Background
Globally, 1.4 million children are estimated to suffer from avoidable childhood blindness and three-quarters of these children live in the poorest regions of Africa and Asia. In Bangladesh, the prevalence of childhood blindness is not known, although it is estimated that there are 40,000 children with blindness.
Design
In 2016 with technical assistance from the World Health Organization Country Office for Bangladesh, the Non-communicable Disease Control unit of the Directorate General of Health Services piloted an intervention package for preventing avoidable childhood blindness in Golapganj Upazila, Sylhet. The aim of this pilot was to trial a model of prevention of avoidable blindness in children under 5 years of age, through early detection of cataract, retinoblastoma (cancer), squint, ulcers, trauma/injuries, structural deformity and retinopathy of prematurity. Initial screening for these conditions was conducted by community based primary health care workers during the course of their routine household visits. The pilot involved:
- Training of the field health workforce (Health Assistants, Assistant Health Inspectors, Health Inspectors, Family Planning Assistants, Family Planning Inspectors, and Community Health Care Providers) on screening for blinding eye conditions, primary management, counseling, and upward referral;
- Training of doctors on assessment of referred children at union and upazila level;
- Training of nurses on counseling of the parents at the Golapganj Upazila Health Complex (UHC)
- Supply of torch light to all trainees;
- Development and use of manual, data recording forms (screening form for field health workers, initial assessment form for doctors) and referral slips; and
- Supplies of communication materials, including posters, leaflets, and stickers to increase public awareness.
A total of 138 field health workers, 10 nurses and 24 doctors from Golapganj UHC received practical training on screening, initial assessment, diagnosis and management of the common eye conditions, using an easy-to-read training manual and pictorial flashcards of pictures specifically developed for this pilot.
Findings
Moving from house to house, over the course of three months the field workers screened 69.0% (29,184) of children under 5 years residing in the upazila. Out of 460 suspected cases of avoidable blindness referred to the Golapganj Upazila Health Complex, 127 children attended. Doctors at Golapganj UHC referred 110 children upward to the ophthalmology department of Sylhet MAG Osmani Medical College Hospital and 33.0% (36) children attended. The most common diagnosis was squint.
This pilot has demonstrated the ability to detect common causes of avoidable childhood blindness in community settings and to provide appropriate care of children at risk through well defined referal mechanisms at low resource setting.
The commitment of the Directorate General of Health Services, the leadership of the health manger of the piloted upazila, engagement of the local health workforce, participation of the local leaders, and the acceptance of the pilot initiative by the community were identified as factors for the pilot’s success. The purposively- developed training manual and communications materials were effective resources to support the field workforce’s training.
Next Steps
Following this pilot, the key next steps include identifying the most cost-effective method to deliver this intervention, exploring methods of integrating this intervention into existing health services for children, and increasing attendance after referral. The Directorate General of Health Services and WHO will work together to further evaluate and plan for the scale up of this intervention, in order to reduce avoidable childhood blindness in Bangladesh.
References