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School screening & Treatment Project in 9 out of 10 counties supported by Jubilee Insurance Company LTD and Standard Media Group

Background information

The Kenya Society for the Blind (KSB) is a charitable organization established in 1956 by an Act of Parliament – The Kenya Society for the Blind Act – Chapter 251. KSB was established “to promote the welfare, education, training and employment of the blind and to assist in the prevention and alleviation of blindness; and for other purposes connected to elimination of avoidable blindness.” KSB is the leading national agency in the fight against visual impairment (VIs) and promotion of education, rehabilitation of the irreversibly blind and eye health care for the VIs.

The Kenya society for the blind (KSB) has been offering eye care services in the country since 1956.

This is a very important component in health as the eye forms the integral part of the both health

and economic development.

KSB has been conducting school screening activities in many schools in the country with the support

Corporate bodies, stakeholders, individuals of goodwill in partnership with ministry of health and

education. However during this activity, teachers and parents ask questions regarding the school

vision screening project. Some the questions asked are:

1. Why is vision screening important? 2. What kinds of eye problems can be detected during visual acuity? 3. What is the difference between vision screening and a comprehensive eye examination, and

which is more appropriate for most children? 4. Why do all optical shops in major town issue spectacles for all eyes complications? 5. Why is it that many eye drops from KSB are found in government eye units and not in private and

mission hospitals?

What is vision screening?- Vision screening is an efficient and cost-effective method to identify children with visual impairment or eye conditions that are likely to lead to vision loss so that a referral can be made to an appropriate eye care professional for further evaluation and treatment

What kinds of eye problems can be detected on a vision screening? - The main goal of vision screening is to identify children who have or are at risk of developing amblyopia, which can lead to permanent visual impairment unless treated in early childhood. Other problems that can be detected by vision screening include strabismus (eye misalignment), cataracts, glaucoma, ptosis (drooping eyelid), refractive errors such as myopia ("near-sightedness"), hyperopia ("farsightedness") and astigmatism, and other more serious conditions such as tumours or neurological diseases.

What is the difference between vision screening and a comprehensive eye examination, and which is more appropriate for most children? - Vision screening is more efficient and cost effective (which allows many more children to be examined) than a complete examination on every child. Only about

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2 to 4% of children have an eye problem that requires treatment, so it is not practical to perform a comprehensive eye examination on every child. In addition, some problems are missed on a one-time comprehensive eye examination, so it is preferable to have several screenings performed over time. Also, mandated comprehensive eye examinations likely result in glasses being prescribed unnecessarily for many children.

Nevertheless, if a child has known risk factors for eye disease, if there is a family history of pediatric eye disease, or if a child has signs or symptoms suspicious for a vision problem, it is reasonable and appropriate for a child to have a comprehensive eye examination.

Why do all optical shops in major town issue spectacles for all eyes complications? Most optical shops are there for profit maximization. The optical sector is not governed by any legal regulation and so optical shops are there as business entities.

Why is it that many eye drops from KSB are found in government eye units and not in private and mission hospitals? KSB eye drops are produced by KSB in partnership with the MOH (Division of Ophthalmic services) by a unit call NEPU (National Eyedrop Production Unit). The ministry of Health eye care practitioners practitioners were trained in KMTC & UON using KSB manufactured eye drops and hence many of these health workers are recommended to use these eye drops. Mission and private hospitals are not required by MOH to specifically use KSB eye drops.

Partnership between KSB and Jubilee Insurance Company LTD.

Project overview

After agreeing on the project concept and narrowing the project details to a Memorandum of

association, the project kicked off. Jubilee Insurance Company Ltd understood the gap in our

schools based on a concept presented by KSB and thought of bridging the eye care gap in our

schools. Out of the 20 counties in Kenya with high prevalence of blindness, 10 counties were

selected as follows hence a target of 1,504 children:

KSB was to liaise with MOE officers to identify not more than 50 very needy cases in pre-determined

school in 10 Counties based on which an Ophthalmic Clinical Officer (OCO) to screen their eyes and

make suitable referrals. However, the MOE pushed the numbers up to 60 per school arguing out that

the resources to screen 50 children can as well treat 60. Hence the target rose to 1,800.

