Establishing a pediatric ophthalmology service in malawi: Developments in childhood cataract surgery

Abstract

PURPOSE:The purpose of this study is to report on the establishment of a Pediatric Ophthalmology Service for Malawi using childhood cataract surgery as a surrogate measure of its effectiveness.MATERIALS AND METHODS:A retrospective review of pediatric cataract surgery at Lions Sight First Eye Hospital, Blantyre, between 2011 and 2016. The paucity of comprehensive records allowed for the sampling of a maximum of 25 cases/year (n = 150) for comparison. Theatre records and population statistics were used to calculate childhood cataract surgical rates (CCSR).RESULTS:A total of 949 cataract operations were performed during the six years studied – 55.8% of these were boys. The number of operations per year remained generally stable. Of the 150 cases reviewed, the mean age at presentation was 6.01 years, with a trend toward a slightly younger age over the period. Over the years studied, the geographical distribution of referrals became more reflective of the population's distribution. Where the logarithm of the minimum angle of resolution (LogMAR) visions were available, these demonstrated a mean improvement from 2.008 (n = 43) preoperatively to 0.613 (n = 51) postoperatively. The mean follow-up was 106 days (0 days–3.25 years). Complication rates were low. The CCSR was 9.2/million population.CONCLUSIONS:A Pediatric Ophthalmology Service has been established in Malawi delivering safe, effective surgery on a country-wide scale for childhood cataract. Over the period studied, the age at presentation reduced, and there was an improvement in the geographical distribution of patients, likely due to an improvement in referral systems throughout Malawi.

Eye Health Integration in Southern and Eastern Africa: A Scoping Review

“…[ 15 16 ] The Malawian Health Ministry identified child eye health as a priority and formed partnerships to provide the necessary services. [ 17 ] In Kenya, the creation of the retinoblastoma strategy group illustrates multisectoral collaboration and a multidisciplinary approach to care. [ 18 ] However, this enthusiastic support at national level fails to cascade to the primary level where there is a general feeling of poor support from supervisors leading to low productivity.…”

“…Increased geographic coverage and access to eye care at primary level were achieved through the delivery of primary eye care by community members and/or primary health workers. [ 17 19 22 26 27 ] Successful performance monitoring was achieved in some settings, mostly aimed at the workers providing primary eye care. [ 28 29 30 ] For instance, in one area of Malawi, between 1999 and 2006, those with blinding cataract who accessed surgery went from 1 in 7–4 in 5 with referrals coming in from community case finders, mobile clinics, and community-based health-care workers who had been trained to identify cataract.…”

“…In the eye health system, workforce integration has taken the form of training physicians, usually junior doctors, to deliver some eye care services for example prescribing near-vision glasses. [ 17 28 29 ] Additionally, several countries report the creation of multidisciplinary teams to take care of particular categories of patients such as in diabetes with nurses and physicians and in retinoblastoma with pathologists, oncologists, laboratory technicians, and social workers coming together with ophthalmologists. [ 18 23 25 ] In countries such as Malawi and Tanzania, eye health workforce integration into the wider health system has been done at primary level by upskilling and delegating primary and maternal health workers for case finding of eye conditions.…”