Anna Palagyi

The George Institute for Global Health · Centre for Health Systems Science

Purpose: The World Health Organization Program for the Prevention of Blindness adopted the principles of universal health coverage (UHC) in its latest plan, Universal Eye Health: A Global Action Plan, 2014–2019. This plan builds on the achievements of Vision 2020, which aimed to reduce the global prevalence of avoidable blindness, and its unequal d...

Background The co-administration of multiple drugs (polypharmacy) is the single most common cause of adverse drug events in the older population, and residents of long-term care facilities (LTCFs) are at particularly high risk of medication harm. ‘Deprescribing’ – the withdrawal of an inappropriate medication with goal of managing polypharmacy and...

Background: To assess the prevalence and predictors of depressive symptoms in a cohort of older adults awaiting cataract surgery and establish threshold vision at which depressive symptoms may emerge. Design: Analysis of cross-sectional baseline data from a longitudinal cohort study of patients aged ≥65 years on Australian public hospital catara...

This review reflects on what the literature to date has taught us about how health systems of low- and middle-income countries (LMICs) respond to emerging infectious disease (EID) outbreaks. These findings are then applied to propose a conceptual framework characterising an EID prepared health system. A narrative synthesis approach was adopted to e...

In this systematic review and meta‐analyses, we sought to determine sex‐disparities in treatment abandonment in children with cancer in low‐ and middle‐income countries (LMICs) and identify the characteristics of children and their families most disadvantaged by such abandonment. Sex‐disaggregated data on treatment abandonment were collated from th...

This mixed-methods study aimed to: 1) characterise veterinary antimicrobial imports into Fiji over a 12 month period; and 2) evaluate the knowledge, perception and practice of antibiotic use and antimicrobial resistance (AMR) among livestock farmers in the Central Division of Fiji. Out of 15 antibiotic import shipments during November 2016−October...

Lower-middle income Indonesia, the world's fourth most populous country, has struggled to contain costs in its mandatory, single-payer public health insurance system since the system's inception in 2014. Public procurement policies radically reduced prices of most medicines in public facilities and the wider market. However, professional associatio...

Background The WHO has warned that substandard and falsified medicines threaten health, especially in low and middle-income countries (LMICs). However, the magnitude of that threat for many medicines in different regions is not well described, and high-quality studies remain rare. Recent reviews of studies of cardiovascular and diabetes medicine qu...

In May 2022, the 75th World Health Assembly recognised the need to accelerate national responses to the growing burden of noncommunicable diseases (NCDs) to achieve the goals of the Global Action Plan (GAP) for the Prevention and Control of NCDs. This article is protected by copyright. All rights reserved.

Background The World Health Organization (WHO) has warned that substandard and falsified medicines threaten health, especially in low- and middle-income countries (LMIC). However, the magnitude of that threat for many medicines in different regions is not well described, and high-quality studies remain rare. Recent reviews of studies of cardiovascu...

Objective To investigate perceptions of iTaukei Fijian women and men around diet and the ability to consume a healthy diet. Design Six focus groups conducted with women and men, separately. Six to 10 women and men participated in each group. Discussions were recorded, transcribed, translated, and thematically analysed. Themes were mapped to an int...

Background Community health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang...

Background The UN Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) represents an international commitment to equality in the enjoyment of human rights. International human rights scholars posit that, in facilitating constructive dialogues between states and human rights experts, the near-universally ratified Conven...

Objective: To compare fall incidence, and visual acuity and refractive status, before surgery and after first and second eye cataract surgery. Design, setting: Prospective observational study in eight tertiary referral ophthalmology clinics in public hospitals in Sydney, Melbourne, and Perth. Participants: People aged 65 years or more referred...

Community health workers (CHWs) are the first point of contact with the primary health care system in many low- and middle-income countries and are situated to play a critical role in the public health response to the COVID-19 pandemic. The knowledge, attitude and practices of CHWs regarding COVID-19 may be influenced by their level of trust and pa...

Objective: To review the evidence on the impact on measurable outcomes of performance-based incentives for community health workers (CHWs) in low- and middle-income countries. Methods: We conducted a systematic review of intervention studies published before November 2020 that evaluated the impact of financial and non-financial performance-based...

