Dr. Abhishek Mandal, PhD
Senior Business Adviser, Vision Science Academy, London, U.K.
Vision Science Academy Exclusive
Global analyses indicate that the preponderance of optical impairment and blindness is continuously rising despite exercising the practices drafted in the Global Action Plan, which aims at reducing these by 2020. Vision impairment negatively affects one’s autonomy, options, and life. The southern and sub-Saharan region of Africa is significant in this regard. These lower and upper-middle-income regions have a high penetration of eye ailments and blindness. They have variant methodologies and action plans to manage them, but much work and progress are still required.
What are the stats on eye diseases and blindness in Africa?
Visual impairments and eye disorders are the major problems in low and middle-income regions. The grave sufferers in this regard are India and southern Africa. The prevailing eye care practices in a region mark the health system state of that region. A research shows that glaucoma-induced blindness has the highest rate in Southern Sub-Saharan Africa (Flaxman et al., 2017). The proportion of blind people here is increasing faster (Resnikoff et al., 2004). The northern countries from Morocco to Egypt are different from the rest by being less prone to eye ailments. Hence for discussions and planning about health, the World Health Organisation (WHO) refers to the sub-Saharan African region as these countries suffer more (Lewallen & Courtright, 2001).
50% of the blindness in Africa is because by the cataract. And the preponderance of blinding bilateral cataracts in Africa is about 0.5% (Leske et al., 2000). Trachoma has been dwindling in most regions of the world; it is still the second major cause of blindness in African countries. About 2.2 million people have trachoma-induced blindness (Wolfson et al., 1999). Open-angle glaucoma (OAG) also has high rates in Africans and develops at a younger age. In the Western Cape of South Africa, the preponderance of OAG of 1.5% was reported, and the prevalence of primary angle-closure glaucoma was 2.3% (Salmon et al., 1993). Onchocerciasis, or river blindness, is yet endemic in 30 countries of Africa and presumably accounts for 99% of the total 270 000 blindness worldwide (Burnham, 1998).
What are the patterns of eye care in South Africa?
A study was conducted in South Africa to assess the eye care utilisation routines and the factors associated with them in the South African people aged 15 years and old by employing the data provided by the South African National Health and Nutrition Examination Survey (SANHANES-1). The factors studied included age, geographical origin, ethnicity, and financial status. The study evaluated whether the participants had an eye check-up and when was the last time they got their eyes examined. The sample comprised 3220 participants, of which 64.9% were females. About 75% of the sample population was not employing eye care. The following graph shows that most people never visit an ophthalmologist (Emerson et al., 1999).
Coming to the factors that affect eye care practices. Age intensifies the eye care routine. A record of an eye check-up gives that 33.6% of 75, while 10.2% of 15–29-yeared people get their eyes examined within the last two years. 81.1% of the rural participants adopted eye care compared to 66.9% of urban participants. Similarly,
African adults have good eye care practices with 78.7% as compared to white adults with 10.7%. 85% of participants from the poor sector never had an eye check-up, while among wealthy participants, 42.2% never had an eye check-up (Akuffo et al., 2020).
Zimbabwe has a blindness rate of 1%. Half of the cases are caused by other than cataracts, and 80% of causal factors are preventable. Chinpendo et al. surveyed Zimbabwe to investigate the stressing factors of eye ailments among the 14-40 years old population. 71% of participants claimed to encounter eye ailments. And there was a link between the profession and the risk of eye diseases. According to the data presented, farm setting jobs and farming impact the eyes worst, as illustrated in the graph below (Chipendo et al., 2012).
What are the patterns of eye care in sub-Saharan Africa?
The eye care practices and services in sub-Saharan Africa (SSA) got sabotaged because of system defaults. A study was conducted in Ghana, Sierra Leone, Senegal, Mali, Tanzania, Kenya, Malawi, and Mozambique to assess the current eye care scenario and suggest improvements.
The data revealed substantial improvement in eye care service systems at the national level. All countries have different eye health programs and update optical health plans except Mali and Senegal. Both countries have their national plans expired. There were loopholes in administration and coordination in all countries. The secondary facilities are different in every country, and tertiary facilities are available in the capital and metropolitan areas. The district-level eye care was different from the national level as it depends on governments’ finances, infrastructure, and personnel. The regulating bodies like Vision 2020 committees were non-functional (Bechange et al., 2020).
Human resources for eye health (HReH) development is crucial to decrease preventable optic impairments by 25%. In sub-Saharan Africa (SSA), the optic workforce is much smaller to meet the criteria. The research was conducted in 21 countries across SSA to evaluate the human resource indicators according to Vision 2020.
In 21 countries, there were 1,444 ophthalmologists, 363 cataract surgeons, 456 ophthalmic clinic officers OCOs, and 2,997 ophthalmic nurses. The stats of optometrists were available for 18 countries only. Nigeria, Sudan, and Ethiopia employed almost two-thirds (64.5%) of the eye specialists. Kenya, Congo, and Ethiopia, with 54.5%, were the largest employers of cataract surgeons, while Nigeria, Sudan, and Botswana, representing one-third of the sample, had no cataract surgeons. The data evaluation indicated that almost none of the countries achieved VISION 2020. Following is the graph of medical specialists in the sample countries (Palmer et al., 2014).
What are the recommendations and future scope of eye care in Africa?
A set of targets set to achieve by 2020 for a better eye health future in Africa is called VISION 2020. It refers to aims and priorities adopted by people, non-government organisations, the WHO, government organisations, and health ministries that work in the domain of blindness prevention. It aims to lower the prognosis of 75 million blind to 25 million. The causes of blindness in impoverished countries have three groups as follows:
(1) Universal causes for which successful and cost-efficient treatments are available, including cataract and refractive disorders.
(2) This attack specified populations and can be averted by affordable treatments. These include deficiency of vitamin A, trachoma, and onchocerciasis.
(3) Blinding ailments that are not well described and for which cost-efficient testing and medicine do not exist presently. Diabetic retinopathy and glaucoma are some of them.
For Africa, it is necessary to give a high preference to the first two causes. For that, there will have to be massive developments in terms of human resources, infrastructure, and organizational capability.
One of the Vision 2020 goals is to have at least one ophthalmic nurse per 100 000 population by 2020. The current cataract surgical rate (CSR) in Africa is estimated to be 200–400, while the target for the coming 5–10 years is to raise the CSR in Africa to 2000. Ailments such as trachoma, onchocerciasis, and vitamin A deficiency-related blindness are handled through primary health care protocols. Eliminating blindness due to these diseases is the goal of several initiatives that are a part of Vision 2020 (Foster, 1999).
Eye diseases have different regions in different countries of the world. Finances, infrastructure, power, and human resource are the factors that are important to consider and work on to provide better eye care services. Also, people should be aware of the illness driving them to blindness and visual impairments. The African countries have different stats on eye ailments, but the common problems are lack of resources, knowledge, and data. It is leading to severe eye ailments and conditions like blindness. Many countries have policies made and paperwork done, but there is less on the implementation side.
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Bechange, S., Jolley, E., Virendrakumar, B., Pente, V., Milgate, J., & Schmidt, E. (2020). Strengths and weaknesses of eye care services in sub-Saharan Africa: A meta-synthesis of eye health system assessments. BMC Health Services Research, 20(1), 1–8.
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