Comprehensive school eye health programmes Child Eye Health course: IAPB General Assembly Clare Gilbert, ICEH, LSHTM

School eye health programme School eye programmes often focus on refractive errors alone, are vertical, bypass the education and health system, and are not sustainable They are rarely monitored or evaluated ? what difference are they making ? are they cost effective/a good use of resources? Programmes need to be comprehensive integrated within school health programmes monitored and evaluated cost effective

Components of comprehensive school eye health programme Identify children with significant refractive errors and supply spectacles Education about eye conditions and eye health Primary eye care for children Eye care for teachers (e.g. presbyopia) Health promoting school environment Child-to-Child approach Links to control programmes for local endemic diseases

Education about eye conditions and eye health Engage with Ministries of Education and Health What is taught depends on local epidemiology: Keeping their eyes healthy (diet; avoid trauma) Common conditions affecting their age group Common conditions affecting younger age group Common conditions affecting the elderly Promote positive attitudes towards blindness and how to interact with someone who is blind

Eye health embedded in school curriculum

Education about eye conditions and eye health Educational materials for children Manuals for teachers

Primary eye care for children identify and treat /refer simple eye complaints identify children with locally endemic eye conditions (e.g. trachoma; vitamin A deficiency) and taking action necessary identify and refer children with non-RE causes of visual impairment

Primary eye care for children Developing curriculum for school nurses: Task analysis – what they should be able to do after training Drives content of training knowledge skills attitudes Drives what they will need to do the job medication / supplies visual acuity charts

Primary eye care for children Focus on common eye problems affecting children allergies conjunctivitis (viral/bacterial) styes/chalazions etc foreign bodies and trauma refractive errors Rare but more serious problems cataract

Primary eye care for children Supplies of topical medication e.g. tetracycline eye ointment Supplies of eye pads, eye shield etc Know where the nearest eye unit is Communication with parents Record keeping

Eye care for teachers Spectacles for uncorrected presbyopia Cup:disc ratio assessment for glaucoma Counsel diabetics to have regular retinal examination

Health promoting school environment Physical: clean water for face and hand washing appropriate sanitation for boys and girls water collection kitchen gardens...how to grow (and cook) nutritious foods Attitudinal disability and inclusion

Child-to-Child: children as agents of change Developed in 1978 by a paediatrician and health educator Builds on natural care-giving and relationships of children Entails a 6 step process links learning, using fun activities with action at home and in the community. participatory learning involving discussion, action and evaluation e.g. carrots in Mongolia Programmes in many countries for nutrition; HIV etc but none for eyecare or ear care. Unpublished pilot studies in India and Nigeria Peer education is inherently sustainable

Link to programmes for control of locally endemic conditions Primary school vitamin a deficiency measles infection All ages MDA for trachoma

Integration Work with Ministries of health / education so that eye health is part of broader school and child health schools are safe and healthy places children learn about eye health school nurses can deliver primary eyecare Should not be a stand alone, vertical program that only deals with refractive error