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RI_AIOS_2012_Dr_Tarun_Sharma_What is needed
1. Dr Tarun Sharma, MD, FRCSEd, MBA Director, Sri Bhagwan Mahavir Vitreoretinal Services Sankara Nethralaya, Chennai, TN, India Diabetic Retinopathy What needs to be done?
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4. Source: Hossain et al. NEJM 2007. Country GLOBAL Estimates from 2000-2030 (million) 2000 2030 % increase Developed nations US and Canada 19.7 33.9 72% Latin America and Caribbean 13.3 33 148% Europe 28.3 37.4 32% Sub Saharan Africa 7.1 18.6 162% Australia 0.9 1.7 89% Developing nations South East Asia 22.3 58.1 161% India 31.7 79.4 150% China 20.7 42.3 104% Eastern Mediterranean and Middle East 20 52.8 164%
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6. Senior Resident Ramachandran A. Current status of Diabetes in India and need for novel therapeutic strategies. JAPI; 58: 2010, Suppl
8. 2001 In crore (%) 2011 In crore (%) Difference India 102.9 121 18.1 Rural 74.3 (72.18%) 83.3 (68.84%) 9.0 Urban 28.6 (27.82%) 37.7 (31.16%) 9.1
9. RURAL = 7% URBAN = 30% Population above 40 year age group RURAL = 68.4% (19.7 Cr) URBAN = 31.6% (9.1 Cr) Total population load (>40 years) with DM RURAL 1.4 Cr URBAN 2.71 Cr Prevalence of DM in > 40 years age group Total population = 121 Cr Diabetic load at present…. 2011 Census Total population All ages Total population > 40 years Total population = 28.8 Cr
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12. K. Kaliyaperumal , I.E.C. Expert, Diabetic Retinopathy Project. Guideline for Conducting a Knowledge, Attitude and Practice (KAP) Study. Community Ophthalmology Vol. IV, No.1, Jan - Mar 2004 What is KAP? The Knowledge: refers to understanding of any given topic – DM/DR The Attitude: refers to their feelings or any preconceived ideas The Practice: translating their knowledge and attitude through their actions
13. It highlights the lacunae in our health care systems and the foci of concern. How to use KAP data?
14. N = 204 Paramedical personnel (PAP); 201 Community members (CM) KAP study (2002-2007) Before questionnaire After questionnaire Knowledge Awareness of Diabetes 59% PAP 28% CM 62% PAP 77% CM Awareness of Diabetic Retinopathy 55% PAP 7% CM 79% PAP 68% CM Awareness of treatment options of DR 24% PAP 3% CM 84% PAP 65% CM Knowledge regarding diet in DM/DR 70% PAP 46% CM 76% PAP 100% CM Attitude Positive attitude for DR 88% PAP 52% CM 94% PAP 83% CM Practice Advocating allopathy for DM/DR 80% PAP 83% CM 96% PAP 96% CM
15. PK Rani, R Raman, S Subramani, G Perumal, G Kumaramanickavel, T Sharma. Rural Remote Health 2008 Jul-Sep;8(3):838.
16. Association of knowledge of diabetic retinopathy on Attitude and Practice Factors Knowledge (n = 718) No knowledge N = 1220) P value Attitude: Should persons with DM go for regular eye examinations YES 93.3% 65.9% <0.0001 NO 6.7% 34.1% Practice: Persons with DM with control of their blood sugar can avoid visiting an ophthalmologist YES 36.5% 55.5% <0.0001 NO 63.5% 44.5%
17. Knowledge of available treatment for DR *Knowledge level of factors in the ascending level of importance Factor level* Factor Knowledge (n = 718) No knowledge (n = 1220) P value 4 Laser treatment 50.1% 22% <0.0001 3 Good control of diabetes 53.2% 34.1% <0.0001 2 Surgery 38.2% 18.4% <0.0001 1 Don’t know 9.2% 22.5% <0.0001
18. *Knowledge level of factors in the ascending level of importance Choice of health care professional in the event of eye problem Factor level* Factor Knowledge (n = 718) No knowledge (n = 1220) P value 4 Ophthalmologist 82.6% 69.8% <0.0001 3 Optometrist 48.3% 41.1% <0.0019 2 Non-ophthalmologist 39.6% 33.4% <0.0060 1 Don’t know 4.0% 9.3% <0.0001