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Title: Evaluation of diabetic retinopathy screening in Brunei Darussalam
Author: Sabtu, K.
ISNI:       0000 0004 5369 2506
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2015
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In recognition of the increasing prevalence of diabetes in Brunei, and the expected increase in diabetic retinopathy (DR), primary health centre based DR screening was introduced in 2006 for seven health centres in the Brunei-Muara district. The Brunei National Prevention of Blindness from Diabetic Retinopathy is a policy document calling for DR screening to be made systematic at a national level. However, the effectiveness of the model in practice was not evaluated and the DR screening programme was launched without a baseline survey and situation assessment. Consequently, the responsiveness of the health system to embed a systematic approach to DR screening has faced many constraints and was slow to evolve. This study has provided evidence to support the implementation of the policy document and baseline information on the gaps and challenges within the key service provision stages for DR screening and treatment. The overall objective of this thesis was to evaluate the DR screening model in the Brunei-Muara District. Results from this study suggest that the DR screening model in Brunei-Muara is partially systematic. The main findings showed that key processes are in place at different stages of DR screening and treatment and that sufficient resources have been allocated to detect sight threatening diabetic retinopathy (STDR) at primary health centres (PHCs) and to treat STDR at the national eye centre (NEC). This was supported by the good DR annual screening uptake rates (77%) and low DR prevalence rates (5.8%) reported in this study. However, the lack of monitoring of both the implementation processes and screening effectiveness was viewed as key limitations in the programme. This was evident through process gaps observed throughout the DR screening and treatment pathway including the identification of patients for screening at PHCs, GP to DR referral process, referral for treatment processes to NEC and disease registers that were not integrated and lacked accuracy. This was also backed by evidence that DR screening coverage rates were low (56%) across all health centres. Based on a generic framework to analyse development of DR screening programmes used in this study, the existing screening model could be enhanced by improving screening coverage rates, universal access to DR treatment, trained and certified workforce, implementation of a call and recall system and systematic digital photography screening system. However, further studies are required before these recommendations could be implemented.
Supervisor: Polack, S. ; Patel, D. Sponsor: Ministry of Health, Brunei
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral