Is the existing knowledge and skills of health workers regarding eye care in children sufficient to meet needs?

Although uncommon, childhood blindness is a major contributor to blind-person years in Africa. Children with vision-related problems need urgent referral, but existing evidence suggests that there is delay in presentation. A pilot study in a random selection of government dispensaries in two districts of Kilimanjaro Region, Tanzania, was conducted to assess the knowledge and skills of primary healthcare workers regarding eye care needs of children. Questionnaires were administered to 16 healthcare workers, and in-depth interviews were conducted with 9 health workers and 2 key informants. Overall, 88% of workers recognised cataract in a picture, 63% knew that it required surgery but only 50% realised surgery was urgent. Only 38% recognised squint as needing referral and none considered this urgent. Moreover, 38% could correctly suggest a cause of a large corneal scar and 44% of workers believed that children with albinism need to attend schools for the blind. Poor knowledge of referral and treatment guidelines are likely due to a number of factors, including inadequate training and the rarity of childhood blindness. Primary eye care manuals should be reviewed to ensure that information regarding childhood blindness is adequate and appropriate. Referral pathways should also be revised.

Lid surgery in patients affected with leprosy in North-Eastern Nigeria: are their needs being met?

Corneal blindness is second only to cataract as a cause of blindness in leprosy patients. Eyelid surgery provided by trained paramedical staff can often prevent blindness in these patients. We sought to determine the extent to which paramedic personnel are meeting the eyelid surgical needs of these patients and to investigate the barriers that may be preventing them from seeking surgery. A total of eight leprosy settlements in north-eastern Nigeria were selected for this study. In these villages, 480 residents who were 30 years of age or older who had been diagnosed as having leprosy had their eyes examined for the presence of lagophthalmos, entropion/trichiasis and evidence of surgery for either of these conditions. Patients who had not been operated on for either of these conditions were questioned to determine their reasons for not seeking surgery. One hundred and sixteen (12.1 %) eyes were in need of surgery while 5.1 % of eyes had been operated upon. The surgical coverage for eyelid surgery was 30%; lagophthalmos had a better surgical coverage of 44.4% compared to entropion/trichiasis, which had 24.7% coverage. Lack of awareness about the treatment available was the most common reason given for not seeking surgery. This study shows that despite the presence of trained paramedical staff in the community, the eyelid surgical needs of these patients are not being met primarily because the level of awareness about the availability of effective treatment still remains low. In addition, the readiness of eye-care staff to visit these settlements was disappointing. Extra efforts will have to be made.