Background Women are disadvantaged by ageing: older women are more likely than older men to suffer from ill-health, have less access to health care and suffer discrimination within the health care system. Globally, there is a dearth of health research on gender and ageing with substantial knowledge gaps in low and middle-income country contexts. Pa...

Background The World Health Organization recommends that community health workers (CHWs) receive a mix of financial and non-financial incentives, yet notes that there is limited evidence to support the use of one type of incentive (i.e. financial or non-financial) over another. In preparation for a larger scale trial, we investigated the acceptabil...

There remains limited literature to facilitate understanding of healthy ageing-related policies in China over the last five-year policy planning cycle. This study aims to characterise all relevant policies and identifies the policy gaps from a health system perspective. A scoping review framework was used. A thorough search for healthy ageing-relat...

Background Women are disadvantaged by ageing: older women are more likely than older men to suffer from ill-health, have less access to health care and suffer discrimination within the health care system. Globally, there is a dearth of health research on gender and ageing with substantial knowledge gaps in low and middle-income country contexts. Pa...

Cardiovascular diseases (CVD) are the leading cause of death in Indonesia, and there are large disparities in access to recommended preventative treatments across the country, particularly in rural areas. Technology-enabled screening and management led by community health workers have been shown to be effective in better managing those at high risk...

Amid massive health system disruption induced by the coronavirus disease 2019 (COVID-19) pandemic, the need to maintain and improve essential health services is greater than ever. This situation underscores the importance of the primary health care (PHC) revitalization agenda articulated in the 2018 Astana Declaration. The objective was to synthesi...

Cataract surgery is a safe, effective and common elective procedure in Australia but access is inequitable. True waiting times for cataract care are undisclosed or inconsistently reported by governments. Estimates of true waiting times range from 4 to 30 months and have been extended during the coronavirus disease 2019 (COVID-19) pandemic. Comparat...

This study examined the association between varying levels of visual acuity (VA) and physical performance (Short Physical Performance Battery) in older adults. A cross-sectional analysis of participants aged ≥50 years with a clinical diagnosis of vision loss across two studies was undertaken. Of 434 (96%) participants with available VA data, 74% (3...

Introduction This paper synthesises evidence on the organisation of primary health care (PHC) service delivery in low-income and middle-income countries (LMICs) in the Asia Pacific and identifies evidence of effective approaches and pathways of impact in this region. Methods We developed a conceptual framework describing key inputs and outcomes of...

Introduction Interventions targeting the financing of primary health care (PHC) systems could accelerate progress towards universal health coverage; however, there is limited evidence to guide best-practice implementation of these interventions. This study aimed to generate a stakeholder-led research agenda in the area of PHC financing intervention...

Health system planners in low- and middle-income countries (LMIC) of the Asia-Pacific region seeking to reorient primary health care (PHC) systems to achieve universal health coverage may be hindered by lack of knowledge of what works in their setting. With limited resources for research available, it is important to identify evidence-based strateg...

Background: Previous research has shown that cataract surgery referral letters to major metropolitan public hospitals in New South Wales have insufficient detail to inform patient triage or apply prioritisation tools. This study aimed to canvass the views of optometrists working in New South Wales and the Australian Capital Territory (NSW/ACT) on...

Chronic kidney disease (CKD) is a significant and growing driver of the global non-communicable diseases (NCD) burden, responsible for 1.2 million deaths in 2016. While previous research has estimated the out-of-pocket costs of CKD treatment and resulting levels of catastrophic health expenditures, less is known about the impact of such costs on ac...

Purpose: Findings from cross-sectional blindness prevalence surveys are at risk of several biases that cause the study estimate to differ from the ‘true’ population prevalence. For example, response bias occurs when people who participate (‘responders’) differ from those who do not (‘non-responders’) in ways that affect prevalence estimates. This s...

Background: It is critical to consult patients to develop patient-centred cataract surgery care. We aimed to identify attributes patients consider when making decisions about cataract surgery in an Australian context, where both publicly and privately funded surgery are available. This is the first step in investigating how decisions are made abou...

