Transcript Dr Robert Lindfield_Best Practices, Kenya

Ocular Morbidity
Robert Lindfield
Clinical Lecturer
International Centre for Eye Health
London School of Hygiene and Tropical Medicine
WHA Resolutions
Blindness
VISION 2020
Ocular morbidity
“Any clinically significant eye disease”
Includes
• Conjunctivitis
• Presbyopia
Non-blinding
• Cataract
• Glaucoma
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:
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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
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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
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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