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
Ocular morbidity
“Any clinically significant eye disease”
• Conjunctivitis
• Presbyopia
• Cataract
• Glaucoma
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
• 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
– 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.
• 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
“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

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