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Auckland, New Zealand

Williams S.,University of Otago | Brian G.,University of Otago | Brian G.,A+ Network | 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 (

Ramke J.,Fred Hollows Foundation New Zealand | Ramke J.,University of New South Wales | Brian G.,Fred Hollows Foundation New Zealand | Brian G.,A+ Network | And 4 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.

Ramke J.,Fred Hollows Foundation New Zealand | Brian G.,Fred Hollows Foundation New Zealand | Brian G.,University of Otago | Brian G.,A+ Network
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.

Ramke J.,Fred Hollows Foundation New Zealand | Brian G.,Fred Hollows Foundation New Zealand | Brian G.,A+ Network | 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.

Brian G.,Fred Hollows Foundation New Zealand | Brian G.,University of Otago | Brian G.,A+ Network | Pearce M.G.,Pacific Eye Institute | And 2 more authors.
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.

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