Detection

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Detection Referral of 4,221 Children with
Cataract from Rural Bangladesh Use of Key
Informants by Child Sight Foundation in Bangladesh
Mohammad A Muhit, Issa Mainuddin, Shehab
Choudhury, Anwar Hossain, Johurul Islam Jewel,
Clare Gilbert International Centre for Eye
Health (ICEH), London School of Hygiene and
Tropical Medicine, UK Child Sight Foundation
(CSF), Bangladesh
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• Introduction and aim
• Globally, over 200,000 children are unnecessarily
  blind from cataract(1).
• Majority of cataract blind children live in
  developing countries, without being detected and
  referred for surgery. Early detection, referral
  and surgery is essential for good visual outcome.
  Over 1/3rd of all blindness in children in
  Bangladesh is due to cataract (2).
• The challenge is to find them early, and to
  develop a referral system.
• The aim of this paper is to describe a large
  scale program, which is based on a model of
  community based action for detection and
  referral of cataract blind children from remote
  villages in Bangladesh.
• This community based programme and Key Informant
  Method (3,4) was developed and piloted by ICEH
  and used in Bangladesh and Malawi (5,6). Since
  2003, CSF has been using the Key Informant Method
  in various districts of Bangladesh to detect and
  refer cataract blind children for sight restoring
  surgery.
• Data from 2005-7 are presented here.

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• Methods
• Key Informant Method (KIM) utilizes trained
  volunteers for case detection of children with
  cataract.
• KIM is implemented by one project staff (CM-
  community mobilizer) in one sub-district (all age
  population 250,000 and child population 100,000)
  in 6 weeks.
• The CM trains 50-100 volunteer KI from each
  sub-district through half-day workshops (each
  workshop attended by 20 KI).
• After training, KI spend about 4 weeks to network
  and disseminate the information for case
  detection list all blind children, including
  children who are blind from cataract.
• All identified children are examined in the
  sub-district by an ophthalmologist. Children, who
  have cataract, are referred to partner eye
  hospitals for cataract surgery.

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Community based eye care services for children
Health education
Training on how to identify a blind child
Awareness campaign
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
Schools
Rehabilitation
Eye hospital
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Key Informant Training Flipchart
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If the eye is damaged by trauma including red
eye, swollen eye etc. If the child is born with
serious eye problem including white pupil,
squint, nystagmus (continuous involuntary
movement of the eye) etc. If the child develop
serious eye problems (white pupil, nystagmus etc)
anytime after birth If the child has difficulty
in seeing things
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Who are the Key Informants volunteers
Imam
NGO field-worker
School Teacher
Community leader
Health worker
Government Officer
Local council Member
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How do the key informants work?
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Activities at sub-district (Thana) level
Volunteer Key Informant Training
Entry and sensitization
Identifying blind children
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Activities at sub-district (Thana) level
Volunteer Key Informant Training
Entry and sensitization
Identifying blind children
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Finding blind children from community
Eye examination of children at sub-district
(thana) level
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Finding blind children from community
Eye examination of children at sub-district
(thana) level
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Providing eye examination services for children
in the community
Eye examination of children at sub-district
(thana) level
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Health education and counselling
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Cataract blind children referred for surgery
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• Results
• From 2005 to 2007, 8 field staff (community
  mobilizer) of CSF trained 12,097 volunteer key
  informants.
• Key informants identified a total of 14,232 blind
  children (VA worse than 6/60 in better eye), all
  were examined by ophthalmologists.
• Of them, 4,221 children had unoperated cataract
  in both eyes.
• Each community mobilizer was able to identify 593
  blind children and about 175 cataract blind
  children every year.
• Each staff (CM) referred children for 350
  cataract surgeries per year.
• This model program demonstrates that every
  paediatric ophthalmology unit may employ one
  full-time staff (CM) and ensure that at least 300
  paediatric cataract surgeries are offered to
  children from remote rural areas, every year.

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Discussion Globally, cataract is the leading
treatable cause of blindness in children. Recent
data from various Asian African countries
indicate that there are thousands of children
staying blind without knowing about the treatment
and without accessing surgical services. Key
Informant Method can be effectively used in rural
communities in Asia and Africa to reach the most
difficult to reach children and can ensure that
children with cataract are detected early and
referred promptly for cataract surgery.
Moreover, community volunteers (key informant)
training provides an opportunity to empower
people with information and knowledge about eye
diseases, so that they can help themselves by
identifying and referring children with cataract.
General increase of awareness and community
participation can play a major role in sustaining
the impact of key informants in reducing cataract
blindness in children.
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Conclusions implications Bangladesh has an
estimated 40,000 blind children, of which 12,000
cataract blind. Over 1/3rd of these children
have already been identified by this ongoing
programme. It is expected that by using Key
Informant Method, by 2010, all blind children
will be identified and cataract blindness will be
eliminated. Other countries with large
population and high prevalence of childhood
cataract may benefit from similar
approaches. CSF is committed to ensure that all
blind children, including children blind from
cataract in Bangladesh, are identified and
referred for services. CSF wishes to collaborate
with eye hospitals like CEITC to bring high
quality paediatric eye care to children living in
rural Bangladesh
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• References
• Muhit, M. Gilbert, C. A review of the
  epidemiology and control of childhood blindness
  Tropical Doctor, 2003 33(4)197-201
• Muhit, M. A., Shah, S. P., Gilbert, C. E.,
  Foster, A. Causes of severe visual impairment
  blindness in Bangladesh A study of 1,935
  children. Br J Ophthalmol. 2007. 91(8)1000-4.
• Muhit M. 2007 Finding blind children The Key
  Informant Method. J Comm Eye Health 2007
  Jun20(62)30-1.
• Muhit, M. A., Shah, S. P., Gilbert, C. E.,
  Hartley, S. D., Foster, A. 2007 The key informant
  method - a novel means of ascertaining blind
  children in Bangladesh. Br J Ophthalmol. 2007,
  91(8)995-9
• Kalua, K, Patel D, Muhit M, Courtright P.
  Effectiveness of Key Informant Method in Malawi.
  Eye . 2008, 1-3.
• Kalua, K, Patel D, Muhit M, Courtright P. Causes
  of blindness among children identified through
  village key informants in Malawi. Cand J ophth .
  2008, 43, 425-7.

This programme was designed by ICEH implemented
by CSF and funded by Christian Blind Mission,
Bank Asia, Sightsavers International and Muslim
Aid UK Presented by Dr M A Muhit, at the 8th
General Assembly of the International Agency for
Prevention of Blindness, Argentina 2008.