Childhood Blindness
description
Transcript of Childhood Blindness
Childhood Blindness
Mohammad Muhit PhD
Child Sight Foundation &University of South Asia
Country profile: BangladeshArea: 144,000 sqkm Population: 140 million, 50m childrenHealth budget : 1.7% of total budgetLife expectancy 58.9
Per capita GDP: US$1,483Population below poverty line: 35.6%
Literacy rate: M- 51.1%; F- 28.6%Rural population: 53.6%
Human Development Index rank: 132 (out of 162 countries)
82 / 4%
5 / 0%
35 / 2%
155 / 8%
246 / 13%
35 / 2%
607 / 31%
515 / 27%
255 / 13%
Glaucoma
Not Examined
Globe Appears Normal
Optic Nerve
Retina
Uvea
Lens
Cornea
Whole Globe
Childhood blindness due to CataractCauses of childhood blindness in Bangladesh
Childhood Blindness ProfileNational Childhood Blindness Study by ICEH-
• Prevalence of CHB: 0.7/1,000 children• 40,000 blind children in Bangladesh
– 36% treatable – 32% preventable
• Childhood cataract (31%) • Treatable cataract -12,000 blind children!
• Innovative approach to case detection (KIM).• Potential of further development of services
using ‘register for blind children’.
Situation in 2003Paediatric Cataract Backlog!
• 12,000 children with bilateral cataract
• 50 million children in the country.
• 1 fully trained paediatric ophthalmologist.
• Absolute lack of awareness about cataract in children – Public and Professionals.
• Services for children’s eye care-limited, expensive, inaccessible.
• No programme for childhood cataract.
Way Forward-
• Research – Causes, Barriers, SA.
• Advocacy-Childhood Blindness Workshop 2003
• Alliances- GO, NGO, policy makers, media..
• Establish the Need
• Provide a Framework for Action
• Develop appropriate tools (KIM)
• Mobilise resources
BCCC: Partnership in Practice
Media
Govt.
Donors
Eye Hospitals
local NGOs
Uni. dept
BCCC
Sight Savers International
ORBIS International
International Centre for Eye Health
Child Sight Foundation
Uttaran
YPSA
CBR projects
Islamia Eye Hospital
BNSB Sirajgonj Eye Hospital
BNSB Khulna Eye Hospital
CEITC, Chittagong Eye Hospital
BJAKS Comilla Eye Hospital
MOH & MOSW, Govt. of Bangladesh
Goal & objectives of the campaign
The Goal is to contribute to the elimination of avoidable Child Blindness by the year 2020, as part of the V2020 programme.
Objectives are-
• To eliminate 90% of the backlog of Childhood cataract in Bangladesh by the year 2008
• To contribute to the development of long term systems that will ensure that future incidence of childhood cataract in Bangladesh is adequately dealt with
• To support the development of long term systems to ensure that all irreversibly blind children receive the services to which they are entitled
• To provide lessons that can be used to inform similar programmes elsewhere
Bangladesh Childhood Cataract Campaign
• Identify 40,000 blind children• Treat 10,000 cataract blind children• 20,000 cataract surgery in children• Raise awareness throughout the country• Develop paediatric ophthalmic centres• Develop and maintain a database of blind children in the
country for future services• Document & disseminate programme learning.
• In 4 years!• With £2 million programme budget.• Campaign was launched in 2004 World Sight Day
Blind Children in their home
Empowering communities & key informants
Health education
Training on ‘how to identify a blind child’
Awareness campaign
Schools
Assessment, counselling & referral by mobile team
IncurableTreatable
Rehabilitation Eye hospital
Community based eye care services for children
Community Mobilizer for Child SightWorking with key
informants, volunteers and other
organisations to develop linkages and to overcome barriers.
Photo courtesy: : Ian Rutherford, Daily Scotsman
Harun-Ur-Rashid, with children Ahsanullah, Fazar Ali, Osman Gani, Khadija, and Yunus, who all can now see thanks to a simple operation.
