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Sebastian N N Nwosu Cyriacus U Akudinobi Guinness Eye Center

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Presentation on theme: "Sebastian N N Nwosu Cyriacus U Akudinobi Guinness Eye Center"— Presentation transcript:

1 Extending eye care to rural Nigeria: The Vision2020 Eye Clinic Ukpor experience
Sebastian N N Nwosu Cyriacus U Akudinobi Guinness Eye Center Onitsha Nigeria

2 Nnamdi Azikiwe University Awka

3 Guinness Eye Center Onitsha

4 Declaration No financial interests

5 Introducton Eye diseases and blindness are of public health importance in Nigeria

6 Political map of Nigeria

7 Introduction...2 Estimated blindness rate in Nigeria
Blindness prevalence in Nigeria The national blindness & low vision survey reported in 2008 that 46 out of every 1000 adults aged even 40 years and above were blind

8 Position of Anambra State in Nigeria

9 Introduction...3 In Anambra State the prevalence of blindness is even higher The rural-urban migration notwithstanding, majority of the populace still reside in rural areas

10 Typical village gate

11 Typical rural house

12 Introduction...2 Anambra State is one of the 36 states in Nigeria
Divided into 21 local government councils, it has the Ministry of Health that regulates and oversees health care delivery especially at secondary care level throughout the state The local governments are in-charge of primary health care activities

13 Introduction...3 Health care services are provided by both the government and the private entrepreneurs However the latter tend to concentrate in urban areas Generally the rural areas are poorly served

14 Water source in rural areas

15 Eye care in Anambra State
There is only one publicly-owned eye hospital in Anambra State – the Guinness Eye Center Onitsha Two other sparsely staffed eye units exist in government run hospitals Private eye care facilities exist but these are located in the urban cities

16 Anambra Strategic Health Plan
To ensure optimal health for the people the government drew up the strategic health development plan But this 74-page document has nothing on eye care

17 Previous efforts... Outreach eye camps... Poor follow-up
Not sustainable Ownership taken by people Seen as occasional patronage from enthusiastic urban dwellers

18 Static eye care facility sought
Dissatisfaction with intermittent eye camp programme led to a shift in approach viz: Possibility of establishing static eye care facilities in rural areas: churches, town unions, influential persons, government officials were contacted

19 Collaboration for eye care
In order to bring quality eye care to the rural dwellers in the state the Nnamdi Azikiwe University collaborated with Nnewi-South Local Government Council to establish the Vision2020 eye clinic at Ukpor This paper reports the experience in the first year of services in the clinic

20 Memorandum of Understanding
Idea of establishing the clinic originated from the Ophthalmology Dept Nnamdi Azikiwe University A memorandum of understanding (agreement) between Nnewi-South Local Government Council Nnamdi Azikiwe University offically ensured the establishment of the clinic

21 Stake holders’ responsibilities
Council: To provide infrastructure & equip the clinic University: To provide ophthalmologists; provide technical support; train primary eye care workers; provide clinical services and conduct research Community: To provide land & security All: maintain advocacy for the eye clinic

22 Developmental phases Community awareness of the clinic’s existence
Clinical services School eye health Eye health promotion & education in the community Self-sustaining services Replication of the model in other communities

23 Results We trained 3 primary health care workers nominated by council in primary eye care Publicity about the clinic existence mounted through de facto leaders in churches, marketplaces, women fora, town union, village meetings, etc Clinical services commenced June 2011 Surgical services became available a year later

24 Results...2 166 new patients – seen; M:F = 1:1.6
Age range: 1-88; mean- 48.8±15.2 Blindness rate: 10.4% (7 male; 7 female) Visual impairment: 17.7%(11 male; 18 female)

25 Bilaterally blind led by son

26 Bilateral cataract

27 Causes of low vision Cause Blindness (%) Visual impairment(%)
Refractive error - 13(44.8) Cataract 10 (71.4) 11(37.9) Glaucoma 4(28.6) 5(17.3) Total 14(100.0) 29(100.0)

28 Clinical diagnosis Diagnosis No. % Refractive error / presbyopia 61
36.8 Cataract 39 23.5 Irritative/allergic conjunctivitis 35 21.1 Glaucoma 21 12.7 Pterygium 13 7.8 Uveitis 7 4.2 Corneal ulcer 5 3.0 Purulent conjunctivitis 4 2.4 Corneal foreign body 2 1.2 Optic atrophy ARMD Diabetic retinopathy Traumatic hyphaema Migraine Retinal detachment 1 0.6 Orbital tumour

29 Comments The establishment of the clinic took more than 5 years of planning & advocacy At initial stage patronage was low Patronage improved when the local elite was satisfied with the services - esp. optical services

30 Comments...2 Implementation of decisions delayed by
Government bureaucracy Unstable council leadership (frequent transfers) Industrial action by council & health workers

31 Comments...3 Low vision rate, though clinic-based, is high
Causes of low vision - largely avoidable Most of the blind require cataract surgery Patients blind from glaucoma presented late

32 Comments...4 Steady, dependable clinical services as well as community health education will expectedly encourage patients to present early The quality of cataract surgery should not be compromised – better visual outcome ensures better uptake

33 Sustainability...? Our greatest worry & challenge

34 Sustainability...2 A clinic revolving fund to be established
Sliding scale of fees charged to ensure that the poor benefits

35 Sustainability...3 Continuing advocacy with the de facto leaders, including government and the local elite

36 Future... Establish such clinics in other local government councils
Draw 5 year strategic plan for eye care Hopefully this will form the nucleus of Anambra State eye care plan

37 Acknowlegdement... Mr E Nwabuagha, Former Head of Service, Nnewi-South Local Government Council, Ukpor, Anambra State, Nigeria Mr Dubem Obaze, Former Commissioner for Local Government and Chieftaincy Matters, Anambra State, Nigeria Prof B Egboka, Vice Chancellor Nnamdi Azikiwe University, Awka, Nigeria Dr Kunle Hassan, Eye Foundation Hospital, Lagos, Nigeria – for some surgical consummables Deseret International Inc. Utah USA – for providing surgical consummables & cataract surgery instruments

38 Adjourn... Thanks for listening

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