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Kik J, Nordmann M, Cainap S, et al. Implementation of paediatric vision screening in urban and rural areas in Cluj County, Romania. Int J Equity Health. 2021;20(1):256doi: 10.1186/s12939-021-01564-6.
Kik, J., Nordmann, M., Cainap, S., Mara, M., Rajka, D., Ghițiu, M., Vladescu, A., Sloot, F., Horwood, A., Fronius, M., Vladutiu, C., & Simonsz, H. J. (2021). Implementation of paediatric vision screening in urban and rural areas in Cluj County, Romania. International journal for equity in health, 20(1), 256. https://doi.org/10.1186/s12939-021-01564-6
Kik, Jan, et al. "Implementation of paediatric vision screening in urban and rural areas in Cluj County, Romania." International journal for equity in health vol. 20,1 (2021): 256. doi: https://doi.org/10.1186/s12939-021-01564-6
Kik J, Nordmann M, Cainap S, Mara M, Rajka D, Ghițiu M, Vladescu A, Sloot F, Horwood A, Fronius M, Vladutiu C, Simonsz HJ. Implementation of paediatric vision screening in urban and rural areas in Cluj County, Romania. Int J Equity Health. 2021 Dec 18;20(1):256. doi: 10.1186/s12939-021-01564-6. PMID: 34922555.
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Int J Equity Health. 2021 Dec 18;20(1):256. doi: 10.1186/s12939-021-01564-6.

Implementation of paediatric vision screening in urban and rural areas in Cluj County, Romania.

International journal for equity in health

Jan Kik, Mandy Nordmann, Simona Cainap, Mihai Mara, Daniela Rajka, Monica Ghițiu, Alin Vladescu, Frea Sloot, Anna Horwood, Maria Fronius, Cristina Vladutiu, Huibert Jan Simonsz

Affiliations

  1. Department of Ophthalmology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
  2. University of Medicine and Pharmacy, Cluj-Napoca, Romania.
  3. Department of Social and Medical Assistance, Cluj-Napoca, Romania.
  4. School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
  5. Department of Ophthalmology, Child Vision Research Unit, Goethe University, Frankfurt am Main, Germany.
  6. Department of Ophthalmology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands. [email protected].

PMID: 34922555 DOI: 10.1186/s12939-021-01564-6

Abstract

BACKGROUND: In 2018 and 2019, paediatric vision screening was implemented in Cluj County, Romania, where universal paediatric vision screening does not yet exist. We report on the preparation and the first year of implementation.

METHODS: Objectives, target population and screening protocol were defined. In cities, children were screened by kindergarten nurses. In rural areas, kindergartens have no nurses and children were screened by family doctors' nurses, initially at the doctors' offices, later also in rural kindergartens. CME-accredited training courses and treatment pathways were organised. Implementation was assessed through on-site observations, interviews, questionnaires and analysis of screening results of referred children.

RESULTS: Out of 12,795 eligible four- and five-year-old children, 7,876 were screened in 2018. In the cities, kindergarten nurses screened most children without difficulties. In Cluj-Napoca 1.62x the average annual birth rate was screened and in the small cities 1.64x. In the rural areas, however, nurses of family doctors screened only 0.49x the birth rate. In 51 out of 75 rural communes, no screening took place in the first year. Of 118 rural family doctors' nurses, 51 had followed the course and 26 screened children. They screened only 41 children per nurse, on average, as compared to 80 in the small cities and 100 in Cluj-Napoca. Screening at rural kindergartens met with limited success. These are attended by few children because of low population density, parents working abroad or children being kept at home in case of bad weather and road conditions.

CONCLUSIONS: Three times fewer children were screened in rural areas as compared to urban areas. Kindergartens in rural areas are too small to employ nurses and family doctors' nurses do not have easy access to many children and have competing healthcare priorities: there are 1.5x as many family doctors in urban areas as compared to rural areas. For nationwide scaling-up of vision screening, nurses should be enabled to screen a sufficient number of children in rural areas.

