Post on 04-Jan-2016
Gender and Blindness: The conditions do matter: differences in use of services for
cataract and trichiasis after implementation of a community based
eye health programme
Ahmed Mousa Abdel Rahim, M. Sc., Ph. D.Lecturer, Ocular Epidemiology,Department of Ophthalmology,College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Major Goal:To increase eye care service utilization by women in rural Upper Egypt.
Achievable through
• Increase the awareness of avoidable blindness.
• Increase surgical uptake of cataract and trachomatous trichiasis. • Build the capacity of local eye care providers.
• Decrease the impact of barriers
Methods:
Intervention
Control
40 K
M
Capital and Hospital
Major Model Components:
Conduct of Community Health Education
Screening and Referral of Eligible Cases
Capacity Building of Local Eye Care Providers
Breaking Down Barriers to Service Utilization
Helping People to Seek Service
Decrease the Blindness Burden
Seven Health Education Messages
Magnitude and causes of avoidable blindness (with a special referral to the area).
Identification of the two main targeted diseases; Cataract Trichiasis.
Hygiene issues and maintaining good eye health.
Detailed message about cataract including; different types, causes, manifestations and availability of treatment (surgical procedures).
Detailed message about trachoma in children; infection, causes, prevention, complications, and treatment.
Detailed message about Trichiasis and its causes, treatment and complications.
Specific message about gender issues, why we focus on females and the impact of reducing gender gap.
Results:
69%
31%
KnowledgeKnow About Cataract and Or TTNever Heard
31%
53%
16%
AttitudePrefer Private Sector Prefer Local ServiceOther Providers
23%
77%
PracticeSought Service Never Did
The KAP Gap
Results: Comparing Pre to Post Intervention Prevalence of Low Vision and Blindness.
Normal VI & SVI Blind
60.10%
30.40%
9.30%
73.40%
24.20%
2.30%
Intervention VillagesPre Intervention Post Intervention
Normal VI & SVI Blind
60.90%
30.20%
8.90%
63.70%
31.40%
4.90%
Control VillagesPre Intervention Post Intervention
Male Female Male Female
67.60%
55.10%
81.00%
68.60%
26.70%
32.90%
18.00%
28.20%
6%
12%
1%3%
Normal LV & SLV Blind
Results: Comparing Pre to Post Intervention Gender Specific Prevalence of Low Vision and Blindness
(Intervention Villages).
Pre Intervention Post Intervention
Results: Comparing Pre to Post Intervention Prevalence of Cataract
86%
14%
69%
31%
69%
31%
76%
24%
Pre Intervention Post Intervention
Intervention
Control
Results: Comparing Pre to Post Intervention Prevalence of TT
96%
4%
91%
9%
90%
10%
92%
8%
Pre Intervention Post Intervention
Intervention
Control
Results: Comparing Pre to Post Intervention Prevalence of Barriers to Eye Care Service
Utilization
S. BarrierNo (%). reported Yes
Difference
95% CI p
Pre Post
1 I didn't feel a problem 77 (87.5) 104 (70.7) 16.80% (6.71 - 26.89) 0.0051
2 Fear of Surgery 78 (90.7) 97 (66.4) 24.30% (14.48 - 34.12) 0.0001
3 Fear of Surgical Outcome 78 (90.7) 83 (63.8) 26.90% (16.61 - 37.19) < 0.0001
4 I am too Old 75 (87.2) 59 (51.8) 35.40% (23.82 - 46.98) < 0.0001
5 Fear of Bad treatment at hospital 59 (68.6) 44 (41.1) 27.50% (13.97 - 41.03) 0.0003
6 Distance to hospital is too long 62 (72.9) 52 (48.1) 24.80% (11.46 - 38.14) 0.0009
7 Expenses of surgery are too much 76 (89.4) 66 (54.5) 34.90% (23.87 - 45.93) < 0.0001
8 No one to accompany me to hospital 47 (56) 42 (40) 16.00% (1.8 - 30.2) 0.041
9 I couldn't quit work to go 36 (42.4) 44 (42.3) 0.10% (-14.06 - 14.26) 0.8933
10No one to take care of family and children
32 (37.6) 25 (30.1) 7.50% (-6.76 to 21.76) 0.3877
