Summary Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.
BackgroundPeripheral arterial disease (PAD) is a major health problem in diabetes patients in high-income countries, but the PAD burden in sub-Saharan Africa is largely undetermined. We studied the prevalence of PAD and exertional leg symptoms in diabetes (DM) patients in a tertiary hospital in Ghana.MethodsIn a case control study design, 485 DM and 330 non-diabetes participants were recruited. PAD was diagnosed as Ankle Brachial Index (ABI) < 0.9. Edinburgh Claudication Questionnaire (ECQ) was used to assess exertional leg symptoms.ResultsThe overall prevalence of classical intermittent claudication was 10.3 % and ABI-diagnosed PAD was 26.7 %, with 3.5 % of the participants having both classic intermittent claudication and ABI-diagnosed PAD. The prevalence of exertional leg symptoms were similar in diabetes patients with and without PAD. In non-diabetes participants, intermittent claudication and rest pain were higher in PAD patients than in non-PAD participants. In multivariable logistic regression, intermittent claudication [OR (95 % CI), 3.39 (1.14 – 8.1), p < 0.05] and rest pain [4.3 (1.58 – 9.67), p < 0.001] were independently associated with PAD in non-diabetes group, and rest pain [1.71 (1.13 – 2.17), p < 0.05] was associated with PAD in all participants.ConclusionsThere is high burden of PAD and exertional leg pains in DM patients in Ghana. PAD is expressed as intermittent claudication and rest pain in non-diabetes individuals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0247-x) contains supplementary material, which is available to authorized users.
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