Paediatric Eye Services in KATH and Northern Ghana

Report
Paediatric Eye Services in KATH
and Northern Ghana
P. Osei- Bonsu, MD
Komfo Anokye Teaching Hospital
Childhood Blindness –Global
Magnitude
37 million people are blindworldwide
-Only 1.4 million are children(0-15
years)
-Why is the elimination of avoidable blindness in
children a Vision 2020 a top issue?

Vision for Children.WHO & IAPB www.v2020.orgGilbert C,FosterA.Bull World Health Org 2001;79:227232
Incidence and prevalence of
blindness in children
Estimated at 500,000 new cases / year
One per minute
Over 50% die within 1-2 years of becoming
blind
Prevalence under-estimates the magnitude of
the problem of childhood blindness, as this
only takes account of children who survive
 Blind years
Childhood blindness in Ghana  Ghana – population 24million
 Population of children 0-15 years is approximately 8,000,000
(33% of population)
 Childhood Blindness prevalence estimate 0.8/1000
 ( based on U 5 mortality rate)
 Estimated number of blind children 6,400 ( excluding
refractive errors)
 Paediatric ophthalmologist 2
 Paediatric eye care centres 2
 Excellent Vitamin A and Measles programme
Northern Ghana
 Made of 5 regions occupying about 2/3 of land mass of the
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country.
Population 11 million
Three regions most deprived& poor
No of opthalmologist 12
Only 4 outside the Ashanti region
1 paediatric ophthalmologist.
Findings from recent schools for the blind surveys in Africa.
Country, year (references)
Number of children in survey
Primary causes of blindness
Cornea = 19%
Malawi, Kenya, Tanzania,
Uganda, 2009 (Njuguna M., Msukwa et al)
Whole globe = 15.7%
701
Retina = 15.4%
Lens = 13.1%
Lens = 26.7%
Nigeria, 2011 (Onakpoya O.H et al
30
Glaucoma = 20%
Retinitis pigmentosa = 16.7%
Cornea = 59.3%
Ghana, 2008 (Ntim-Amponsah C.T.,
Amoaku W.M.K )
201
Lens = 23%
Glaucoma = 15.6%
Cornea = 32.1%
Cameroon, 2010 (Noche C.D., Bella A.L.
56
Optic lesion = 26.8%
Lens = 19.6%
Glaucoma = 22%
Nigeria 2009 (Okoye O.I. et al)
45
Cornea = 20%
Lens = 13.3%
KATH records
Cataract / uncorrected
aphakia 30%
Glaucoma 20%
Corneal lesions
injuries
Other causes
 Refractive errors
 Retinal diseases
 Cortical blidness
Why are they blind
 Most of the causes are avoidable – so why ?
 GOOD NEWS- good EPI has reduced corneal cause of
blindness
Case Finding- School screening
 Nationwide no properly organized school screening
 Current school screening is cumbersome and the
yield is poor with lot of false positives
 Need to streamline current methods- simple but
effective tools needed
Case finding
At the community level
Identification and referral
 No Community based programme to look for cases –
A study has shown that only 33% of CEHTF in Africa had
active case finding programmes in 2008, World Health Organization.

