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Childhood Blindness

Childhood Blindness. Mohammad Muhit PhD Child Sight Foundation & University of South Asia. Country profile: Bangladesh. Area: 144,000 sqkm Population: 140 million, 50m children Health budget : 1.7% of total budget Life expectancy 58.9 Per capita GDP: US$1,483

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Childhood Blindness

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  1. Childhood Blindness Mohammad Muhit PhD Child Sight Foundation & University of South Asia

  2. Country profile: Bangladesh Area: 144,000 sqkm Population: 140 million, 50m children Health budget : 1.7% of total budget Life expectancy 58.9 Per capita GDP: US$1,483 Population 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)

  3. Causes of childhood blindness in Bangladesh Childhood blindness due to Cataract

  4. Childhood Blindness Profile National 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’.

  5. 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.

  6. 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

  7. BCCC: Partnership in Practice 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

  8. 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

  9. 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

  10. Community based eye care services for children Awareness campaign Training on ‘how to identify a blind child’ Health education Empowering communities & key informants Community Mobilizer for Child Sight Working with key informants, volunteers and other organisations to develop linkages and to overcome barriers. Blind Children in their home Assessment, counselling & referral by mobile team Incurable Treatable Eye hospital Schools Rehabilitation

  11. Harun-Ur-Rashid, with children Ahsanullah, Fazar Ali, Osman Gani, Khadija, and Yunus, who all can now see thanks to a simple operation. Salma and Shetu after cataract surgery; with their mother Photo courtesy: : Ian Rutherford, Daily Scotsman Photo courtesy: : Pany Petro CSF

  12. 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

  13. 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

  14. Strategic Evaluation: BCCC 2010 • Effectiveness: BCCC was effective, as the objectives and targets were met or almost met.

  15. 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.

  16. Time efficiency

  17. Uptake of cataract surgery among cataract blind children identified, by case finding partner

  18. Cost efficiency in case finding

  19. Reimbursement of clinical partners for managing cataract in children.

  20. 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

  21. Thank you!

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