Purpose: To clarify the effect of first-eye cataract surgery on the incidence of falls and identify components of visual function associated with fall risk. Setting: Eight public hospital eye clinics in Sydney, Melbourne, and Perth, Australia. Design: Prospective cohort study. Methods: The study recruited patients who had bilateral cataract,...

Background: Benchmarking exercises are important to document referral processes and to identify areas where improvements can be made. Design Cross-sectional study with longitudinal follow-up conducted at two metropolitan public hospitals in New South Wales, Australia. Samples 400 sequential cataract referral letters. Methods: An audit of catarac...

Objective Cross-sectional blindness prevalence surveys are essential to plan and monitor eye care services. Incomplete or inaccurate reporting can prevent effective translation of research findings. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement is a 32 item checklist developed to improve reporting of ob...

Medline search strategy. (PDF)

STROBE and blindness prevalence surveys data. (XLSX)

List of blindness prevalence studies included in the evaluation of STROBE adherence. (PDF)

Background Patient‐reported outcome measures (PROMs) are becoming increasingly recognised as a key component in assessing the relative effectiveness of cataract surgery. This manuscript presents the protocol methodology and baseline characteristics of a prospective cohort study investigating patient‐centred predictors of cataract surgery outcomes....

Aim: To examine fear of falling and associated factors in a cohort of older adults with cataract, and investigate the interplay of vision and physical function with respect to fear of falling. Methods: We analyzed baseline data from a longitudinal study of adults aged ≥65 years referred for cataract surgery. Fear of falling was assessed by the S...

Purpose: Strong evidence indicates an increased fall risk associated with cataract. Although cataract surgery can restore sight, lengthy wait times are common for public patients in many high-income countries. This study reports incidence and predictors of falls in older people with cataract during their surgical wait. Methods: Data from a prosp...

Background General Practitioners (GPs) are responsible for primary prescribing decisions in most settings. Elderly patients living in Advanced Care Facilities (ACFs) often have significant co-morbidities to consider when selecting an appropriate drug therapy. Careful assessment is required when considering appropriate medication use in frail older...

Background There is strong evidence of increased falls risk associated with cataract. Although cataract surgery can restore sight, lengthy waiting times are common in many high income countries, including Australia. Here, we report the risk and determinants of falls in older people with cataract during their surgical wait. Methods Data from a pros...

Background: Although cataract surgery can restore sight, lengthy waiting times are common in public hospitals in Australia. We investigated the driving status of older people during their surgical waiting period. Methods: Baseline, cross-sectional data from two prospective cohort studies of patients aged 50 years and older on Australian public h...

The patient pathway to cataract surgery in Australia generally begins with optometric services; however, little is known about the cataract surgery referral criteria used by optometrists in Australia. Members of Optometrists Association Australia were invited to complete an online survey in April 2013. The survey elicited information on practice de...

Falls result in >$1 billion in treatment, disability, lost output and mortality each year in Australia and people with cataract are at increased risk. Previous research is inconclusive; one large Australian study using linked hospital data found no protective effect of cataract surgery. We aim to examine the impact of cataract-related vision impair...

To examine the financial viability of the Timor-Leste National Spectacle Program as it increases spectacle availability, affordability and uptake, particularly for Timor's poor. In rural areas, three models of ready-made spectacles were dispensed according to a tiered pricing structure of US$3.00, 1.00, 0.10 and 0.00. In addition, custom-made spect...

To determine the use of medical services for eye problems in Fiji, and barriers to seeking that care. An interview-based questionnaire was administered as part of a population-based cross-sectional survey of adults selected by multistage random sampling from those aged ≥40 years living on Fiji's main island. Participation rate was 73.0% (n = 1381)....

To determine the independent, relative, and combined impact of reduced distance and near vision on the vision-specific quality of life (VS QOL) of adults in Timor-Leste. A population-based cross-sectional eye health survey was conducted in urban and rural areas in Timor-Leste. Participants were 40 years or older. Those with better eye presenting di...

