Sebastian N N Nwosu Cyriacus U Akudinobi Guinness Eye Center Onitsha Nigeria.

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