The economic impacts of cataract surgery on sustainable vision and quality of life in Katsina state.

Background: This study investigates the economic impacts of eye care interventions on the quality of life in Katsina state. Eye care intervention is a requirement for equitable and inclusive development in the state. Methods: The study used a survey method and 5-point Likert scale questionnaire to collect data. A multistage sampling strategy was employed to select 300 beneficiaries from the existing beneficiaries of Noor Dubai Foundation (NDF) eye care interventions. Results: The findings show that cataract surgery interventions improve economic benefits and quality of life of beneficiaries in Katsina state. The results show that productivity, income, employability, dignity and skills of beneficiaries have improved significantly after the cataract surgery. Precisely, 96.2% of the beneficiaries agree that their productivity has improved; 99.6% of the beneficiaries revealed that their income has improved; 99% of respondents evidence that their employability has improved; 90% of beneficiaries have experienced an improvement in their dignity; while 97% agreed that their skills have improved. Conclusion: The implication of these findings is that poor eye health is negatively related to economic benefits and quality of life while good eye health is a vital determinant of standard of living. Without good eye health, it is hard to participate in the labour force, produce goods and earn income. Thus, the Katsina state government should further improve awareness of good eye health to mitigate preventable cases of blindness for equitable and inclusive development.

Impact Survey Results after SAFE Strategy Implementation in 15 Local Government Areas of Kebbi, Sokoto and Zamfara States, Nigeria.

PURPOSE: To determine prevalence of trachoma after interventions in 15 local government areas (LGAs) of Kebbi, Sokoto and Zamfara States, Nigeria. METHODS: A population-based impact survey was conducted in each LGA using Global Trachoma Mapping Project (GTMP) protocols. In each LGA, 25 villages were selected, except in Arewa LGA, where we selected 25 villages from each of four subunits to obtain finer-resolution prevalence information. Villages were selected with probability proportional to size. In each village, 25 households were enrolled and all consenting residents aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT). Information on sources of household water and types of sanitation facilities used was collected through questioning and direct observation. RESULTS: The number of households enrolled per LGA ranged from 623 (Kware and Tangaza) to 2488 (Arewa). There have been marked reductions in the prevalence of TF and TT since baseline surveys were conducted in all 15 LGAs. Eight of the 15 LGAs have attained TF prevalences <5% in children, while 10 LGAs have attained TT prevalences <0.2% in persons aged ≥15 years. Between 49% and 96% of households had access to water for hygiene purposes within 1 km of the household, while only 10-59% had access to improved sanitation facilities. CONCLUSION: Progress towards elimination of trachoma has been made in these 15 LGAs. Collaboration with water and sanitation agencies and community-based trichiasis surgery are still needed in order to eliminate trachoma by the year 2020.

Multilevel Analysis of Trachomatous Trichiasis and Corneal Opacity in Nigeria: The Role of Environmental and Climatic Risk Factors on the Distribution of Disease.

The distribution of trachoma in Nigeria is spatially heterogeneous, with large-scale trends observed across the country and more local variation within areas. Relative contributions of individual and cluster-level risk factors to the geographic distribution of disease remain largely unknown. The primary aim of this analysis is to assess the relationship between climatic factors and trachomatous trichiasis (TT) and/or corneal opacity (CO) due to trachoma in Nigeria, while accounting for the effects of individual risk factors and spatial correlation. In addition, we explore the relative importance of variation in the risk of trichiasis and/or corneal opacity (TT/CO) at different levels. Data from the 2007 National Blindness and Visual Impairment Survey were used for this analysis, which included a nationally representative sample of adults aged 40 years and above. Complete data were available from 304 clusters selected using a multi-stage stratified cluster-random sampling strategy. All participants (13,543 individuals) were interviewed and examined by an ophthalmologist for the presence or absence of TT and CO. In addition to field-collected data, remotely sensed climatic data were extracted for each cluster and used to fit Bayesian hierarchical logistic models to disease outcome. The risk of TT/CO was associated with factors at both the individual and cluster levels, with approximately 14% of the total variation attributed to the cluster level. Beyond established individual risk factors (age, gender and occupation), there was strong evidence that environmental/climatic factors at the cluster-level (lower precipitation, higher land surface temperature, higher mean annual temperature and rural classification) were also associated with a greater risk of TT/CO. This study establishes the importance of large-scale risk factors in the geographical distribution of TT/CO in Nigeria, supporting anecdotal evidence that environmental conditions are associated with increased risk in this context and highlighting their potential use in improving estimates of disease burden at large scales.

Prevalence of blindness and diabetic retinopathy in northern Jordan.

