Using primary health care (PHC) workers and key informants for community based detection of blindness in children in Southern Malawi.

BACKGROUND: There is great interest in providing primary eye care (PEC) through integration into primary health care (PHC). However, there is little evidence of the productivity of PHC workers in offering primary eye care after training and integration, and there is need to compare their effectiveness to alternative methods. The current study compared the effectiveness of trained Health Surveillance Assistants (HSAs) versus trained volunteer Key Informants (KIs) in identifying blind children in southern Malawi. METHODS: A cluster community based study was conducted in Mulanje district, population 435 753. Six clusters each with a population of approximately 70 000 to 80 000, 42% of whom were children were identified and randomly allocated to either HSA or KI training. From each cluster 20 HSAs or 20 KIs were selected for training. Training emphasized the causes of blindness in children and their management, and how to identify and list children suspected of being blind. HSAs and KIs used multiple methods (door to door, school screening, health education talks, village announcements, etc.) to identify children. Using the World Health Organization (WHO) estimates (eight blind children per 10 000 children); approximately 144 to 162 blind children were expected in the chosen clusters. Listed children were brought to a centre within the community where they were examined by an ophthalmologist and findings recorded using the WHO form for examining blindness in children. RESULTS: A total of 59 HSAs and 64 KIs were trained. HSAs identified five children of whom two were confirmed as blind (one blind child per 29.5 HSAs trained). On the other hand, the KIs identified a total of 158 children of whom 20 were confirmed blind (one blind child per 3.2 KIs trained). More blind boys than girls were identified (77.3% versus 22.7%) respectively. CONCLUSION: Key Informants were much better at identifying blind children than HSAs, even though both groups identified far fewer blind children compared with WHO estimates. HSAs reported lack of time as a major constraint in identifying blind children. Based on these findings using HSAs for identifying blind children would not be successful in Malawi. Gender differences need to be addressed in all childhood blindness programs to counteract the imbalance

Glaucoma, "the silent thief of sight": patients' perspectives and health seeking behaviour in Bauchi, northern Nigeria.

BACKGROUND: In Nigeria, glaucoma has a high prevalence and is the second cause of blindness among adults after cataract. People with glaucoma frequently present very late with advanced disease, and acceptance of and adherence to treatment is low. The purpose of the study was to explore how patients' understand and respond to glaucoma in order develop an intervention to improve adherence to treatment. METHOD: Hospital based qualitative study. Six focus group discussions were held with patients with advanced disease and who had either undergone glaucoma surgery, were receiving medical treatment, or had neither surgery nor medical treatment. Two traditional healers who treat eye conditions were interviewed. Audio files were transcribed, translated into English and recurring themes coded and categorized as the impact of vision loss, and understandings of the disease and its management. RESULTS: Visual loss impacted significantly on the lives of people with glaucoma in many ways. Many heard the term "glaucoma" for the first time during the study. Local terms to describe the symptoms included Hawan jinin ido ("hypertension of the eye"). Patients sought treatment in pharmacies, or with traditional healers who had different interpretations of glaucoma and its treatment to biomedical understandings. Cost and forgetfulness were the main reasons for low adherence to treatment while fear was a reason for not accepting surgery. Lack of money and negative staff attitudes were reasons for low follow up. CONCLUSION: Halting the progression of glaucoma is possible with treatment but the condition will remain a "silent thief of sight" in West Africa unless awareness, uptake of services and adherence to treatment improve. Understanding how glaucoma is locally conceptualised, lived with and responded to by patients is essential to aid the design of interventions to prevent glaucoma blindness in Africa. Findings have been used to adapt a motivational interviewing intervention, which is being evaluated in a clinical trial

Retinopathy of prematurity: it is time to take action.

Retinopathy of prematurity affects babies born preterm: before 37 weeks of gestation. Unless these babies are carefully managed, they can become visually impaired or blind. But there is hope: the condition can be prevented and treated

Treating ROP: how and when.

Laser treatment of ROP is highly effective. However, special care should be taken when treating preterm or newborn infants, and long-term follow-up is essential. There are also new treatments on the horizon, particularly in cases where laser treatment is not possible or has failed

Screening for ROP.

Screening babies for ROP is very important. Unless ROP is detected early and promptly treated, it can lead to blindness and permanent visual impairment. This article describes who to screen, when and where to screen, how to screen, and what to do next

Following up children born preterm.

Babies born preterm, particularly those who have been treated for retinopathy of prematurity, are at greater risk of other eye conditions. Examining these children again, at the right time, can save their sight

Exploration of indigenous knowledge systems in relation to couching in Nigeria

Background: Couching is a traditional treatment for cataracts but often has poor visual outcomes, as identified during the Nigerian National Blindness Survey.Objectives: To investigate why couching is accessed by individuals with cataracts in northern Nigeria.Methods: The ten rural clusters in Jigawa State included in the National BlindnessSurvey were revisited to trace four groups of participants: cataract blind individuals, those couched or who had undergone cataract surgery and local couchers. Additional postoperative patients were recruited from the local eye department. Semi-structured interviews were undertaken with cataract blind and cataract-operated participants, and 27 in-depth interviews were conducted with those couched and five couchers. Qualitative data were translated, transcribed and analysed after immersion and reflection using a thematic framework.Results: Half of the cataract blind attributed the cause to spiritual factors or past misdeeds, only 25% knew they had cataracts and 83% had not undergone ophthalmic examination. Cost, distance and unreliability of services were the main barriers to accessing surgery. Facilitators of couching were the responsiveness of couchers in relation to location, timing and payment, and immediate visual improvement. Couchers understood local beliefs, were itinerant and used a network of case finders.Conclusions: Couching is accepted as it is entrenched in traditional beliefs and indigenous knowledge systems, and couchers are responsive. Lack of awareness and inaccessibility were barriers to cataract surgery. Strategies to improve cataract surgery must take account of local beliefs and factors influencing health-seeking behaviour. Couchers were willing to collaborate with professional eye care providers, but this will require time, skill and mutual trust.Keywords: couching</jats:p

Twenty years of childhood blindness: what have we learnt?

Over the last 20 years, much has been achieved in controlling blindness in children. Prior to the launch of VISION 2020, a number of international initiatives and programmes had raised the profile and increased interventions for child health and survival, which also had a positive impact on eye diseases and blindness in children, e.g. the Expanded Programme for Immunisation (EPI )(1974) and the Global School Health Initiative (1995). Since 2000, the United Nations' Millennium Development Goals have emphasised the need to promote child health and survival