Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial

Authors list

Rono H, Bastawrous A, Macleod D, Mamboleo R, Bunywera C, Wanjala E, Gichui S, Burton MJ

A smartphone-based eye screening and referral system used by community members has been shown to almost triple the number of people with eye problems attending primary care, as well as increasing appropriate uptake of hospital services, compared to the standard approach. The new findings come from research carried out in Kenya

The randomised controlled trial included more than 128,000 people in Trans Nzoia County, Kenya, and was carried out by researchers from the International Centre for Eye Health (ICEH) at the London School of Hygiene & Tropical Medicine, Kitale County Hospital, the University of Nairobi and Peek Vision.

In low- and middle-income populations, limited access to eye services and a shortage of eye care providers mean there is a high prevalence of avoidable vision impairment. Globally, more than 1.1 billion people have a vision problem that is preventable or treatable, often with something as simple as glasses or a cataract operation. Key barriers to care include a lack of access to and awareness of eye services.

The results demonstrate the potential of using mobile health (mHealth) tools such as the Peek Community Eye Health system (Peek CEH) evaluated in this trial, to improve access to care, target limited eye health resources, and manage more patients effectively at the primary level so that hospitals can focus on more complex cases.

Peek CEH is a smartphone-based referral system which includes vision screening, SMS reminders to those requiring follow-up appointments, and real-time reporting to follow the patient journey to see who is accessing follow-up care and receiving treatment.

Community sensitisation (posters and verbal notices in churches and schools) was carried out in both groups, followed by a triage clinic at the linked health facility four weeks later. During triage, participants in both groups were assessed and treated, and were referred on to Kitale Eye Unit (hospital) if further treatment was required. Participants in the intervention group received further SMS reminders about their hospital appointment.

The researchers found that the average attendance rate at triage by participants with eye problems was considerably greater in the intervention group where the Peek Community Eye Health system was used compared to the control group (1,429 per 10,000 participants in the intervention group, compared with 522 per 10,000 in the control group – a rate difference of 906 per 10,000 people). The average hospital attendance rate for those with eye problems was also greater (82 per 10,000 in the intervention group compared with 33 per 10,000 in the control group – a rate difference of 49 per 10,000).

Study lead author, Dr Hillary Rono, ICEH and Peek researcher and Ophthalmologist at Kitale Eye Hospital, said: “My experience as one of very few eye doctors in this rural region of Kenya has shown me that we need more innovative ways to get eye care services to the many people who require them. Our findings show the great potential of using the Peek Community Eye Health system to help ensure that limited health resources are effectively maximised.”

His thoughts were echoed by study co-author, Dr Andrew Bastawrous, Peek Vision CEO and ICEH researcher, said: “This study is incredibly exciting as it demonstrates real systems change. This change resulted in the right people getting the right services at the right location, while the specialist services gained much needed capacity to focus on more complex conditions despite a big increase in demand overall being generated. As populations grow and age, the number of people being left behind is increasing. We are delighted to see that this is an evidence-based approach to tackle the growing vision crisis.”

Journal details

The Lancet Digital Health
Published:July 2021

Full-text links

Available at:https://www.thelancet.com/journals/landig/article/PIIS2589-7500(21)00083-2/fulltext
PubMed ID:34167763