Can frontline workers be effective in presbyopia screening? An experience from BRAC reading glass project

Introduction: Demand in near vision correction in the community exist in the Bangladeshi context with a thin presence of formal eye care support. This study aimed to test the screening capacity of BRAC frontline health workers... [ view full abstract ]

Introduction: Demand in near vision correction in the community exist in the Bangladeshi context with a thin presence of formal eye care support. This study aimed to test the screening capacity of BRAC frontline health workers in identifying near vision or presbyopia-cases in order to ensure frequent services to meet the community need.
Objective: To assess the accuracy of presbyopia diagnosis by frontline workers.
Methods: A cross- sectional analytical study, done in 6 randomly selected sadar (urban) upazillas (sub-district), organizing a total of 105 eye-camps with a minimum sample required was 1050, where 2059 camp-patients were screened. Health-cadres for example, program organizers (PO), upgraded shasthya shebikas (USS, health volunteers) and old shasthya shebikas (OSS)
working in BRAC reading glass project, were assigned to one of three arms consisting two sadars through permuted-block randomization. Sensitivity and specificity was calculated to understand presbyopia screening performance by the three different cadres. Their screening reports were matched with the gold standard by recruiting optometrists.
Results: Screening of PO-arm was 76% accurate (CI, 74.4-80.3) USS-arm, 73% (CI, 69.8-76.2) while OSS-arm, 61% (CI, 56.6-65.3). The sensitivity of the PO-arm was 77%, USS, 76% and OSS-arm, 58%. The specificity was 78% (PO-arm), 67% (USS-arm) and 69% (OSS-arm). Proportion of false positive rate was similar for PO (23.1%) and USS-arm (24.3%), but higher in OSS-arm, 42 %, on the other hand the false negative rate in USS was 33%, CI, 27.2-39.5 in compared to OSS-arm, 31 % (23.4-39.2) but in PO-arm, it was 22% (CI, 17.7-26.4).
Conclusion: This study concluded that health volunteers with nominal education and experience can identify presbyopia cases in urban community, and could be utilized as a potential health human resources in correcting near vision cases in the absence of sufficient community eye care support.

Key words: Frontline worker, presbyopia, screening, community