© 2021. The Author(s).

Keywords: Amblyopia; Children; Disparity; Implementation study; Rural; Urban; Vision screening

References

  1. Høeg TB, Moldow B, Ellervik C, Klemp K, Erngaard D, la Cour M, et al. Danish Rural Eye Study: the association of preschool vision screening with the prevalence of amblyopia. Acta Ophthalmol. 2015;93:322–9. - PubMed
  2. EUSCREEN Vision Screening Country Reports. https://www.euscreen.org/vision-screening-country-reports . Accessed 25 May 2021. - PubMed
  3. Cole RBW. The problem of unilateral amblyopia: a preliminary study of 10,000 national health patients. Br Med J. 1959;1(5116):202–6. - PubMed
  4. Holmes J, Levi D. Treatment of amblyopia as a function of age. Vis Neurosci. 2018;35:E015. - PubMed
  5. Groenewoud JH, Tjiam AM, Lantau VK, Hoogeveen WC, Tjeerd J, de Faber HN, et al. Rotterdam AMblyopia screening effectiveness study: detection and causes of amblyopia in a large birth cohort. IOVS. 2010;51:3476–84. - PubMed
  6. van de Graaf ES, van der Sterre GW, van Kempen-du Saar H, Simonsz B, Looman CW, Simonsz HJ. Amblyopia and Strabismus Questionnaire (A&SQ): clinical validation in a historic cohort. Graefes Arch Clin Exp Ophthalmol. 2007;245(11):1589–95. - PubMed
  7. van Leeuwen R, Eijkemans MJC, Vingerling JR, Hofman A, de Jong PTVM, Simonsz HJ. Risk of bilateral visual impairment in individuals with amblyopia: the Rotterdam study. Br J Ophthalmol. 2007;91(11):1450–1. - PubMed
  8. EUSCREEN. https://www.euscreen.org . Accessed 3 Sept 2020. - PubMed
  9. Council of the European Union. Council conclusions on early detection and treatment of communication disorders in children, including the use of e-Health tools and innovative solutions. Brussels: Council of the European Union; 2011. - PubMed
  10. OECD/European Observatory on Health Systems and Policies. Romania: country health profile 2019, state of health in the EU. Paris: OECD Publishing, European Observatory on Health Systems and Policies; 2019. - PubMed
  11. Mackey AR, Bussé AML, Hoeve HLJ, Goedegebure A, Carr G, Simonsz HJ, et al. Assessment of hearing screening programmes across 47 countries or regions II: coverage, referral, follow-up and detection rates from newborn hearing screening. Int J Audiol. 2021:1–10. - PubMed
  12. Guvernul României Ministerul Sanatatii. Raportul De Activitate Pentru Anul 2018. Bucharest: Ministry of Health; 2019. - PubMed
  13. Vedere clara, ochi sanatosi. https://web.archive.org/web/20200809024000/http://revista-lions.ro/vedere-clara-ochi-sanatosi . Accessed 5 Mar 2020. - PubMed
  14. Bara AC, van den Heuvel WJA, Maarse JAM. Reforms of health care system in Romania. Croat Med J. 2002;43(4):446–52. - PubMed
  15. Romanian National Institute for Statistics. http://statistici.insse.ro:8077/tempo-online/#/pages/tables/insse-table . Accessed 2 Apr 2019 and 22 Mar 2021. - PubMed
  16. Vlãdescu C, Scîntee SG, Olsavszky V, Hernández-Quevedo C, Sagan A. Romania: health system review. Health Syst Transit. 2016;18(4):1–170. - PubMed
  17. Andermann A, Blancquaert I, Beauchamp S, Déry V. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bull World Health Organ. 2008;86(4):317–9. - PubMed
  18. Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E. Explaining trends in inequities: evidence from Brazilian child health studies. Lancet. 2000;356(9235):1093–8. - PubMed
  19. Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013;347:f6753. - PubMed
  20. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Admin Pol Ment Health. 2011;38(2):65–76. - PubMed