Preventing blindness in children: Report of a WHO/IAPB Scientific Meeting. WHO/PBL/00.77; 2000.
19. Agarwal P.K., Bowman R., Courtright P. Child eye health tertiary facilities in Africa. JAAPOS. 2010;14:263–
266.
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Transport- Not all cases identified or referred will travel to KATH
Poor awareness
Childrens’ issues especially chidren eye issues- not top priority.
Cost- paediatric surgery is much more expensive than adult surgery
Community level
 Late presentation
Surgery- Late presentation
Why are they blind
 Chlidhood glaucoma is
the second most impotant
cause of visual
impairment.
 Juvenile glaucoma- 80%
of cases present already
legally blind
Why are the children blind Blind
 HOSPITAL LEVEL
 The Provider factor - non availability of critical staff-
“The Doctor is not there”-.
Dr is attending a meeting
Doctors/ Nurses on strike
----not very good news for parents
Why are the children blind
HOSPITAL LEVEL
 Limited theatre time-
No electricity, No water, no consumables, No drapes?, another
programme is running in the theatre
 Appropriate equipment- vitrector, frequent breakdown of
essntial equipment like operating microscope, inappropriate
size IOL,biometry, vitrectomy
 Consecutive refractive error-
Why are they blind
HOSPITAL LEVEL_ Anaesthesia
 Paediatric anaesthesia is still a considerable risk
 Currently -Provider of anaesthetic services are
mainly nurses
 Rate determining step of Surgery
 Maximum no per day 4 cases
 Preoperative assessment is cumbersome and
expensive, though necessary- investigationsnot
covered by NHIS
 Anaesthesia is not covered by NHIS
Low Vision services
 HOSPITAL LEVEL
 Low vision service is still very infantile expecially in the
northern sector. Few Low Vision Aids.
Paediatric eye care at KATH- The Moran
Eye Centre / HCP factor
 Paediatric HBT from 2009
 And 3 months observership
 Mentorship
 Infrastructure
 Equipment
ORBIS support
Aim
 Develop Komfo Anokye Teaching Hospital as a
Childhood Tertiary Eye Health Training Facility
(CTEHTF) with fully deloveloped Infrastructure,
equipment and adequately trained paediatric
team
Orbis support-What we seek to achieve
 To develop human resource for paediatric eye care
 Training primary health care workers/ key informants.
 Delveop and desseminate approprite awareness and public
information materials.
 Annual surgical output of 400+ cases when programme is
well established.
 Prevention of childhood blindness activities are integrated
into primary health care programmes in Ghana .
Orbis support-What we seek to achieve
 To establish a database of paediatric ophthalmology
 Establish low vision and optical services to provide affordable
spectacles and low vision aids for children
 Establish a functioning school screening programme and
screen of children in the programme area for refractive
errors and amblyopia and other treatable diseases.
Current state- Infrastructure and
equipment
 Child eye clinic with 2 consulting rooms, nurses room,
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orthoptist room.
One dedicated theatre with Anaesthetic machine
Hand held autorefractor/keratometre
Mobile fundus camera
Vitrectome
Mobile A/B scann
Basic vision assessment tools
Tonopens
Hand held slit lamp
Phoropter
Current state-HR
 Ophthalmologist
 Second ophtalmologist being trained
 Paediatric ophthalmic nurse
 Optometrist
 Paediatric eye care coordinator
Current State- Service delivery
2 Surgery days a week
Fully dedicated theatre
2 clinic days per week
School screening started actively from 2013
Child Friendly Environment
Ward For Kids
Equipment for more efficient service delivery
Plans for 2014 and after
Human resources
Hospital Based Training
development
Paediatric
Ophthalmology,2
HBTs
Paediatric
Anaesthetists,2HBTs
Ophthalmic Nurses,2HBTs
Orthoptist, 1HBT
Fellowships
Paediatric
ophthalmologist
Paediatric Anaesthetists
Non-clinical training
courses
Child Eye Health
Coordinator
Child Eye Health
Counselors
Provision equipment
Procurement of
equipment
and
consumables
Procurements of
consumables
Prioritise outstanding
equipment for
procurement
in years 1& 2
Once yearly procurement
of
child spectacle frames
Twice yearly local
purchase of toys
Refurbishment to ensure
child-friendly
Computer literacy training
Programme Technology for
Eye Department Staff
Expansion fo KATH’s
electronic medical record
system
Local training
Future plans
 Community Based programmes
 Visits to school for the blind
 Train key informers
 Train teachers
Twins with cataract. Referred by school
teacher (before SURGERY)
Same twins
THANK YOU

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