PURPOSE: To estimate the prevalence of blindness, visual impairment, diabetes, and diabetic retinopathy in north Jordan (Irbid) using the rapid assessment of avoidable blindness and diabetic retinopathy methodology. METHODS: A multistage cluster random sampling technique was used to select participants for this survey. A total of 108 clusters were selected using probability proportional to size method while subjects within the clusters were selected using compact segment method. Survey teams moved from house to house in selected segments examining residents 50 years and older until 35 participants were recruited. All eligible people underwent a standardized examination protocol, which included ophthalmic examination and random blood sugar test using digital glucometers (Accu-Chek) in their homes. Diabetic retinopathy among diabetic patients was assessed through dilated fundus examination. RESULTS: A total of 3638 out of the 3780 eligible participants were examined. Age- and sex-adjusted prevalence of blindness, severe visual impairment, and visual impairment with available correction were 1.33% (95% confidence interval [CI] 0.87-1.73), 1.82% (95% CI 1.35-2.25), and 9.49% (95% CI 8.26-10.74), respectively, all higher in women. Untreated cataract and diabetic retinopathy were the major causes of blindness, accounting for 46.7% and 33.2% of total blindness cases, respectively. Glaucoma was the third major cause, accounting for 8.9% of cases. The prevalence of diabetes mellitus was 28.6% (95% CI 26.9-30.3) among the study population and higher in women. The prevalence of any retinopathy among diabetic patients was 48.4%. CONCLUSIONS: Cataract and diabetic retinopathy are the 2 major causes of blindness and visual impairment in northern Jordan. For both conditions, women are primarily affected, suggesting possible limitations to access to services. A diabetic retinopathy screening program needs to proactively create sex-sensitive awareness and provide easily accessible screening services with prompt treatment.

Challenges of trachoma control: an assessment of the situation in northern Nigeria.

Over the last three decades, a lot has been achieved in the control of trachoma worldwide. New assessment techniques, effective evidence-based control strategy with new methods and drugs, and an aggressive global partnership for the control of the disease have evolved. As such the number of people with the disease and blindness due to the disease had drastically reduced. Trachoma is now only responsible for about 4% of blindness worldwide down from 12% some few decades ago. Some countries are on the verge of eliminating the disease as a public health problem. Despite these achievements numerous challenges remain for achieving trachoma control in endemic communities. This article highlights the challenges faced in one of the known trachoma endemic areas - northern Nigeria. Aspects on the dearth of complete situational data on trachoma, fragmented implementation of the SAFE strategy, community apathy, difficulties faced in ensuring safe, and quality lid surgery in the most difficult terrain where the disease thrives are discussed here. Other unique challenges like managing children with severe trichiasis, curbing the high rate of early-onset recurrence of trichiasis after lid rotation surgery and challenges to maintain supply of antibiotics and implementation of facial cleanliness and environmental improvement components of the control strategy are presented along with the learnt experiences and recommendations. These challenges and their remedies are likely to be shared by other trachoma endemic areas in Africa.

Outcome of cataract surgery in Nigeria: visual acuity, autorefraction, and optimal intraocular lens powers--results from the Nigeria national survey.

OBJECTIVE: To describe presenting and corrected visual acuities after cataract surgery in a nationally representative sample of adults. Another objective was to describe refractive errors in operated eyes and to determine the optimal range of intraocular lens (IOL) powers for this population. DESIGN: Cross-sectional, population-based survey. PARTICIPANTS: Adults aged 40 years and more were selected using multistage stratified sampling and proportional to size procedures. A sample size of 15027 was calculated, and clusters were selected from all states. METHODS: Individuals who had undergone cataract surgery were identified from interview and examination. All had their presenting visual acuity (VA) measured using a reduced logarithm of the minimum angle of resolution chart and underwent autorefraction. Corrected VAs were assessed using the autorefraction results in a trial set. An ophthalmologist conducted all examinations, including slit-lamp and dilated fundus examination. Causes of visual loss were determined for all eyes with a presenting VA <6/12 using the World Health Organization recommendations. Biometry data were derived from 20449 phakic eyes using the SRK-T formula after excluding those with poor VA or corneal opacities. MAIN OUTCOME MEASURES: Presenting and corrected visual acuities in pseudo/aphakic individuals and autorefraction findings; biometry profile of Nigerian adults. RESULTS: Data from 288 eyes of 217 participants were analyzed. Only 39.5% of eyes had undergone IOL implantation at surgery. Only 29.9% of eyes had a good outcome (i.e., ≥6/18) at presentation, increasing to 55.9% with correction. Use of an IOL was the only factor associated with a good outcome at presentation (odds ratio 9.0; 95% confidence interval, 4.3-18.9; P=0.001). Eyes undergoing cataract surgery had a higher prevalence and degree of astigmatism than phakic eyes. Biometry data reveal that posterior chamber IOL powers of 20, 21, and 22 diopters (D) (A constant 118.0) will give a postoperative refraction range of -2.0 D to emmetropia in 71.4% of eyes, which increases to 82.6% if 19 D is also included. CONCLUSIONS: Postoperative astigmatism needs to be reduced through better surgical techniques and training, and use of biometry should be standard of care.

