title: The Capacity of Eye Care Services for Patients with Glaucoma in Botswana.
abstract: OBJECTIVE
  To evaluate current delivery of glaucoma care in Botswana; in particular, the service infrastructure available and glaucoma-related workload.
  
  
  METHODS
  A multi-center cross-sectional study was undertaken comprising government eye care institutions and ophthalmic personnel across Botswana. Data on human resources, equipment types and numbers, diagnostic criteria routinely used, treatments routinely provided, and new and repeat glaucoma consultations were obtained through quantitative and qualitative surveys.
  
  
  RESULTS
  In 27 government eye care institutions there were two general ophthalmologists, neither of whom had a subspecialty interest in glaucoma, 64 ophthalmic nurses, two optometrists, one low vision therapist, one refractionist, and two equipment technicians. Only 8.5% of available ophthalmic human resources were taken up with provision of glaucoma care. About 1/3 of hospitals did not have tonometers, most primary hospitals lacked slit lamp biomicroscopes and most hospitals lacked sensitive diagnostic equipment. A diagnosis of glaucoma was made by either an ophthalmic nurse or an ophthalmologist, but only 10% of institutions could meet recommendations for follow-up assessment. Topical glaucoma medications were prescribed by almost all hospital clinics, usually by ophthalmic nurses. Drug choices were largely determined by local availability. Glaucoma surgery accounted for 0.8% of total eye operations. Glaucoma patients took up 8.5% of total clinic visits. The total number of glaucoma visits was highest in the two hospitals with ophthalmologists. New glaucoma cases took up 10.3% of total glaucoma visits.
  
  
  CONCLUSIONS
  This study highlights the challenges faced in caring for glaucoma patients in Botswana; in particular, lack of professional human resources, equipment and availability of effective treatments.
authors.affiliation: a University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital , Cambridge , UK .
authors.forename: Mohammad S
authors.initials: MS
authors.lastname: Razai
authors.affiliation: a University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital , Cambridge , UK .
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Jackson
authors.affiliation: b University of Botswana School of Medicine , Gaborone , Botswana .
authors.forename: Rosemary
authors.initials: R
authors.lastname: Falama
authors.affiliation: b University of Botswana School of Medicine , Gaborone , Botswana .
authors.forename: Matlhogonolo
authors.initials: M
authors.lastname: Mongwa
authors.affiliation: b University of Botswana School of Medicine , Gaborone , Botswana .
authors.forename: Mishell G
authors.initials: MG
authors.lastname: Mutapanduwa
authors.affiliation: b University of Botswana School of Medicine , Gaborone , Botswana .
authors.forename: Chao
authors.initials: C
authors.lastname: Baemisi
authors.affiliation: b University of Botswana School of Medicine , Gaborone , Botswana .
authors.forename: Engelinah
authors.initials: E
authors.lastname: Josiah
authors.affiliation: b University of Botswana School of Medicine , Gaborone , Botswana .
authors.forename: Oathokwa
authors.initials: O
authors.lastname: Nkomazana
authors.affiliation: c Department of Public Health , Ministry of Health , Gaborone , Botswana .
authors.forename: Alice
authors.initials: A
authors.lastname: Lehasa
authors.affiliation: d Addenbrooke's Abroad, Addenbrooke's Hospital , Cambridge , UK .
authors.forename: Evelyn
authors.initials: E
authors.lastname: Brealey
authors.affiliation: e Department of Ophthalmology , Addenbrooke's Hospital , Cambridge , UK .
authors.forename: Deborah
authors.initials: D
authors.lastname: Jankowski
authors.affiliation: f University of Cambridge, Cambridge NIHR Biomedical Research Centre , Cambridge , UK , and.
authors.forename: Andrew J R
authors.initials: AJ
authors.lastname: White
authors.affiliation: e Department of Ophthalmology , Addenbrooke's Hospital , Cambridge , UK .
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Kerr Muir
authors.affiliation: e Department of Ophthalmology , Addenbrooke's Hospital , Cambridge , UK .|f University of Cambridge, Cambridge NIHR Biomedical Research Centre , Cambridge , UK , and.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Martin
authors.affiliation: g Department of Public Health and Primary Care , Institute of Public Health, University of Cambridge , Cambridge , UK.
authors.forename: Jeremiah M
authors.initials: JM
authors.lastname: Ngondi
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001902:Botswana / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D005901:Glaucoma / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006282:Health Personnel / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006280:Health Workforce / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D009313:National Health Programs / Q000706:statistics & numerical data; D009885:Ophthalmology / Q000458:organization & administration; D009907:Optometry / Q000458:organization & administration; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents
keywords: Botswana; glaucoma care; glaucoma-related workload; institutional capacity; public health; service infrastructure