An outreach eye care programme, Zambia
Based in Lusaka, Zambia, the clinic mainly visits areas around the capital. But the outreach programme ventures further into rural areas.
The mobile clinic is publicised in advance and people from the surrounding area congregate to be screened. Suitable patients (usually mature cataracts) are then transported to the eye camp. These are local hospitals, where a visiting ophthalmologist and a team will stay for a few days. The operations are then performed and the patients transported home free of charge.
Zambia has unique geographical problems. It has one of the lowest population densities worldwide. Thus it is hard to justify building extensive ophthalmic services across the country.
The mobility of the outreach programme aims to solve these problems. Free transport is provided, thus minimising costs to US $5 per patient. If they cannot afford this, the cost can be reduced to US $3.50 and even US $ 1.70!
Following the team through 4 villages, 126 patients were interviewed and examined.
The following were investigated:
- Demographics of presenting patients
- Ophthalmic conditions encountered
- Patients visual acuities
- Barriers that prevented patients from seeking eye services earlier.
Eye conditions seen in four villages: 126 patients
|Eye Condition||Men (%)||Women (%)||Children (%)|
|Cataract 29 21 0||29||21||0|
A substantial proportion of patients, 12%, were blind. Sixty-one percent of these were due to cataracts, which correlate well with figures in the literature.1 A small proportion, 8% of blind patients, was due to corneal diseases other than trachoma. This includes injury, xeropthalmia, use of traditional eye preparations, keratitis due to untreated infections, and many others.
Men and women presented in almost equal numbers, 43% and 38% respectively. One major difference between the sexes was that women were more affected by trachoma than men, 19% compared to 4%. This corresponds with the well-known observation that Chlamydia Trachomatis is spread mostly between mothers and their children due to poor hygiene.1
Children mostly suffered from conjunctivitis (29%). This could be reduced with increased awareness about face washing. Xerophthalmia was less of a problem than expected. Only 14% of children were affected compared to a previous 1994 UNICEF estimate of 25-50%.2 This suggests that the recent government campaign of vitamin A supplementation for children under-5 is working effectively.
Refractive errors were the commonest presenting complaint for adults (39% of men and 35% of women). As most spectacles in Zambia are second-hand, donations should be encouraged.
Distance and money were the main barriers that prevented the blind from seeking specialist help earlier (33% and 51%). This corresponds well with known statistics for the developing world in the literature: 48% for money and 44.8% due to logistics in Nepalese patients.3 As the outreach programme is mobile, this tackles the distance issue while free transport and discounted costs should overcome the financial barrier.
Fear was the third barrier at 16%. The study in Nepal also found fear to be next after money and distance at 33%.3 This apprehension could be due to lack of awareness, culture, beliefs or uncertainty over surgical outcome. Improved education and publicity showing cataract patients with restored vision, should hopefully overcome this.
Mobile eye programmes should be integrated into existing primary health care programmes at district hospitals.
Community health workers, traditional healers and schoolteachers should be given basic training in recognising eye conditions.
Community awareness about the prevention of blindness should be raised. For example, it could be included on the teaching syllabus of primary and secondary schools.
1 Sandford-Smith J. Eye Diseases in Hot Climates 3rd edition. Butterworth-Heinemann, 1997, 106-120, 187-189.
2 Zambia Social Indicators. UNICEF 1994.
3 Snellingen T et al. Socioeconomic barriers to cataract surgery in Nepal: the South Asian cataract management study. Br J Ophthalmol 1998; 82(12): 1424-1428.
4 Vaidyanathan K et al. Changing trends in barriers to cataract surgery in India. Bull WHO 1999; 77(2): 104-109.
5 Fletcher AE et al. Low uptake of eye services in rural India: a challenge for programs of blindness prevention. Arch Ophthalmol 1999; 117(10): 1393-1399.
6 Johnson JG et al. Barriers to the uptake of cataract surgery. Tropical Doctor 1998; 28(4): 218-220.
7 Courtright P et al. Barriers to acceptance of cataract surgery among patients presenting to district hospitals in rural Malawi. Tropical and Geographical Medicine 1995; 47(1): 15-18.