Global Child Eye Health Project – Developing and pilot testing an eye module for inclusion in the UNICEF/World Health Organization child health programme in Tanzania.

Dr Malik reports: On one of my first visits to Tanzania I met Ashura and her child Shadrack at the Muhimbili hospital in Dar es Salaam. Ashura explained that she knew soon after Shadrack was born that there was something wrong with his eyes. They looked large, were watery and he hardly opened them. When she visited the local child health clinic she told the child health care workers about her son’s eye problems. However they did not know what to do or how to examine his eyes, so did nothing. This sequence was repeated another four times over a period of three months. Not knowing how to examine Shadrack, the child health care workers either ignored his mother’s questions or gave her antibiotic eye drops. Finally, she decided she would seek help herself and made her way to the hospital. It was there that he was diagnosed with congenital glaucoma – a rare eye disease which leads to increased pressure in the eye – untreated, it can lead to blindness. Shadrack was fortunate enough to be able to access treatment just in time, and is now making good progress.

For every one blind child in a high income country there are ten times more in low income countries, such as Tanzania. Three quarters of these children have treatable or preventable conditions, but there is a lack of local skilled eye care professionals to provide preventative measures and to detect and treat eye problems. Children frequently present too late for effective treatment to take place leading to avoidable visual loss and blindness. Mothers and children do regularly access primary level child health clinics in order to receive vaccinations, health advice and education. However, health care workers are not taught about eye problems in children. In fact child health systems and programmes, including the UNICEF/World Health Organization Integrated Management of Childhood Illness (IMCI) do not include eye care in their primary level services for young children.

The funding from BCPB has allowed us to develop and pilot test an eye care training module which can be included in the programme.

We have been working closely with the Ministry of Health (MoH) in Tanzania to develop this module and then test it in Bahi, a rural central area in Tanzania. We have developed an eye care training module, self-assessment, training videos and a poster. We distributed arc lights, an innovative new low-cost device which can check the reflex of babies and children, to all the health care workers allowing them to detect important, treatable eye diseases in children such as cataract and retinoblastoma. The results from our work have shown a significant improvement in the knowledge and skills of child health care workers who found the training easy to understand and relevant and were able to apply it in their daily practice, including checking the red reflex with an arc light.

Feedback from health care workers we have trained overwhelmingly said they would like videos to show some of the examinations and cases that were being taught in the eye module. This led us to set up a film studio in the eye clinic in Muhimbili national hospital in Dar Es Salaam and, after overcoming many challenges, seven educational videos have been produced as part of the training module. The Ministry of Health were delighted with our eye module work and have now included it into all IMCI training nationally. We are now planning to build on this work by evaluating the programme in Tanzania to provide evidence for scale-up in the global IMCI programme. This has the potential to give mothers and children access to basic eye care services in over one hundred low income countries.

Since this project has been completed the Ministry of Health in Tanzania have now trained 3,000 workers (and counting!) over 8 regions across Tanzania. This means that 100,000s of children will have now benefited.