DR remains a threat to sight in people with diabetes in this elderly Kenyan population. The National Guideline for Integrated Management of Acute Malnutrition was prepared with the active participation of nutrition experts from several organizations and institutions in Kenya. Of 87 individuals with DR, 23 had visual impairment (visual acuity <6/12). ... 2018. Antiangiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) modalities is used to try to improve vision in people with DMO. Unfortunately, vision that has been lost may never be regained. Authors' conclusions: However, the results suggest that anti-VEGFs can reduce the risk of intraocular bleeding in people with PDR. Overview of Primary and Secondary ASCVD Prevention The ACC Cholesterol Guideline Clinical Why go beyond the ‘Basic Protocols’ Even countries with resources have national/regional guidelines/protocols The need to standardise care Majority of neonates are not looked after by paediatricians & neonatal nurses Basic protocols lack details & many common other problems not covered Newborn Protocols 3 The protocol borrows various international recommendations including the World Health Organization, from experience of other countries such as China that has 2017. To estimate the prevalence of and factors associated with diabetic retinopathy (DR) among people aged ≥ 50 years in Nakuru, Kenya. Whereas all reasonable precautions have been taken by the authors to verify the information contained in this publication, the published material is being distributed without warranty. Clinical Guidelines for Diagnosis and Treatment of Common Conditions in Kenya Government of Kenya Ministry of Health W.H.O. Loss of peripheral vision/visual eld loss, recommendation is to use less intense laser, Vitrectomy / Internal limiting membrane (ILM) peeling, Concurrent laser treatment is also done intraoper, also being appropriately monitored by a primary care or specialist diabetes, pathways for patients from the diabetes clinic to the eye clinic, Monitoring and Evaluation of the DR services, The clinical practice guidelines (CPGs) adhere to the basic principles for the, screening of a disease at population level, and will guide scr, screening and management in the DR referr, The Monitoring & Evaluation framework pr. September 2018 . We calculated the risk ratio (RR) or the mean difference (MD), and 95% confidence intervals (CI). So, in low resources countries, adaptation of high quality guidelines is the way to go. All studies were at risk of performance bias because the treatment and control were different and no study attempted to produce a sham treatment. With new treatments available, it is imperative that diabetics be properly screened. This is partly related to reporting of trials conducted many years ago, after which panretinal photocoagulation has become the mainstay of treatment of proliferative diabetic retinopathy.Future Cochrane Reviews on variations in the laser treatment protocol are planned. People receiving anti-VEGF were less likely to have vitreous or pre-retinal haemorrhage at 12 months (RR 0.32, 95% CI 0.16 to 0.65; 3 RCTs, 342 participants, low quality evidence). This can be done in a scientific way using the ADAPTE methodology and toolkits. This article highlights some pertinent questions regarding use of telescreening for diabetic retinopathy. Telescreening for diabetic retinopathy seems to be a cost-effective, accurate, and reliable method for screening for diabetic retinopathy. We used standard methods as expected by the Cochrane Collaboration. There is high quality evidence that antiangiogenic drugs provide a benefit compared to current therapeutic options for DMO, that is grid laser photocoagulation, in clinical trial populations at one or two years. Background: The incidence of diabetes mellitus is rapidly increasing worldwide and over 366 million people have diabetes and according to the Kenyan Ministry of Health over 2 million Kenyans are affected by diabetes. Three studies were considered to be at risk of attrition bias.At 12 months there was little difference between eyes that received laser photocoagulation and those allocated to no treatment (or deferred treatment), in terms of loss of 15 or more letters of visual acuity (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.89 to 1.11; 8926 eyes; 2 RCTs, low quality evidence). A second consultative meeting to We did not use any date or language restrictions in the electronic searches for trials. The generation of EBCPGs is not an easy task. Guidelines on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children: supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. http://www.health.go.ke/wp-content/uploads/2017/11/Guidelines-for-Screening-and-Management-of-Diabetic-Retinopathy-in-Kenya.pdf, Steps followed in development of national DR guidelines, The relationship between the patient and other people who are important in diabetes care to prevent diabetic retinopathy, All figure content in this area was uploaded by Nyawira Mwangi, Guidelines for the screening and management of Diabetic Retinopathy in Kenya, This guideline is a publication of the Ophthalmic Services Unit and the Division, of Non Communicable Disease (DNCD), Ministry of Health Keny, No part of this publication may be reproduced, distributed, or tr, written permission of the Ministry of Health Kenya, e, quotations in critical reviews and certain other non-commercial uses permitt, These Guidelines for the screening and management of diabetic, Head, Ophthalmic Services Unit, Ministry of Health, P, The recommended citation for this document is as f, Ministry of Health, Guidelines for the screening and management of Diabetic, Diabetes mellitus (DM) is a global epidemic with signicant morbidity, The aim of these guidelines is to provide e, for screening and management of diabetic retinopath. It seeks to demystify TB diagnosis in children especially in the We examined 4414 adults (response rate 88.1%), of whom 287 had diabetes. The Journal of the Florida Medical Association. Main results: Further carefully designed clinical trials should be able to improve this evidence. The most common grade of DR was mild/moderate non-proliferative DR (NPDR; 22.1%, 95% CI 16.1-29.4%), while severe NPDR and proliferative DR were less frequent (13.9%, 95% CI 10.0-18.8%). Geneva: World Health Organization; 2018. 