Tracing children with blindness and visual impairment using the key informant survey in a district of north-Western Nigeria.

PURPOSE: To identify children with irreversible blindness in a district of northern Nigeria for enrolment into an inclusive education pilot project. MATERIALS AND METHODS: Using key informants (KIs) working and residing within the communities, children with blindness and visual impairment in Gwadabawa local government area (LGA) were identified and then examined by a team of ophthalmologists/optometrists. Data analysis was performed manually using simple percentages and proportions. RESULTS: Sixty children were reported with visual problems by parents/guardians of whom 58 (97%) were examined. Twenty children (35%) were blind, 17 (29%) were irreversibly blind, and 9 (16%) had low vision (<6/18 to 3/60) with presenting vision. The major causes of childhood blindness were corneal opacity/phthisis bulbi (75%), and cataract (15%). The cause of irreversible blindness in these children was largely preventable (80%) as it was due to childhood-related illnesses, such as vitamin A deficiency and measles. CONCLUSIONS: The major causes of childhood blindness in the study area were avoidable and the use of KI survey in this study provided an opportunity for service delivery.

Causes of blindness and visual impairment in Nigeria: the Nigeria national blindness and visual impairment survey.

PURPOSE: Determine causes of blindness and visual impairment among adults aged >or=40 years. METHODS: Multistage, stratified, cluster random sampling with probability proportional to size procedures were used to identify a nationally representative sample of 15,027 persons >or=40 years of age. Distance vision was measured with a reduced logMAR tumbling E-chart. Clinical examination included a basic eye examination of all subjects and a more detailed examination of those who had presenting vision <6/12 in either eye. Cause for vision loss was assigned to all subjects with presenting vision <6/12 in any eye. RESULTS: Of the 15,122 persons aged >or=40 years who were enumerated, 13,599 (89.9%) were examined. In 84%, blindness was avoidable. Uncorrected refractive errors were responsible for 57.1% of moderate (<6/18-6/60) visual impairment. Cataract (43%) was the commonest cause of blindness (<3/60). Prevalence of cataract-related blindness was 1.8% (95% CI: 1.57-2.05) and glaucoma-related blindness was 0.7% (95% CI: 0.55-0.88). Increasing age was associated with increasing prevalence of all major blinding conditions. Females, illiterate persons, and residents in the North East geopolitical zone had significantly higher odds of cataract-induced blindness and severe visual impairment. CONCLUSIONS: The high proportion of avoidable blindness, with half being attributable to cataract alone and uncorrected refractive errors being responsible for 57% of moderate visual impairment, means that appropriate and accessible refraction and surgical services need to be provided. If priority attention is not given, the number of blind and severely visually impaired adults in Nigeria will increase by >40% over the next decade.

Long-term complications of extracapsular cataract extraction with posterior chamber intraocular lens implantation, in Nigeria.

AIM: To identify the long-term complications of extracapsular cataract extraction with posterior chamber intraocular lens implantation surgery, in the National Eye Centre, Kaduna, Nigeria. METHODS: The study is a retrospective review of patients that have had extracapsular cataract extraction with posterior chamber intraocular lens implantation, in the National Eye Centre, Kaduna, Nigeria from January 1996 to December 1999. The medical records of all patients that satisfy these criteria were retrieved. Information collected included age, sex, eye operated upon, intra-operative complications, pre-operative visual acuity and last follow-up, and long-term post-operative complications. RESULT: Medical records of only 66 patients (71 eyes) that maintained a minimum follow-up of at least one year were retrievable. No major intra-operative complications were recorded. Only one eye had posterior capsule rent. Ninety percent of the operated eyes had vision of 6/60 or better one year post-operative. The overall visual outcome (WHO criteria) was borderline. Of the corrected eyes, the consultants have a statistically significantly better outcome than residents. The following post-operative complications were recorded in 25 (35.2%) eyes: pseudophakic bullous keratopathy (11.3%); posterior capsular opacification (7.0%); persistent inflammation (7.0%); secondary glaucoma (2.8%); pupil distortion (5.6%); and ocular hypotony (1.4%). CONCLUSION: ECCE + PC-IOL microsurgery is associated with long-term complications like PBK (Pseudophakic bullous keratopathy) and PCO (Posterior capsular opacification). Their management creates new demands in our country. This study is limited by the small number of eyes eligible for review at least one year after surgery.