Poverty and Cataract—A Deeper Look at a Complex Issue

Susan Lewallen discusses a new study that shows an association between visual impairment from cataract and poverty in three low-income countries

Why are we addressing gender issues in vision loss?

In the last decade, there has been increasing evidence that women are affected by blindness and visual impairment to a much greater degree than men. A systematic review of global population-based blindness surveys carried out between 1980 and 2000 showed that blindness is about 40 per cent more common in women compared to men (in persons older than 50 years). Since then, there have also been a number of large national surveys (for example, in Pakistan and Nigeria), as well as many rapid assessment of avoidable blindness studies (RAABs), which have confirmed the earlier findings. We now know that being a woman is a significant risk factor for some eye diseases; it is also an important factor in the use of eye care services

The Need for Management Capacity to Achieve VISION 2020 in Sub-Saharan Africa

Susan Lewallen and Amir Bedri Kello argue that human resources management will be crucial in reaching the global goal of eliminating avoidable blindness by the year 2020

Estimated Prevalence of Monocular Blindness and Monocular Severe Visual Impairment in Children of Cross Rivers State, Nigeria

Aim: The aim was to report on the prevalence of monocular blindness/monocular severe visual impairment (MB/MSVI) in children found in Cross River State Nigeria, using the key informant method (KIM). Settings and Design: A cross‑sectional study using the KIM. Patients and Methodology: Key informants were trained to identify children with vision problems through recognition of pictures of disease conditions, observation of behavior of the child and discussion with villagers during house to house visits, school visits, church visits, or market visits. They were instructed to bring the children to a predetermined health center for examination by a pediatric ophthalmologist led team. The children were examined, and findings recorded on the World Health Organization/prevention of blindness and low vision recording form for children. Statistical Analysis Used: Data were entered into MS Excel, transferred and analyzed with STATA 11. Results: Among 994 children with suspected visual impairment, 21.5% were diagnosed as MB/MSVI, with a population prevalence of 0.18/1000 children in the state. Males accounted for 61%. The leading anatomical causes were the cornea in 41%, the whole globe in 20%, and lens‑related in 19%. Boys were 2.6 times (95% confidence interval: 1.4–4.7, P = 0.002) more likely to have trauma as an etiology compared with girls. Conclusions: Monocular blindness/monocular severe visual impairment children are essentially “one‑eyed” children at risk of becoming blind individuals. The prevalence of MB/MSVI is 2.25 times that of bilateral blindness and severe visual impairment in children in this population. The main anatomical causes, as well as ocular trauma, are largely avoidable. Trauma that is avoidable was a significant etiology in boys compared with girls. MB/MSVI adds to the burden for child eye care services.Keywords: Child eye care services, monocular blindness, monocular severe visual impairment, Nigeria, ocular traum

Key informant perceptions of vision loss in children and implications for their training

Background: The role of key informants (KIs) in identifying children with vision loss is expanding, yet there is a minimal understanding of KI perceptions of vision loss in children. The aim of the study was to understand the KI’s perception of childhood vision loss in order to design more effective training programmes.Materials and Methods: A population-based study on the prevalence and causes of childhood blindness and severe visual impairment was conducted using the KI method. KIs were selected by their communities and trained in advocacy, identifi cation and referral of children with visual impairment. Prior to the KI training, a pre-test was conducted, asking, “what is your perception of vision loss in children and how will you identify these children in your community?”.Result: The 742 KI provided 1,650 responses. There were three main methods suggested to identify children; observation of a child, vision assessment of a child, and recognition of isolation of a child.Conclusion: KI have a good understanding of the impact of vision loss on children. Training programmes should use existing knowledge of KI. Furthermore, training programmes should include the social impact of severe vision loss to help identify children needing the assessment.Keywords: Childhood blindness, key informant, Nigeria, perception, visio

Achieving universal eye health coverage: planning and human resource lessons from trachoma

Teamwork has made a crucial difference to the success of trachoma elimination programmes. However, more trained supervisors are needed

Skills of general health workers in primary eye care in Kenya, Malawi and Tanzania

BACKGROUND:Primary eye care (PEC) in sub-Saharan Africa usually means the diagnosis, treatment, and referral of eye conditions at the most basic level of the health system by primary health care workers (PHCWs), who receive minimal training in eye care as part of their curricula. We undertook this study with the aim to evaluate basic PEC knowledge and ophthalmologic skills of PHCWs, as well as the factors associated with these in selected districts in Kenya, Malawi, and Tanzania. METHODS: A standardized (26 items) questionnaire was administered to PHCWs in all primary health care (PHC) facilities of 2 districts in each country. Demographic information was collected and an examination aimed to measure competency in 5 key areas (recognition and management of advanced cataract, conjunctivitis, presbyopia, and severe trauma plus demonstrated ability to measure visual acuity) was administered. RESULTS: Three-hundred-forty-three PHCWs were enrolled (100, 107, and 136 in Tanzania, Kenya, and Malawi, respectively). The competency scores of PHCW varied by area, with 55.7%, 61.2%, 31.2%, and 66.1% scoring at the competency level in advanced cataract, conjunctivitis, presbyopia, and trauma, respectively. Only 8.2% could measure visual acuity. Combining all scores, only 9 (2.6%) demonstrated competence in all areas. CONCLUSION: The current skills of health workers in PEC are low, with a large per cent below the basic competency level. There is an urgent need to reconsider the expectations of PEC and the content of training