The target was also 30 schools. But when this information was shared with County officers, the

targeted schools invited the neighbouring schools for this rare eye screening moment. About 45

schools were involved.

A predetermined number of officers were to be involved. This changed completely after the MOE

made a requirement that its officers will have to be included. In some counties we worked closely

with EARC officers, KIEP Coordinator and County Education Coordinators.

The Some County Executive Officers of health also imposed some requirements. In some counties,

we had to work with Ophthalmic Clinical Officers (OCOs) and Ophthalmic Nurses (ON). Apart from

the planned visiting team of 4 (KSB staff/Report Writer/Driver writer; KSB Ophthalmic Nurse, MOH

Ophthalmologists/OCO, MOH Pharmacist). The extended team often included the 4 plus, EARC, Plus

County Ophthalmic Nurse, Education officers representing the County Education Directors and KIEP

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Coordinators. KSB also took advantage of this scenario by requesting for extra drugs from the

County Hospitals. This cushioned us in some counties like Kisumu, Kitui, Makueni, Nakuru and

Machakos. After all the Counties also used this project to give statistics on their eyes screening

outreach programmes.

Another change was in dates. Most of the dates for the planned screening changed. There was

schedule one and later schedule two. In Kisumu there was rearrangement of dates due to political

insecurity. Kibos which was supposed to be the last ended being the first and Olwa the last.

County

Number

school Schools

Target

Number

Patients to

Screen

Dates for

the events

Nairobi 5

Kilimani Primary

60 2-Oct-17

Langata Barracks Primary

60 11-Sep-17

Huruma Primary

60 5-Oct-17

Kinyanjui Road Primary

60 4-Oct-17

Ofafa Primary

60 6th-Oct-17

Kisumu 4

Kibos Primary School for the

Blind

60 11-Oct-17

Agai Primary

60 12-Oct-17

Sondu Union Primary

60 13-Oct-17

Olwa Primary

60 14-Oct-17

Mandera 4

Mandera Arid Zone/Madear

D.E.B. School

60 10-Oct-17

Mandera Boys

60 10-Oct-17

Bulla Mpya Primary

60 12-Oct-17

Shafshafey Primary

60 16-Oct-17

Nakuru 3

Menegai Primary

60 3-Oct-17

Kaptembwo Primary

60 4-Oct-17

Milimani School

60 5-Oct-17

Trans

Nzoia 3

Mitoto Primary School for the

Blind

60 11-Oct-17

Cherengani Primary

60 9-Oct-17

Mosombor Primary

60 10-Oct-17

Machakos 3 Machakos Primary 4-Oct-17

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60

Machakos/Muslim Township

Primary

60 6-Oct-17

Mutituni Primary

60 5-Oct-17

Kitui 2 Muslim Primary

60 2-Oct-17

Kwa Ngindu Primary

60 3-Oct-17

Turkana 2 Katilu Primary (integ Prog)

