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Extending eye care to rural Nigeria: The Vision2020 Eye Clinic Ukpor experience. Sebastian N N Nwosu Cyriacus U Akudinobi Guinness Eye Center Onitsha Nigeria . Nnamdi Azikiwe University Awka. Guinness Eye Center Onitsha. Declaration . No financial interests. Introducton . - PowerPoint PPT Presentation
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Extending eye care to rural Nigeria: The Vision2020 Eye Clinic Ukpor
experienceSebastian N N NwosuCyriacus U Akudinobi
Guinness Eye Center Onitsha Nigeria
Nnamdi Azikiwe University Awka
Guinness Eye Center Onitsha
Declaration No financial interests
Introducton Eye diseases and blindness are of public
health importance in Nigeria
Political map of Nigeria
Introduction...2Estimated blindness rate in Nigeria
Blindness prevalence in Nigeria
The national blindness & low vision survey reported in 2008 that 46 out of every 1000 adults aged even 40 years and above were blind
Position of Anambra State in Nigeria
Introduction...3In Anambra State
the prevalence of blindness is even higher
The rural-urban migration notwithstanding, majority of the populace still reside in rural areas
Typical village gate
Typical rural house
Introduction...2Anambra State is one of the 36 states in
NigeriaDivided into 21 local government councils, it
has the Ministry of Health that regulates and oversees health care delivery especially at secondary care level throughout the state
The local governments are in-charge of primary health care activities
Introduction...3Health care services are provided by both the
government and the private entrepreneursHowever the latter tend to concentrate in
urban areasGenerally the rural areas are poorly served
Water source in rural areas
Eye care in Anambra StateThere is only one publicly-owned eye hospital
in Anambra State – the Guinness Eye Center Onitsha
Two other sparsely staffed eye units exist in government run hospitals
Private eye care facilities exist but these are located in the urban cities
Anambra Strategic Health PlanTo ensure optimal
health for the people the government drew up the 2010-2015 strategic health development plan
But this 74-page document has nothing on eye care
Previous efforts...Outreach eye
camps...Poor follow-upNot sustainableOwnership taken by
peopleSeen as occasional
patronage from enthusiastic urban dwellers
Static eye care facility soughtDissatisfaction with intermittent eye camp
programme led to a shift in approach viz:Possibility of establishing static eye care
facilities in rural areas: churches, town unions, influential persons,
government officials were contacted
Collaboration for eye careIn order to bring quality eye care to the rural
dwellers in the state the Nnamdi Azikiwe University collaborated with Nnewi-South Local Government Council to establish the Vision2020 eye clinic at Ukpor
This paper reports the experience in the first year of services in the clinic
Memorandum of UnderstandingIdea of establishing the
clinic originated from the Ophthalmology Dept Nnamdi Azikiwe University
A memorandum of understanding (agreement) betweenNnewi-South Local
Government CouncilNnamdi Azikiwe University
offically ensured the establishment of the clinic
Stake holders’ responsibilitiesCouncil: To provide infrastructure & equip
the clinicUniversity: To provide ophthalmologists;
provide technical support; train primary eye care workers; provide clinical services and conduct research
Community: To provide land & securityAll: maintain advocacy for the eye clinic
Developmental phasesCommunity awareness of the clinic’s
existence Clinical servicesSchool eye health Eye health promotion & education in the
communitySelf-sustaining servicesReplication of the model in other
communities
Results We trained 3 primary health care workers
nominated by council in primary eye carePublicity about the clinic existence mounted
through de facto leaders in churches, marketplaces, women fora, town union, village meetings, etc
Clinical services commenced June 2011 Surgical services became available a year
later
Results...2166 new patients – seen; M:F = 1:1.6Age range: 1-88; mean- 48.8±15.2Blindness rate: 10.4% (7 male; 7 female)Visual impairment: 17.7%(11 male; 18
female)
Bilaterally blind led by son
Bilateral cataract
Causes of low visionCause Blindness (%) Visual
impairment(%)Refractive error - 13(44.8)Cataract 10 (71.4) 11(37.9)Glaucoma 4(28.6) 5(17.3)Total 14(100.0) 29(100.0)
Clinical diagnosisDiagnosis No. %
Refractive error / presbyopia
61 36.8
Cataract 39 23.5
Irritative/allergic conjunctivitis
35 21.1
Glaucoma 21 12.7
Pterygium 13 7.8
Uveitis 7 4.2
Corneal ulcer 5 3.0
Purulent conjunctivitis 4 2.4
Corneal foreign body 2 1.2
Optic atrophy 2 1.2
ARMDDiabetic retinopathy
22
1.21.2
Traumatic hyphaema 2 1.2
Migraine 2 1.2
Retinal detachment 1 0.6
Orbital tumour 1 0.6
Comments The establishment of the clinic took more
than 5 years of planning & advocacy At initial stage patronage was lowPatronage improved when the local elite was
satisfied with the services - esp. optical services
Comments...2Implementation of decisions delayed by
Government bureaucracyUnstable council leadership (frequent
transfers)Industrial action by council & health workers
Comments...3Low vision rate, though clinic-based, is highCauses of low vision - largely avoidableMost of the blind require cataract surgeryPatients blind from glaucoma presented late
Comments...4Steady, dependable clinical services as well
as community health education will expectedly encourage patients to present early
The quality of cataract surgery should not be compromised – better visual outcome ensures better uptake
Sustainability...?Our greatest worry
&
challenge
Sustainability...2 A clinic revolving fund to be establishedSliding scale of fees charged to ensure that
the poor benefits
Sustainability...3Continuing advocacy
with the de facto leaders, including government and the local elite
Future...
Establish such clinics in other local government councils
Draw 5 year strategic plan for eye care Hopefully this will form the nucleus of
Anambra State eye care plan
Acknowlegdement...Mr E Nwabuagha, Former Head of Service, Nnewi-
South Local Government Council, Ukpor, Anambra State, Nigeria
Mr Dubem Obaze, Former Commissioner for Local Government and Chieftaincy Matters, Anambra State, Nigeria
Prof B Egboka, Vice Chancellor Nnamdi Azikiwe University, Awka, Nigeria
Dr Kunle Hassan, Eye Foundation Hospital, Lagos, Nigeria – for some surgical consummables
Deseret International Inc. Utah USA – for providing surgical consummables & cataract surgery instruments
Adjourn...
Thanks for listening