Transcript Dr Mohammad Muhit_Childhood Blindness IAPB 2012

Childhood Blindness
Mohammad Muhit PhD
Child Sight Foundation &
University of South Asia
Country profile: Bangladesh
Area: 144,000 sqkm
Population: 140 million, 50m children
Health budget : 1.7% of total budget
Life expectancy 58.9
Per capita GDP: US$1,483
Population below poverty line: 35.6%
Literacy rate: M- 51.1%; F- 28.6%
Rural population: 53.6%
Human Development Index rank: 132
(out of 162 countries)
Causes
of childhood
blindness
in Bangladesh
Childhood
blindness
due to Cataract
Lens
Cornea
607 / 31%
515 / 27%
Uvea
Whole Globe
35 / 2%
255 / 13%
Retina
Glaucoma
246 / 13%
82 / 4%
Not Examined
5 / 0%
Globe Appears Normal
35 / 2%
Optic Nerve
155 / 8%
Childhood Blindness Profile
National Childhood Blindness Study by ICEH• Prevalence of CHB: 0.7/1,000 children
• 40,000 blind children in Bangladesh
– 36% treatable
– 32% preventable
• Childhood cataract (31%)
• Treatable cataract -12,000 blind children!
• Innovative approach to case detection (KIM).
• Potential of further development of services
using ‘register for blind children’.
Situation in 2003
Paediatric Cataract Backlog!
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•
•
•
12,000 children with bilateral cataract
50 million children in the country.
1 fully trained paediatric ophthalmologist.
Absolute lack of awareness about cataract
in children – Public and Professionals.
• Services for children’s eye care-limited,
expensive, inaccessible.
• No programme for childhood cataract.
Way Forward•
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•
•
•
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Research – Causes, Barriers, SA.
Advocacy-Childhood Blindness Workshop 2003
Alliances- GO, NGO, policy makers, media..
Establish the Need
Provide a Framework for Action
Develop appropriate tools (KIM)
Mobilise resources
BCCC: Partnership in Practice
Sight Savers International
ORBIS International
Uni.
dept
International Centre for Eye Health
local
NGOs
Media
Child Sight Foundation
Uttaran
YPSA
BCCC
CBR projects
Eye
Hospitals
Govt.
Islamia Eye Hospital
BNSB Sirajgonj Eye Hospital
BNSB Khulna Eye Hospital
Donors
CEITC, Chittagong Eye Hospital
BJAKS Comilla Eye Hospital
MOH & MOSW, Govt. of Bangladesh
Goal & objectives of the campaign
The Goal is to contribute to the elimination of avoidable Child
Blindness by the year 2020, as part of the V2020 programme.
Objectives are-
• To eliminate 90% of the backlog of Childhood cataract in
Bangladesh by the year 2008
• To contribute to the development of long term systems that will
ensure that future incidence of childhood cataract in
Bangladesh is adequately dealt with
• To support the development of long term systems to ensure
that all irreversibly blind children receive the services to which
they are entitled
• To provide lessons that can be used to inform similar
programmes elsewhere
Bangladesh Childhood Cataract Campaign
•
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Identify 40,000 blind children
Treat 10,000 cataract blind children
20,000 cataract surgery in children
Raise awareness throughout the country
Develop paediatric ophthalmic centres
Develop and maintain a database of blind children in the
country for future services
• Document & disseminate programme learning.
• In 4 years!
• With £2 million programme budget.
• Campaign was launched in 2004 World Sight Day
Community based eye care services for children
Awareness
campaign
Training on ‘how to
identify a blind child’
Health
education
Empowering communities
& key informants
Community
Mobilizer for
Child Sight
Working with key
informants,
volunteers and other
organisations to
develop linkages and
to overcome barriers.
Blind Children
in their home
Assessment, counselling & referral
by mobile team
Incurable
Treatable
Eye hospital
Schools
Rehabilitation
Harun-Ur-Rashid, with children
Ahsanullah, Fazar Ali, Osman
Gani, Khadija, and Yunus, who all
can now see thanks to a simple
operation.
Photo courtesy: : Ian Rutherford,
Daily Scotsman
Salma and Shetu after cataract
surgery; with their mother
Photo courtesy: : Pany Petro
CSF
Achievements in the first year: 2005
• 2 Paed Ophth teams trained in India & Tanzania
• 5 Centres has been enhanced with equipments
• Over 3,000 cataract surgery in nearly 1,500 cataract
blind children
• 3 ‘case finding’ NGOs are working in 3 divisions
• Database for blind children designed & tested
• Working Group of BCCC partners formed & active
• Standard data recording forms have been designed and
trained for Child Cataract clinical data
• Baseline data collected on KAP and SA
• Key Performance Indicators for programme monitoring
Challenges and lesson in the first year
• Broad based partnership is challenging
• Case finding in remote areas
• Training of Paed Ophth team- expensive, training centres,
time
• Procurement of IOL, glasses and LVA for children
• Follow-up: long term and regular?