60 3rd –Oct-17

Lodwar Mixed Primary

60 5th–Oct -17

Kiambu 2 Thika School for the Blind

60 5-Oct-17

Kiambu Primary

60 12-Oct-17

Makueni 2 Mukuyuni Primary

60 12-Oct-17

Unoa Primary

60 13-Oct-17

Total

1,800

Drug Distribution Table

Code Name of County Name of Schools

Children Treated

Number of Bottles Per County

Dispensed With GOK additions

1 Machakos

County

Machakos Township Primary School 101

249

Machakos Primary School 68 289

Mutituni Primary school 59

2 Kisumu County

Kibos Primary School 110

268

Agai Primary School 83 316

Sondu Primary School 63

St Pius Olwa Primary School 22

3 Mandera County

Mandera DEB Primary School 76

239

Bulla Primary School 53 239

Shashafey Primary School 102

Mandera Boys Primary School 44

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4 Makueni County

Makuyuni Priamry School 109 233

268

Unoa Priamry School 106

5 Kitui county Kwa Ngindu Primary School 68

239 271

Muslim Primary School 81

6 Transzoi County

Mitoto Primary School 61

249

Mosombor Primary School 56 249

Cherangani Primary School 38

7 Nairobi County

Ofafa Jericho Primary School 102

336

Langata Primary School 62

Kinyanjui Primary School 102 336

Kilimani Primary School 137

Huruma Priamry School 88

8 Nakuru County

Menengai Primary School 62

389

Kaptemboi Primary School 113 456

Milimani Primary School 85

9 Turkana County

Turkana integrated 239

Lodwar primary 239

2441 2663

Summary of Treatment

The school vision screening activities targeted 30 primary schools in 10 counties. The table below

shows the name of the counties, schools and number of children screened per school.

Table 1: Name of the counties, schools and number of children screened per school.

Code Name of County Name of Schools Number of Treated

1 Machakos County

Machakos Township Primary School 101

Machakos Primary School 68

Mutituni Primary school 59

2 Kisumu County Kibos Primary School 110

Agai Primary School 83

Sondu Primary School 63

St Pius Olwa Primary School 22

3 Mandera County Mandera DEB Primary School 76

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Bulla Primary School 53

Shashafey Primary School 102

Mandera Boys Primary School 44

4 Makueni County Makuyuni Priamry School 109

Unoa Priamry School 106

5 Kitui county Kwa Ngindu Primary School 68

Muslim Primary School 81

6 Tranzoia County Mitoto Primary School 61

Mosombor Primary School 56

Cherangani Primary School 38

7 Nairobi County Ofafa Jericho Primary School 102

Langata Primary School

Kinyanjui Primary School 102

Kilimani Primary School 137

Huruma Priamry School 88

8 Nakuru County Menengai Primary School 62

Kaptemboi Primary School 113

Milimani Primary School 85

9 Kiambu County Thika School For the Blind 68

Kiambu Primary 81

St Patricks Special For Mentally 23

Mugomoini Primary 4

10 Turkana County Lodwar Primary 113

Turkana Intergrated 149

Katilu Boys 30

Graphical 1: Graphical presentation of children treated per school

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Based on the above the graph you can see that Kinyanjui primary school in Nairobi County screened

and treated the highest number of pupils, followed by Menengai primary school in Nakuru County

and Kibos primary school in Kisumu County.

The school with the lowest number of pupils treated is Sondu primary school, Mandera boys and

Cherangani primary schools.

The table below shows the eye conditions diagnosed during the screening activity in both counties.

Table 2: Eye conditions diagnosed during the screening activity in both counties

DX code Eye condition Number of Cases

1 Normal eye 253

2 Bacterial Conjuctivitis 49

3 Asthenopia 19

4 Allergic Conjuctivitis 1,456

5 Chronic allergic Conjuctivitis 58

6 Refractive error 231

7 Lid warts 1

8 Chalazion 1

9 Hyper pigmentation 2

10 Trauma 6

11 Cataract 20

12 Squint 15

13 Pterigium 1

14 Ophthalmic Neonatium 1

15 Keratoconous 12

16 Diplopia 2

17 Idiopathic 6

18 Blephratisis 6

19 Ptosis 2

20 Retinal Conditions 1

21 Others 72

22 SLE/Funduscopic 1

23 Uveitis/Photophobia 3

24 Painful eye 3

25 Myopia 14

26 Chorowal ulcer 1

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27 Dry eye syndrome 11

28 Mono eye/cornea scar 3

29 Pseudophokia 10

30 Esotropia 4

31 Corneal ulcers 28

32 VCK 30

33 NLD BLOCKAGE 1

34 Mental health 1

35 Corneal opacity 15

36 Nystagums 3

37 Referrals 66

38 Optic atrophy 15

39 Congenital glaucoma 1

40 Ocular albinism 2

41 Steven Johnson syndrome 1

42 Micro ophthalmas/micro-cornea 4

43 SVCK 3

44 Low vision 21

45 Assessment 22

46 Bilateral blindness 1

47 Albinism 1

48 Physcal Bulb 2

49 Complicated TT/socket 3

50 Chalazion 1

51 Post Operative 1

52 Alupic Cory 1

53 Symblpharon 1

54 Night Blindness 5

55 Blind eye 9

56 Sub - conjunctiva haemorrhage 1

57 Tearing 3

58 Floaters 1

59 Dermold cyst 2

60 Fallen body 1

Total 2,220

Pie Chart 2: Eye conditions diagnosed during the screening activity in both counties