The Western Pacific region has a dearth of appropriately educated eye care providers, training programs and large and increasing eye health needs. To ensure regional eye health needs would be met, an iterative process sought triangulations between the literature and consultations with local stakeholders from various fields. This information was use...

A 12-month Diploma of Eye Care course for mid-level eye care workers was initiated in 2007 as part of Timor-Leste's National Eye Health Strategy. This paper reports the development and implementation of this course, examines its initial results and makes suggestions for improvements to the training and deployment of these workers. Course curriculum...

To develop output and outcome indicators for the correction of refractive error and presbyopia to a level comparable with those advocated by Vision 2020 for cataract. World Health Organization, Vision 2020 and published eye care intervention literature were searched to find evidence of best practice. This information was used to construct a suite o...

To test the applicability of standards of appearance, construction, optical quality and performance, and durability proposed for readymade spectacles to be used by eye care programs in low-resource countries. Orders of readymade spectacles were procured from three suppliers by an eye care program in Timor-Leste. Feedback regarding quality was given...

To conduct a survey of willingness to pay for ready-made spectacles in the low-resource country of Timor-Leste, and, uniquely, subsequent validation with actual payment information. A systematic random sampling strategy was used to apply a binary with follow-up stated willingness to pay methodology. Findings were validated by comparing the amount d...

Vision impairment has significant impact on quality of life and substantial economic consequences. Yet, in the Pacific Islands, as in other low resource settings, it is predominantly caused by chronic conditions that can be treated or prevented. A whole of health approach is required to rectify this, and must include an increase in workforce capaci...

Little information is available regarding the perceived need, previous acquisition, use and willingness to pay for spectacles in Fiji, on which to base spectacle provision services. Using a rapid appraisal technique, semi-structured interviews were conducted with 174 urban and rural households in Fiji's Central Province to assist in planning eye-ca...

Given that uncorrected refractive error is a frequent cause of vision impairment, and that there is a high unmet need for spectacles, an appraisal of public sector arrangements for the correction of refractive error was conducted in eight Pacific Island countries. Mixed methods (questionnaire and semi-structured interviews) were used to collect inf...

To develop and determine the reliability and validity of a vision-specific quality-of-life instrument (TL-VSQOL) designed to assess the impact of distance and near vision impairment in adults living in Timor-Leste. A vision-specific quality-of-life questionnaire was developed, piloted, and administered to 704 Timorese aged >or=40 years during a pop...

To evaluate against its objectives the achievements of the first 5 years of a national eye health programme in Vanuatu. Programme clinical activity data were collated from surgical logs, clinic and outreach reports, and patient register books. Cataract surgical outcomes were retrieved from monitoring software. Programme annual reports provided info...

To assess willingness to pay for spectacles in provincial Cambodia, and use this to inform creation of a financially self-sustaining spectacle scheme within a blindness prevention programme. An interview-based questionnaire was used to elicit willingness to pay for spectacles of all people dispensed spectacles during an outreach refraction service...

Background: To determine utilization of Western-style conventional health services for eye problems in Timor-Leste, and barriers to seeking that care. Methods: An interview-based questionnaire was administered as part of a population-based cross-sectional survey of 50 clusters (urban and rural) of 30 people aged > or =40 years. Results: Of 147...

To estimate the prevalence and causes of blindness and low vision in people aged > or = 40 years in Timor-Leste. A population-based cross-sectional survey using multistage cluster random sampling to identify 50 clusters of 30 people. A cause of vision loss was determined for each eye presenting with visual acuity worse than 6/18. Of 1470 people enu...

To investigate the aspects of spectacle correction of vision-impairing refractive error and presbyopia in those aged >or=40 years in Timor-Leste. A population-based cross-sectional survey with cluster random sampling was used to select 50 clusters of 30 people. Those who had uncorrected or undercorrected refractive error (presenting acuity worse th...

Purpose: To determine the prevalence of visually significant and unoperated blinding cataract, and the coverage, characteristics and outcome of cataract surgery in Timor-Leste. Methods: Based on the World Health Organization Rapid Assessment of Cataract Surgical Services protocol, a population-based cross-sectional survey was conducted in 2005....