Bruce Chooma
11 October 2007
Ndola — CHILDREN are said to be the hope of the world, and humanity is increasingly realising the importance of securing the future of children and adequately looking into their welfare.
The health of children is a crucial aspect to the development of the whole world! Child eye health in particular needs to be successfully attended to - because Zambia, like many other developing countries, is still grappling with the challenge of childhood blindness, a condition caused by a myriad of factors.
Statistics indicate clearly how serious the problem is. At least a child goes blind every minute, and that children most at risk are those below five years old, according to the World Health Organisation (WHO).
Sadly enough, up to 60 per cent die within one year of becoming blind and those that survive can expect to spend on average 40 years without sight. The WHO estimates that up to 90 per cent of blind children receive no education and the great majority would be unable to realise their full potential.
These thoughts should indeed preoccupy the minds of all Zambians as the country joins the rest of the world in observing World Sight Day today with the theme "Vision for Children."
Zambia is a signatory to Vision 2020, a global initiative between the WHO and the International Agency for Prevention of Blindness (IAPB) seeking to alleviate the causes of avoidable blindness.
Vision 2020 has three key pillars: The first being human resource development, and the second is infrastructure development, while the third one is disease control.
Strengthening of infrastructure to guarantee effective medical, surgical and rehabilitative services to control childhood blindness by providing necessary equipment, supplies and appliances is crucial in this vein.
Visual impairment in children not only impacts the child's life but it also profoundly affects their families. Children can also miss out on educational, social and developmental opportunities when a family member experiences vision loss.
A number of children - both the visually impaired and the totally blind - could be helped in their educational and other activities through the provision of optical aids.
Low cost spectacles and unsophisticated, yet effective, low-vision aids such as magnifiers could be produced to meet this need, particularly in developing countries like Zambia.
In about 70 per cent of new cases, blindness is due to vitamin A deficiency. Other important causes of loss of vision are conjunctivitis of the newborn, measles, accidents and certain hereditary and congenital conditions and, in some settings, harmful traditional practices.
Some studies have shown that up to 70 per cent of blindness in children is due to corneal scarring followed by infection with measles. Measles is a severe disease in many developing countries such as Zambia but is now being brought under effective control through immunisation.
Trachoma is one of the most common infections in the world and while not in itself a major cause of blindness in children, it is a major cause of morbidity in children in Africa and Asia.
Systemic infections in childhood may lead to blindness through involvement of the central nervous system. Among these, cerebral malaria an acute bacterial and tuberculosis meningitis, are significant in countries where these infections are common.
Consider the story of 15-year-old Cynthia Sikanaku, a pupil at Mutendere Basic school in Kafue who cries for sight day and night. Terrible headaches, painful and tearful eyes are familiar experiences in the life of this intelligent girl.
Cynthia says her eyes have given her serious problems ever since she was a small child and she can now hardly read and study for an hour without experiencing headaches and tears start falling from her eyes on their own.
Having lost both parents and without siblings, Cynthia, who now keeps up with her aunt says her life is a struggle because her family has very limited resources.
"My teachers are forced to bring me very close to the board for me to be able to read from the blackboard, but even then I cannot read for a long time without my eyes paining and tears rolling down," Cynthia narrates.
Cynthia had great difficulties acquiring assistance for her eye treatment and it took a penfriend's assistance for her to get spectacles.
Cynthia says the doctor at the Lusaka Eye Hospital told her that had her eye condition been diagnosed earlier, she would not have degenerated to this extent.
She is one case of many children today who are suffering due to late diagnosis and delayed treatment of childhood blindness.
If nothing is done to help Cynthia address her deteriorating eye condition, she might lose her sight all together in future and the social and economic loss on her part will be greater as she will have more blind years to live a potentially unproductive life.
University Teaching Hospital (UTH) eye consultant, Grace Chipalo Mutati, runs the UTH Comprehensive Eye Programme which caters for 15 districts in Central, Lusaka and Southern provinces with a total population of over 2.8 million people.
She says one sure and effective approach is to combating childhood blindness is to ensure that primary eye care is integrated in primary health care.
Through a programme supported by Sight Savers International, the hospital trains community health workers, traditional birth attendants and involves community members in health care and educates them on the importance of early recognition of blinding conditions.
The programme also trains secondary and mid-level eye personnel (nurses, clinical officers) so that they can be able to man the districts that are currently being covered by the UTH.
Dr Mutati says once the system is operational, UTH will stop going to these districts to provide clinical and surgical care. UTH will then concentrate on referral cases since it is at tertiary level.
"We emphasise on prevention of blindness. For example, the traditional birth attendants are taught that when the child is born you need to wipe the eyes and instill some antibiotics to prevent Conjunctivitis New Born which is a major cause of scarring.
"We teach community heath workers to encourage the public in the immunisation against measles. So under this programme, supported by Sight Savers International, we go out and train health workers at the community level," Dr Mutati said.
Free eye screening is being conducted at various points in the country.
She also disclosed that there were plans to build a new eye hospital within the UTH with support from Operation Eye Sight, Sight Savers International and the Ministry of Health.
"We will come up with a modern facility to carry out eye care service delivery at tertiary level. SSI has already ordered equipment for district hospitals so that when the mid-level eye care personnel come from training they will find equipment for use," Dr Mutati said.
She said many districts were receptive to the idea of integration and the programme was going on well.
Dr Mutati appealed to general health workers to ensure that they practiced quick referral to tertiary level once they noticed anything they saw as abnormal, especially in a child between birth and the first four weeks of life.
"We need to emphasise more on prevention, not treatment. Sometimes our population tends to seek medical advice when something is beyond treatment," Dr Mutati said.
The programme is targeting to screen at least 350,000 children by 2009 in schools and provide them with appropriate treatment as well for those in need.
It also aims to provide low vision support (surgical support or optical support) and other low vision aids to about 170 children within its catchment area.
Dr Mutati also said there was need to create a pediatric-oriented ophthalmology team to effectively address the causes of blindness in children, which were varied and responded differently to treatment.
The fourth Millennium Development Goal aims to reduce child mortality, hence reduced blindness reduces child mortality.
With Zambia intensifying efforts aimed at combating avoidable blindness by the year 2020, the question we have to deal with is whether children, over whom the economic cost of blindness is higher, are getting the attention they deserve in eye care service programmes.
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