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Community Ophthalmology Significance of Screening for Refractive Error Need for Normal Vision:
Prevalence of Refractive Error: Refractive error is a leading cause of blindness in school children accounting 7.35%. World Health Organization NPCB Survey 1986 – 89 In one of the biggest study so far carried out in five years in India, teachers screened 5.39 million children and refraction was done on 205,082 children. Prevalence of refractive error (RE) was 3.8%. Results of school eye screening of 5.4 million children in India- a five year follow study Limburg H, Kansara HT, d'Souza S. ( Acta Ophthalmol Scand 1999 Jun;77(3):310-4.] Significance of Refractive Error Refractive Error (RE) Study in Children from Chile reveals Myopia -0.50 diopter or less in either eye was present in 3.4% of 5-year-old children, increasing to 19.4% in males and 14.7% in females by age 15 years (Refractive Error Study in Children: results from La Florida, Chile. Maul E, Barroso S, Munoz SR, Sperduto RD, Ellwein LB. Am J Ophthalmol. 2000 Apr;129(4):525-7.) Refractive error is a leading cause of blindness in school children accounting 7.35%(World Health Organization NPCB Survey 1986 – 89 ). Blindness in childhood is a priority of Vision 2020. Even though the in worldwide total of 45 million blind people, only 1.4 million blind children but blind children have a lifetime of blindness ahead, which affects their opportunities for education, employment, and earning. Blindness that starts early in life for children but adversely affect psychomotor, social, and emotional development. And blind children have a higher death rate than their sighted counterparts. An estimated 500 000 children become blind each year, but, in developing countries, up to 60% are thought to die within a year of becoming blind. Almost half of all blindness in children--particularly those in the poorest communities--is due to avoidable causes that are amenable to cost effective interventions((World Health Organization. Elimination of avoidable visual disability due to refractive errors. Geneva: WHO, 2000. (WHO/PBL/00.79.) ). There may be many different dangers of not using glasses apart from the blurred vision and potential effects on the personality Refractive errors are a major cause of visual impairment. Correction of refractive errors in school children is considered a priority, because of their negative effect on children’s education. Approximately 5% of the children (approximately 3500 in our target population), may suffer from refractive errors. Teachers are in a prime, strategic position to detect these children and refer them to a suitable facility to get correction. Teachers are also an educated part of the society, and in the rural and semi rural setting, where this program is to be carried out; teachers may be the only educated segment of the society. By giving them the awareness, and the know-how, they could be recruited into the primary eye care delivery human resource, not only for the school children, but also for the rest of the populace. The concept of the School Eye Health programme being run in Chakwal is based on Hans Limburg’s work in India, with some modifications based on local experience gained in last three years by Munawwar Memorial Hospital, to indigenise the programme. MMH started SEHP as pilot in few schools in tehsil Chakwal.
Quality control Measures built within the program
Training Contents Self, Hospital & SEHP(old & present) SEHP ---------- 15min
A one-day workshop is given to teachers about PEC and their role in detection of common eye diseases in children (like Vitamin A deficiency, Ophthalmia neonaotrum, Squint and Trachoma etc) and in detection of Refractive Errors. These teachers later screened children of their respective school and come to MMH on the fix dates. CBOs members ,Community Health workers (CHWs) & Lady Health Workers (LHWs) are also trained in PEC for screening of non-school going children All referred children are examined in MMH and glasses & eye medications are provided where necessary. Motivational visits for the teachers & the children and, refreshers with on-the-spot training are also provided during the next 3 months. Impact of Refractive Error (Decrease Vision) on Children Decrease & blur vision
Ambylopia
Salient Features of Programme
1. Primary Eye Care (PEC) workshops to School teachers. School Children Vision screening program sponsored by Plan Pakistan 1. Situation Analysis - Vision screening April 2000
2. Pilot Project in Late 2000 with the support of Sight Savers Interventional
Children Vision Screening Program supported by TVO in 57 Elementary Schools of Chakwal, 2001 to 2002  Children Vision Screening Project in Plan Communities sponsored by Plan Pakistan - 2002 – 03  School Eye Health Programs 2004 to 30th June 2010 - supported by Plan Pakistan and Munawwar Foundation  A typical training workshop consisted of a 90 minute session, where a lecture is given to outline detection and management of common eye disease, accompanied by an easy to understand booklet. A few simple tools to diagnose and provide ophthalmic first aid are distributed and their use demonstrated as illustrated in the picture. This methodology is well established for these types of screening and rapid assessment programmes. Free eye camps after these workshops provide an opportunity for the teacher to demonstrate to the PEC workers methods of examination and further care.  