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Abstract
Background:
Of an estimated 1.4 million children blind globally, 300,000 are in Africa and nearly
9,000 in Ghana; yet 50% of childhood blindness is avoidable through timely referral
for treatment. Although Korle-Bu Teaching Hospital (KBTH) in Ghana has a tertiary
paediatric eye centre, little is known about the referral system.
Objectives:
To evaluate the referral pathways for children referred to a tertiary paediatric eye
centre in Ghana, and to examine concordance between reasons for referral and final
diagnosis.
Methods:
A retrospective cross-sectional audit of consecutive medical records of children aged
0-15 years referred to the paediatric eye centre of KBTH between April-December
2012 was conducted. Demographic, clinical and referral information was collected
from the patient register, medical records and referral letters using a pre-designed
spreadsheet and analysed using SPSS.
Results:
The mean age of the 517 children referred was 2.3 years. The median time delay to
present at the eye centre after referral was 4.0 days, and between the first
presentation and initial paediatric ophthalmologist consultation was 23.0 days. The
commonest reasons for referral were strabismus/nystagmus (21%), lens (15%) and
developmental (11%) issues. The main referrers were ophthalmic nurses, general practitioners and ophthalmologists, referring 22%, 19% and 17% of cases
respectively. There were 10% self-referrals. Ophthalmic nurses mostly referred
strabismus/nystagmus (35% of cases) and cataract (44%), ophthalmologists referred
25% and 30% respectively, whilst optometrists mostly referred cataract (11%) and
general practitioners/specialists mostly referred developmental anomalies (86% of
cases). There was high agreement between KBTH specialists and referrers in patients
with strabismus (78%), cataract (91%) and oculoplastics (69%). KBTH staff concurred
with reasons for referral by optometrists, other ophthalmologists, self referrers ,
ophthalmic nurses and general practitioners in 80%, 70%, 69%, 67% and 42% of
cases respectively.
Conclusions:
Ophthalmic and non-eye trained professionals differed in their referral patterns. The
percentage of parents who sought care directly at KBTH was low but largely
appropriate. Targeted campaigns to improve knowledge of the more common ocular
conditions in the various professions in Ghana will improve overall referral accuracy
from just 61%. It should be noted, this study did not investigate carers’ compliance
with referral advice and hence the real number of children with oculovisual
conditions needing tertiary care requires further investigation.