SUMMARY A population based survey of blindness and eye disease has been conducted throughout the whole country of The Gambia, and 8174 people were examined. The prevalence of blindness (best acuity less than 3/60) was 0 7% and low vision (6/24-3/60) 1.4%. The causes of blindness were cataract (55%), non-trachomatous corneal opacity/phthisis (20%), and trachoma (17%). An estimated 5500 people in The Gambia require cataract surgery, 4600 eyelid surgery for entropion, and 4600 people spectacles to correct a refractive error which causes a visual acuity of less than 6/18. More than half the current burden of blindness in The Gambia is potentially remediable through the provision of cataract surgery and aphakic spectacles.
Objective: To examine the production and use of health education films in Kenya, Tanzania and Zambia. Design: A review was undertaken of the community health education films produced by a film production company and their use by three partner organisations in lower-and middle-income countries. Methods: A focused content analysis of 18 community health education films was conducted and three exemplar films were selected for review. Interviews were carried out with four film production personnel and seven project workers using the films within health education projects in Kenya, Tanzania and Zambia. Concepts drawn from the Ottawa Charter for Health Promotion and Anchored Instruction informed the study. Findings: The films, produced primarily for use in sub-Saharan Africa, mostly convey biological information and address behavioural issues related to specific maternal and child health topics. The predominantly low-literacy audiences reached by the projects may benefit from local content highlighting the social determinants of health and engaging communities in narrative format. While broader health education initiatives may provide opportunities to discuss the films after screening, linked problem-solving activities could raise community awareness of the multiple factors influencing health and help members formulate holistic action plans. Conclusion: The production company responded to emerging findings, noting that more context-specific films should be produced with community members being more fully in the planning, production and evaluation. This should generate more relevant content and engage audience members more effectively in problem-solving related to health and wellbeing.
Entropion-trichiasis is seen mainly in adults. It was observed only in old people in South West Africa (Eiselen and Gear, I960), and in Casamance was rarely present in children under I5 years and not at all in infants (Vellieux, Le Breton, Oliveau, and Larmane, I959). It was not found amongst 556 trachomatous schoolchildren in Senegal (Vola, 1958). In a Gambian village of 400 inhabitants there were four cases, all in adults (Sowa, Sowa, Collier, and Blyth, I965). I have seen it infrequently in Gambian children but not hitherto in an infant. This paper describes severe bilateral entropion-trichiasis in a i6-month-old baby.Case report A x6-month-old baby boy was brought to the ophthalmic out-patients clinic with a history of discharging eyes for a year after birth and in-turning eyelashes for the last 5 months. There were two older siblings who had no eye trouble. ExaminationThe baby was healthy and well-nourished. His exact age is known because it was recorded by a government midwife; he was still mainly breast fed and the dentition and physical development were consistent with that of a Gambian child of I6 months.There was severe entropion-trichiasis of both upper eyelids (Fig. i). Slit-lamp examination of the upper tarsal conjunctivae showed some oedema and hyperaemia with a few papillae and mature follicles in the canthi, and linear scarring in both eyes, worse in the left. In the corneae there was fine trachomatous punctate keratitis with a vascularized opacity in the lower half of each, corresponding to the rubbing lashes. There was no abnormality of the upper limbus. Scrapings from the upper tarsus were examined by the iodine method (Sowa and others, I965), but no inclusion bodies were found.
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