Ocular Morbidity Robert Lindfield Clinical Lecturer International Centre for Eye Health London School of Hygiene and Tropical Medicine

Blindness VISION 2020 WHA Resolutions

Ocular morbidity “Any clinically significant eye disease” Includes Conjunctivitis Presbyopia Cataract Glaucoma Non-blinding Blinding

OM Study OM Study in Mbeere District, Kenya – Sightsavers in partnership with ICEH and University of Nairobi, Kenya – PI – Dr Kahaki Kimani Three components: – Survey of OM (including those reporting an OM in previous 3 months) – Situational Analysis – Qualitative Study with patients

Survey Methods Four teams: – Ophthalmologist, ophthalmic nurse & optometrist – House to house examining everyone in the household. – Had to examine 100 people per village – Simple examination with direct ophthalmoscope Data – Recorded on proforma – Entered into a database – Cleaned – Analysed

Results 15.5% had at least one OM in at least one eye – 25.1% of over 35s had presbyopia (unable to see N8 at 40cm without correction ) – Most common sites: conjunctiva and lens – Increased with age – Increased if manual worker 9.6% reported an OM in previous six months – 59.7% sought advice 53.9% sought advice from a health worker No-one reported seeking advice from a traditional healer.

Numbers 200,000 people in Mbeere District – 25,000 had at least one OM – 20,000 had an OM in last six months – 10,000 sought advice about the OM

Situational Analysis Mbeere District – 2 hospitals – 3 health centres – 27 dispensaries Over 12 months – 1.2% of patients seen were reported to present with eye problems (3850 patients) Over same time period 5700 drops/ointment prescribed

Qualitative Study Dr Salome Bukachi, University of Nairobi Interviews with patients, health care workers, Focus group with community members Key findings: – Lots of perceived need in the community – Distrust/dislike of camps – Need to services closer to home “We would like that services be brought closer in-order to reduce the distance” “To be assisted by the eye camps/outreaches depends on your economic strength. Those who are poor don’t get help”

Can people with an OM be managed in primary care? Demand Need? – Complicated Quantity Quality Community perspective

Next steps Learning from pilot Survey in Kwara State, Nigeria – Recently completed – Awaiting results