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!