• Multiple donors, hospitals, MOUs etc.
• Programme monitoring system
• Engaging media for awareness campaign
• Competition between partners
• Transparent and democratic decision making
• BCCC partner hospitals- inclusive or exclusive?
• Linkage with education and rehabilitation
Strategic Evaluation: BCCC 2010
• Effectiveness: BCCC was effective, as the objectives
and targets were met or almost met.
Blind children
Cataract blind children
Traced
Target
Identified
N
% of those
traced
BCCC
28,520
9,373
33%
NonBCCC1
4,456
1,286
29%
32,976
(82%)
10,659
32%
Total:
40,000
Operated
Target
10,000
7,674
(77%)
BCCC Efficiency:
• efficiency of the different types of case finding
• financial efficiency i.e. the cost per blind child and cataract
blind child found
• whether the project was good value for money.
•
Next slide: Number of blind children and cataract blind children expected,
and identified, by case finding partner.
Case finding partner
Metho
d
Population
allocated
(millions)
Population estimates
Cases identified
Cases operated
Blind1
Cat
blind
(30%)
Blind
found
% of
estimate
Cat
blind
% of
estimate
From
CFP
Upta
ke
(%)
Walkin
15.7
10,960
3,288
10,492
96%
3,439
105%
2,361
69%
49
26.7
11.0
7,670
2,301
1,438
19%
1,147
50%
1,083
94%
387
H-t-H
17.7
7.3
5,087
1,526
4,992
98%
607
40%
587
97%
82
Uttaran
H-t-H
15.9
6.5
4,557
1,367
6,433
141%
1,517
111%
708
47%
0
RDSS
H-t-H
11.4
4.7
3,268
980
2,018
62%
1,046
107%
819
78%
108
VARD
H-t-H
9.1
3.7
2,612
783
2,287
88%
1,133
145%
530
47%
0
Not clear
9.9
4.1
2,848
854
510
18%
147
17%
147
100
%
233
Not clear
1.5
0.61
426
128
15
4%
15
12%
15
100
%
32
37,428
11,227
28,185
75%
9,051
81%
6,250
69%
891
All
ages
Child
pop
KI
38.2
All CBR
CBR
YPSA
CSF
Subtotal
:
CSF MA
TOTAL
KI
12.2
5.0
3,509
1,053
4,456
127%
332
32%
322
97%
211
42.6
8.8
40,937
12,280
32,641
80%
9,383
76%
6,572
70%
1,102
Time efficiency
Months
Cataract blind
found
Cataract
blind/month
Under BCCC:
CSF Dhaka
20
2,567
1281
CSF Barisal
Uttaran
YPSA Chittagong
24
42
36
827
1,517
560
35
36
16
YPSA Chittagong
HTs
29
47
2
VARD Sylhet
RDSS
26
26
1,133
1,046
44
40
Uptake of cataract surgery among cataract
blind children identified, by case finding partner
Case finding partner
CBR
CSF
RDSS
Uttaran
VARD
YPSA
Acceptance of
surgery among
bilaterally cataract
blind children
94%
69%
78%
47%
47%
97%
Cost efficiency in case finding
Total
reimbursed
(BDT)
Blind
children
found
Reimbursed per
blind child found
Cataract blind
children found
Reimbursed per
cataract blind child
found
CSF
22,012,048
10,492
2,098
3,439
6,401
Uttaran
9,699,355
6,433
1,508
1,517
6,394
Case finding
partner
YPSA
4,992
607
VARD
6,549,507
2,287
2,864
1,133
5,781
RDSS
9,569,689
2,018
4,742
1,046
9,149
CBR partners
848,594
1,438
590
1,147
740
Others
115,724
860
135
494
234
59,528,517
28,520
2,087
9,383
6344
Sub-total
Reimbursement of clinical partners for managing
cataract in children.
Total reimbursed
Reimbursed per
surgery
(BDT)
499
4,652,548
9,320
1,605
14,669,112
9,140
BNSB Moulavibazar
722
5,631,687
7,800
BNSB Dinajpur
3173
19,150,605
6,040
BNSB Khulna
2202
12,554,893
5,700
BNSB Sirajgang
5994
33,805,763
5,640
CEITC
2000
9,077,197
4,540
Islamia Eye Hospital
8398
36,965,653
4,400
Others
218
360,355
1,650
24,811
136,867,813
5,520
Clinical Partners
BNSB Mymensing
BJAKS
Sub-total
Surgeries
Beyond BCCC
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Unique programme for Child Cataract
Replicable in other Asian, African and LA?
200,000 cataract blind children globally
Development of more training centres
Technical input & collaboration –ICEH
Standard data recording forms and software
available – childhood blindness & childhood
cataract
• Sustainability- Technical, managerial, financial
Thank you!