiered-pricing based on willingness-to-pay information to cover spectacle stock replacement costs and produce profit, while using cross-subsidization to provide spectacles to the poor. © 2012 Informa Healthcare USA, Inc.


Ramke J.,Fred Hollows Foundation New Zealand | Ramke J.,University of New South Wales | Brian G.,Fred Hollows Foundation New Zealand | Brian G.,University of Otago | And 3 more authors.
Ophthalmic Epidemiology | Year: 2012

Purpose: To estimate the 2010 prevalence and causes of blindness and low vision among Timor-Leste adults aged ≥40 years, and compare these to the results of a survey conducted 5 years previously. Method: A population-based cross-sectional survey used multistage cluster random sampling proportionate to size to identify 50 clusters of 45 people each. Cause of vision loss was determined for each eye with presenting visual acuity worse than 6/18. Results: A participation rate of 89.5% (n=2014) was achieved. The gender-age-domicile adjusted prevalence was 7.7% (95% confidence interval [CI] 6.5, 8.8) for 6/60, and 3.6% (95% CI 2.7, 4.4) for 3/60 blindness (better eye presenting vision worse than 6/60 and 3/60, respectively) among Timorese aged ≥40 years. Cataract caused most blindness (69.3% at 6/60). The population prevalence of low vision (better eye presenting vision of 6/60 or better, but worse than 6/18) was 13.6% (95%CI 12.1, 15.1), most caused by uncorrected refractive error (57.4%) or cataract (39.5%). The prevalence and causes of blindness were unchanged compared with 5 years earlier, but low vision was less common. Conclusion: Unusually for a developing country, Timor-Leste has initiated a cycle of evidence-based eye care in which, although with limitations, population data are periodically available for monitoring and planning. © 2012 Informa Healthcare USA, Inc.


Brian G.,Fred Hollows Foundation New Zealand | Brian G.,University of Otago | Maher L.,Fred Hollows Foundation New Zealand | Ramke J.,Fred Hollows Foundation New Zealand
Ophthalmic Epidemiology | Year: 2012

Purpose: To determine the use of medical services for eye problems in Fiji, and barriers to seeking that care. Methods: An interview-based questionnaire was administered as part of a population-based cross-sectional survey of adults selected by multistage random sampling from those aged ≥40 years living on Fiji's main island. Results: Participation rate was 73.0% (n=1381). A current vision or eye problem was reported by 931 participants, and a further 235 recalled a previous difficulty. Urban dwellers (P=0.002) and those aged ≥50 years (P=0.017) were more likely to report a problem. Gender was not predictive (P=0.215). "Blurred/poor vision" was the most common complaint (78.5%). Over half (53.3%) had not sought care for the problem most important to them. For current problems, being younger (P<0.001) and from a household without paid income (P=0.007) were predictive of being less likely to seek treatment. Gender was not (P=0.416). The most frequently cited principal reason for not seeking care was "able to manage/accept the problem" (66.5%; of whom 84.7% claimed vision problems). Direct and indirect costs were mentioned as deterrents. "Thought nothing could be done" (P=0.032) and "lack of awareness of service availability" (P=0.026) were more common among rural dwellers. Of participants who sought care, 75.6% used government services. Most participants requiring spectacles or medication incurred costs for these. Satisfaction with overall care was independent of provider (P=0.062) and user gender (P=0.851). Conclusion: With expanding service delivery, increased eye health promotion, and attention to the financing of treatments, improved service use ought to be possible in Fiji. © 2012 Informa Healthcare USA, Inc.


Ramke J.,Fred Hollows Foundation New Zealand | Brian G.,Fred Hollows Foundation New Zealand | Brian G.,University of Otago
Public Health Nutrition | Year: 2012

Objective To determine the distribution and sociodemographic associations of BMI (kg/m 2) among adults aged ≥40 years living in Timor-Leste. Design BMI was calculated for participants of a population-based cross-sectional survey. Setting Urban and rural Timor-Leste. Subjects Adults aged ≥40 years living in Timor-Leste. Results Of those enumerated, 2014 participated (89·5 %). Male gender, rural domicile, older age, illiteracy and source of household income were associated with BMI < 18·5 kg/m 2 on multivariate analysis. Female gender, urban domicile and literacy were associated with BMI ≥25·0 and ≥30·0 kg/m 2. Adjusting for gender, age and domicile, and extrapolating to those aged ≥40 years across Timor-Leste, 9·9 %, 36·0 %, 6·6 % and 0·8 % had BMI <16·0, <18·5, ≥25·0 and ≥30·0 kg/m 2, respectively. Conclusions At this time, being 'underweight' or 'severely thin' is more prevalent in the Timorese adult population than being 'overweight' or 'obese'. © The Authors 2012.

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