Results: Comparing Pre to Post Intervention Prevalence of Female Specific Barriers to Eye Care
Service Utilization
S. Barrier
Reported Yes, No (%). Differenc
e95% CI p
Pre Post
1 I didn't feel a problem 58 (86.6) 69 (68.3) 17.60% 5.44 to 29.76 0.015
2 Fear of Surgery 60 (90.9) 65 (64.4) 26.50% 14.87 to 38.13 0.0002
3 Fear of Surgical Outcome 62 (93.9) 57 (60.6) 33.30% 21.86 to 44.74 < 0.0001
4 I am too Old 56 (84.8) 39 (47.6) 37.20% 23.35 to 51.05 < 0.0001
5 Fear of Bad treatment at hospital 39 (70.9) 32 (39) 31.90% 15.91 to 47.89 0.0005
6 Distance to hospital is too long 48 (73.8) 38 (46.9) 26.90% 11.66 to 42.14 0.0018
7 Expenses of surgery is too much 60 (90.9) 43 (49.4) 41.50% 28.91 to 54.09 < 0.0001
8 No one to accompany me to hospital 35 (53.8) 29 (35.4) 18.40% 2.46 to 34.34 0.0387
9 I couldn't quit work to go 29 (43.9) 29 (38.2) 5.70% -10.51 to 21.91 0.6044
10No one to take care of family and children
25 (37.9) 16 (26.2) 11.70% -4.39 to 27.79 0.2228
Results: Comparing Pre to Post Intervention Surgery Uptake
2002 2003 2004 2005 2006 2007 20080
50
100
150
200
250
300
350
400
450
500
Cataract Surgery Uptake
Male Female
2002 2003 2004 2005 2006 2007 20080
50
100
150
200
250
300
350
400TT Surgery Uptake
Male Female
Important Limitations
• Lack of well trained local cadres.• Considerable percentage of errors in screening.• Difficulty to change perceptions, behaves and norms.• Lack of equipment at local hospital.• Community mistrust of local providers.• Difficulty to dissolve persistent barriers. • Inflexibility of some MoH bylaws.• Inability to calculate exact figures for comparisons.• Percentage of error in relating the improvement in
service uptake to the intervention.• Degree of precision in calculating accurate win rates.• Community expectations exceeded the program
capacity.
Important Conclusions and Recommendations:
• Interventions to control blindness should be integrated to cover different aspects.
• Major avoidable causes should be prioritized then Targeted.
• A pre intervention community assessment should include:– Current situation analysis.– Understanding community in terms of perceptions and barriers.
• Community health education is a quite successful tool.
• Community volunteers and area residents are the best candidate to deliver such messages.
• Using program logic models adds a lot of value in planning and evaluation processes.
Important Conclusions and Recommendations contin’d:
• Conduct of pre and post intervention assessments helps in evaluation of the model and its components.
• Capacity building of local providers enables absorption of the increase in demand and re-build confidence.
• Participatory development approach that engages the community would guarantee sustainability.
• Gender sensitive approach accelerates the prevention and control processes.
• Sustainability of results should be incorporated in the plan a priori.
So, what’s next
• Encourage developing countries to adopt and implement gender sensitive interventions.
• Widening the range of national and international collaborators
(ex. Including other ministries; education, scientific research, water and sanitation, etc.
• Research to develop and document more action oriented research for prevention of blindness.
• Incorporation of prevention of blindness activities into primary health care activities.
• Paying special attention to training and capacity building research.
Funders and Collaborates
• Funders & Supporters:– The Canadian Institute for Health
Research (CIHR-IGH). Canada.– British Columbia Centre for
Epidemiologic and International Ophthalmology (BC-EIO). Canada.
– Al Noor Magrabi Foundation. Egypt.–Magrabi Eye Care Group. Egypt.
Thank you for y
our kind attention