1 enya National Guidelines ... 3.2 Clinical Approach to STI Management 29 3.3 Syndromic Approach to STI Management 29 CHAPTER 4: CASE MANAGEMENT OF STIs 31 4.1 Urethral Discharge Syndrome in Men 33 ... prevention at all levels of the Kenya Health System. diet, increased physical activity and weight r, early in the course of diabetes has an important impact on long-term outcome, Encourage regular monitoring of blood sug, prole should be done at least annually (f, Hypertension in diabetes is associated with development of diabetic r, management of hypertension combined with lifestyle change and glycaemic, monitoring of blood pressure in a health car, Lipid-lowering has been shown to reduce the risk of prog, Serum fasting lipids prole should be assessed at diagnosis and annuall, Consider statins in primary and secondary prevention of DR but discontinue, should be assessed for diabetic retinopath, inhibitors should be discontinued in patients who are planning f, Although diabetic retinopathy can permanently damage the retina and lead t, on a calendar or medical record, and ackno, starting at the time of diagnosis of diabetes mellitus, unless the eye specialist, expect and to highlight the importance of yearly risk assessment such as eye. All rights reserved. presence of cataract or vitreous haemorrhage. How can the role of patients and patient education in screening be, strengthened?..................................................................................................16, Diagnostic evaluation of patients at the e, Monitoring and Evaluation of the DR services.................................................31, Cost of implementing the DR guidelines........................................................................34, Implementation of the Guidelines...................................................................................34, Revision of the guidelines..............................................................................................34, REFERENCES..............................................................................................................35, APPENDICES...............................................................................................................38, Appendix 6: Grading of Diabetic Macular Edema, Appendix 7: Management of Diabetic Maculopath, Appendix 9: Mapping of DR services in Ken, people who are important in diabetes care to pre, Simplied Classication of Diabetic Retinopath, Diabetic Retinopathy is a major complication of diabetes, including cataract and glaucoma, all of which are ref, In terms of the burden of dependence associated with this epidemic, the pot, social costs of severe visual impairment threat, on individuals and their families due to the cost of insulin and other essential, medicines, substantial economic implications arise from increased use of health, services, loss of productivity and the long-term support needed for people with, The International Diabetes Federation estimat, country is experiencing a rise in diabetes owing to demographic, nutritional, at the tertiary facilities for treatment of end organ damage, One in every three people with diabetics de, The risk of vision loss in people with diabetes is up to 25 times greater than, Good long-term diabetes management is essential to pre, individual support for adoption of healthy diet, reduce body weight, increase, Loss of vision from diabetic retinopathy can be pr, examination at diagnosis of diabetes or soon af, The decision to commence treatment should be discussed between the person, with diabetes and the health professional, as this enhances compliance, laser photocoagulation, intravitreal Injections of anti-V, mechanisms, and education of patients and care provider, Health services and systems research will be r, disease, particularly access to care, quality of care and nancing for scr, the distribution of diabetes and diabetic eye disease in dif, Clinical practice guidelines (‘guidelines’) ar, statements to assist practitioner and patient decisions about appr, The guidelines will apply to all persons living with diabet, services, by educators for supporting training and by health car, guide resource allocation for service delivery, health problem of diabetes and diabetic r, management of DR, particularly the International Council of Ophthalmology, taken to ensure harmonization with other guidelines such as the International, The guidelines are consistent with resear, The anticipated outcome of the use of the guidelines is improv, will be monitored using process and outcome indicat, to Non-Communicable diseases in the country, in dissemination of guidelines, and low utilization of guidelines by health, These clinical practice guidelines have been de, evidence-based clinical guidelines using the overlapping, ownership of the adapted guideline and ultimatel, Introduction to diabetes and diabetic eye disease, in 10 adults (642 million people) will be living with diabet, the global health expenditure is on diabetes and its complications, International Diabetes Federation (IDF) estimates the pr, of diabetic eye disease, particularly diabetic retinopathy (DR) ar, disease, and the risk increases with the duration of diabetes(1, the leading cause of vision loss in working age adults.
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