Photo courtesy: : Pany Petro CSF
Salma and Shetu after cataract surgery; with their mother
Achievements in the first year: 2005• 2 Paed Ophth teams trained in India & Tanzania• 5 Centres has been enhanced with equipments• Over 3,000 cataract surgery in nearly 1,500 cataract
blind children• 3 ‘case finding’ NGOs are working in 3 divisions• Database for blind children designed & tested• Working Group of BCCC partners formed & active• Standard data recording forms have been designed and
trained for Child Cataract clinical data• Baseline data collected on KAP and SA• Key Performance Indicators for programme monitoring
Challenges and lesson in the first year
• Broad based partnership is challenging• Case finding in remote areas• Training of Paed Ophth team- expensive, training centres,
time• Procurement of IOL, glasses and LVA for children• Follow-up: long term and regular? • Multiple donors, hospitals, MOUs etc.• Programme monitoring system• Engaging media for awareness campaign• Competition between partners• Transparent and democratic decision making • BCCC partner hospitals- inclusive or exclusive?• Linkage with education and rehabilitation
Strategic Evaluation: BCCC 2010• Effectiveness: BCCC was effective, as the objectives
and targets were met or almost met. Blind children Cataract blind children
Traced Operated
TargetIdentifie
dN
% of those traced
Target
BCCC 28,520 9,373 33%
Non-BCCC1 4,456 1,286 29%
Total: 40,00032,976(82%)
10,659
32% 10,0007,674(77%)
BCCC Efficiency: • efficiency of the different types of case finding
• financial efficiency i.e. the cost per blind child and cataract blind child found
• whether the project was good value for money.
• Next slide: Number of blind children and cataract blind children expected, and identified, by case finding partner.
Case finding partner Population allocated (millions)
Population estimates Cases identified Cases operated
Method
All ages
Child pop
Blind1
Cat blind (30%)
Blind found
% of est-
imate
Cat blind
% of est-
imate
From CFP
Uptake (%)
Walk-in
CSF KI 38.2 15.7 10,960 3,288 10,492 96% 3,439 105% 2,361 69% 49
All CBR CBR 26.7 11.0 7,670 2,301 1,438 19% 1,147 50% 1,083 94% 387
YPSA H-t-H 17.7 7.3 5,087 1,526 4,992 98% 607 40% 587 97% 82
Uttaran H-t-H 15.9 6.5 4,557 1,367 6,433 141% 1,517 111% 708 47% 0
RDSS H-t-H 11.4 4.7 3,268 980 2,018 62% 1,046 107% 819 78% 108
VARD H-t-H 9.1 3.7 2,612 783 2,287 88% 1,133 145% 530 47% 0
Not clear 9.9 4.1 2,848 854 510 18% 147 17% 147 100% 233
Not clear 1.5 0.61 426 128 15 4% 15 12% 15 100% 32
Subtotal:
37,428 11,227 28,185 75% 9,051 81% 6,250 69% 891
CSF MA KI 12.2 5.0 3,509 1,053 4,456 127% 332 32% 322 97% 211
TOTAL 42.6 8.8 40,937 12,280 32,641 80% 9,383 76% 6,572 70% 1,102
Time efficiency
MonthsCataract
blind found
Cataract blind/mont
h
Under BCCC:
CSF Dhaka 20 2,567 1281
CSF Barisal 24 827 35
Uttaran 42 1,517 36
YPSA Chittagong 36 560 16
YPSA Chittagong HTs 29 47 2
VARD Sylhet 26 1,133 44
RDSS 26 1,046 40
Uptake of cataract surgery among cataract blind children identified, by case finding partner
Case finding partner
Acceptance of surgery among
bilaterally cataract blind
children
CBR 94%CSF 69%RDSS 78%Uttaran 47%VARD 47%YPSA 97%
Cost efficiency in case finding
Case finding partner
Total reimbursed
(BDT)
Blind children found
Reimbursed per blind child
found
Cataract blind children found
Reimbursed per cataract blind
child found
CSF 22,012,048 10,492 2,098 3,439 6,401
Uttaran 9,699,355 6,433 1,508 1,517 6,394
YPSA 4,992 607
VARD 6,549,507 2,287 2,864 1,133 5,781
RDSS 9,569,689 2,018 4,742 1,046 9,149
CBR partners
848,594 1,438 590 1,147 740
Others 115,724 860 135 494 234
Sub-total 59,528,51
728,520 2,087 9,383 6344
Reimbursement of clinical partners for managing
cataract in children. Clinical Partners Surgeries Total reimbursed
Reimbursed per surgery(BDT)
BNSB Mymensing 499 4,652,548 9,320
BJAKS 1,605 14,669,112 9,140
BNSB Moulavibazar 722 5,631,687 7,800
BNSB Dinajpur 3173 19,150,605 6,040
BNSB Khulna 2202 12,554,893 5,700
BNSB Sirajgang 5994 33,805,763 5,640
CEITC 2000 9,077,197 4,540
Islamia Eye Hospital 8398 36,965,653 4,400
Others 218 360,355 1,650
Sub-total 24,811 136,867,813 5,520
Beyond BCCC
• Unique programme for Child Cataract
• Replicable in other Asian, African and LA?
• 200,000 cataract blind children globally
• Development of more training centres
• Technical input & collaboration –ICEH
• Standard data recording forms and software available – childhood blindness & childhood cataract
• Sustainability- Technical, managerial, financial
Thank you!