Blindness and low vision are major causes of morbidity and have a profound effect on the quality of life for many people as well as reduction in the economic well being of individuals and their families. Cataract blindness develops at an earlier age in developing countries often striking people in their early 40s.It has profound economic burden on the limited national governments funds of in developing countries, in terms of lost productivity and livelihood and the costs of rehabilitation and special education for them. MMH & NRSP has been playing vital role by improving the quality life of rural communities through social mobilization since 2001. Now we have Alhamdulila has different partners who is also supporting to eliminate blindness from their communities. We have come to know that blindness is more common in women instead of men due to numbers of factors, due to this significance hospital has started a specific day for women. The major cause of blindness globally is cataract blindness, with an estimated 16 million cataract blinds worldwide. In Pakistan, it is estimated that 1.4 million people are cataract blind in the both eyes. This number is more than the total population of district Chakwal!! However, 80% of blindness is avoidable, through either prevention or treatment and, according to WHO, cataract surgery can be one of the most cost effective of all health intervention. The World Bank has developed a single measure of health status known as disability adjusted life years (DALYs). It is a combined indicator of the time lived with a disability and time lost due to premature mortality, and is both a qualitative and quantitative measure. When this measure is considered with the availability and cost of interventions, it leads to an assessment of their comparative cost effectiveness, i.e. cost per DALY saved. Why In Chakwal Chakwal is one of the underserved districts of Pakistan. The population of the district Chakwal is 1.1 million scattered over an area of nearly 6524 Sq. Geographically, it is part of Rawalpindi division and has three tehsils. Majority of the terrain is rain fed with small patches having access to irrigated water, while half of the terrain is not fit for cultivation. Due to extreme weather conditions, there is a weak industrial base. Majority of the labor force is employed in the defence forces or they work as formers. The urban to rural population ratio is 12 to 88 percent with female to male ratio of 1.08:1. [1998 District Censes Report Chakwal by Population Welfare Organization 2000]. Why we are with NRSP National Rural Support Programme (NRSP) is the largest Rural Support Programme in Pakistan in terms of outreach, staff and development activities. It is a not for profit organization registered under Section 42 of Companies Ordinance 1984. Its mandate is to alleviate poverty by harnessing people's potential and undertake development activities in Pakistan. It has a presence in 32 Districts in all the four Provinces including Azad Jammu and Kashmir through Regional Offices and Field Offices. NRSP is currently working with more than half a million poor households organized into a network of more than 29,000 Community Organizations. With sustained incremental growth, it is emerging as Pakistan's leading engine for poverty reduction and rural development. NRSP is interested in reduction in blindness, as a tool to alleviate poverty A recent review indicated that there is evidence of the impact of visual impairment on multiple dimensions of poverty (Poverty and blindness: a survey of the literature Feb 2004) Major Supports from NRSP Free Eye Camps Free Surgeries for Deserving patients Free glasses & medicine Full sponsored Friday Clinic Eye Care Trainings Trainings support of two Ophthalmic Technician Strategy as to identify the beneficiaries? The main beneficiaries for cataract screening camps, and cataract surgery will be the poor and deserving patients from different communities. We have very good penetration into various communities and carry out over 50 eye camps per year. We also have outreach staff and additional capacity in the system as a whole. In a typical camp, arranged in our catchments area, in collaboration with communities mentioned below, our qualified optometrist will carry out this activity, all patients will be screened free of charge and Near glasses and medicines will be provided to camp patients free of charge. All these services are made available to patients who are eligible for zakat. This will help us to reduce the blindness in the area. NRSP Sponsored Camp: A CO (community Organization) of NRSP that arranges a camp activity is made up of around 10- 20 community members mostly very poor, rural people. These CO are mostly based on same family or some other common social background. When it arranges a camp, they utilize their own (small and limited) resources for publicity. In early camps, other inhabitants of the villages who were not the members of that community / village, were excluded from that activity for surgery sponsorships form NRSP. But later this facility of cataract sponsorship extended to all needed coming to the camps provided CO members recommend him or her. Detail of Eye Camps  Blindness Reduction in females  To develop the capacity builidings of the students as well as trained human resource, MMH started this initiative and started the services of Vision Care Centre in the remote tehsil of District Attock. Lots of people benefited from this service and counless numbers of patients got cataract extraction surgeries. Now MMH has recently started its another center in the Chakwal city with the same aim & objective to serve the community to the best of their level. |
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