  21. Tjiam AM, Asjes-Tydeman WL, Holtslag G, Vukovic E, Sinoo MM, Loudon SE, et al. Implementation of an educational cartoon (“the Patchbook”) and other compliance-enhancing measures by orthoptists in occlusion treatment of amblyopia. Strabismus. 2016;24(3):120–35. - PubMed
  22. Telleman MAJ, Sloot F, Benjamins J, Simonsz HJ. High rate of failed visual-acuity measurements with the Amsterdam Picture Chart in screening at the age of 36 months. Acta Ophthalmol. 2019;97(1):24–8. - PubMed
  23. Romanian census 2011. http://www.recensamantromania.ro/rezultate-2/ . Accessed 2 May 2019. - PubMed
  24. World Bank. Achieving Roma inclusion in Romania: what does it take? Washington, DC: The World Bank; 2014. - PubMed
  25. European Commission. Education and training monitor 2019 Romania. Luxembourg: Publications Office of the European Union; 2019. - PubMed
  26. Ciolan L, Iucu R, Petrescu A, Bucur C. Romania – ECEC Workforce Profile. In: Oberhuemer P, Schreyer I, editors. Early Childhood Workforce Profiles in 30 Countries with Key Contextual Data. Munich; 2018. p. 930-954. - PubMed
  27. Donaldson L, Subramanian A, Conway MI. Eye care in young children: a parent survey exploring access and barriers. Clin Exp Optom. 2018;101:521–6. - PubMed
  28. WMA. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects . Accessed 21 Nov 2019. - PubMed
  29. Casa Naţională de Asigurări de Sănătate. http://www.cnas.ro . Accessed 10 Apr 2019. - PubMed
  30. Vladescu C, Galan A, Olsavszky V, Scîntee SG. Romanian health system strategic directions for the next decade. Ital J Public Health. 2009;6(1):21–9. - PubMed
  31. Predescu M. Quality in and equality of access to healthcare services. Country report for Romania. Bucharest: The Institute of Public Health; 2008. - PubMed
  32. Pop OM, Brînzaniuc A, Şirlincan EO, Baba CO, Cherecheş RM. Assessing health literacy in rural settings: a pilot study in rural areas of Cluj County, Romania. Glob Health Promot. 2013;20(4):35–43. - PubMed
  33. Nicula FA, Neamtiu L, Nicula B. Cervical Cancer Screening Resources Evaluation in Romanian North Western Region. Deliverable 2 of the Eurochip-III project funded under the European Union's Health Programme GA No: 2007121. - PubMed
  34. Todor RD, Bratucu G, Moga MA, Candrea AN, Marceanu LG, Anastasiu CV. Challenges in the prevention of cervical cancer in Romania. Int J Environ Res Public Health. 2021;18(4):1721. - PubMed
  35. Lancrajan IC, Lisencu IC, Ignat LF, Trisca R, Topor ID, Coman MA, et al. Evaluation of attitudes and knowledge on cervical cancer among women from rural and urban areas of Romania. JWHIC. 2017;6:5. - PubMed
  36. Gyawali B, Keeling J, van Teijlingen E, Dhakal L, Aro AR. Cervical cancer screening in Nepal: Ethical considerations. Med Bioethics. 2015;5:1–6. - PubMed
  37. Crockett R, Wilkinson TM, Marteau TM. Social patterning of screening uptake and the impact of facilitating informed choices: psychological and ethical analyses. Health Care Anal. 2008;16:17–30. - PubMed
  38. Lantz PM, Weigers ME, House JS. Education and income differentials in breast and cervical cancer screening. Policy implications for rural women. Med Care. 1997;35(3):219–36. - PubMed
  39. Latorre-Arteaga S, Gil-González D, Bascarán C, Núñez RH, Morales MD, Orihuela GC. Visual health screening by schoolteachers in remote communities of Peru: implementation research. Bull World Health Organ. 2016;94(9):652–9. - PubMed

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