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Feedback from Trans Nzoia (Kitale) (19/01/2018)

NAME GENDER AGE CLASS VISUAL ACUITY DIAGNOSIS

Oded Simiyu M 13 5 6/36 6/36 Refractive error

Vivian Nasimiyu F 14 8 6/9 6/9 Refractive error

Florida Nafula F 14 6 6/9 6/9 Refractive error

Charles Wasike M 14 6 cf 2m cf 2m Refractive error

Caren Ageri F 16 8 6/6 6/6 Refractive error

Esther Imo F 14 6 6/9 6/9 Refractive error

Ibrahim Nyongesa M 8 1 6/24 6/18 Refractive error

Lavender Awuor F 6 1 6/6 6/6 Refractive error

Gideon Kiprotich M 13 6 6/6 6/6 Refractive error

Dorcas Chemah F 13 5 6/18 6/9 Refractive error

Dickson Munanagt M 16 8 6/18 6/36 Refractive error

Kemoi Langat M 15 7 6/6 6/6 Refractive error

Norah Cheprotich F 16 8 cf 2m 6/12 Refractive error

Wilbroda Chepkemoi F 15 8 6/60 6/60 Refractive error

Lilian Baraza F 17 8 6/24 6/24 Refractive error

Rose Nyongesa F 12 7 cf 2m 6/36 Refractive error

Metrine Nafula F 15 5 6/18 6/12 Refractive error

Grace Wanyonyi F 11 2 6/12 6/60 Refractive error

Normal eye

BacterialConjuctivitis

Asthenopia

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Valary Baraza F 9 1 cf 1m cf 1m Refractive error

Samuel Kibet M 11 2 6/18 6/12 Refractive error

Winnie Chepkorir F 11 5 6/18 6/18 Refractive error

Tom Baraza M 14 6 6/12 6/12 Refractive error

Antonina Nakhumicha F 17 8 6/18 6/12 Refractive error

Mercy Cheruro F 15 8 6/6 6/6 Refractive error

Levin Yego F 10 5 6/6 6/7 Refractive error

Lilian Nukonga F 13 7 6/36 6/6 Refractive error

Joseph Wanjala M 13 6 6/6 6/6 Refractive error

Joan Wamalwa F 11 5 6/6 6/9 Refractive error

Ezekiel Wanjala M 13 3 6/24 6/9 Refractive error

Abiud Omanchari F 14 6 6/12 6/9 Refractive error

Abel Naiba M 9 1 6/18 6/9 Refractive error

Sylvia Chepkwemoi F 16 7 6/12 6/18 Refractive error

Korir Lameck M 14 7 6/6 6/9 Refractive error

Chepkwemoi Faith F 16 8 6/9 6/9 Refractive error

Joan Chepkirui F 12 4 6/18 6/24 Refractive error

David Wekesa M 12 5 6/18 6/18 Refractive error

Sarah Juma F 15 8 6/6 6/6 Refractive error

Linda Jepchumba F 15 8 6/36 6/36 Refractive error

Lynetus Moraa F 12 6 6/6 6/9 Refractive error

June Suter F 12 5 6/36 6/36 Refractive error

Purity Jelagat F 12 4 6/6 6/6 Refractive error

Dorcas Auma F 15 8 6/9 6/9 Refractive error

Ruth Nanjala F 9 3 6/12 6/12 Refractive error

Tony Kutoto M 10 3 6/9 6/18 Refractive error

Augustine Baraza M 12 3 6/36 6/9 Refractive error

Sarah Wabomba F 13 7 6/18 6/12 Refractive error

Emmanuel Keya M 15 8 6/12 6/9 Refractive error

Rose Andisi F 13 7 6/12 6/24 Refractive error

Sammy Ayieko M 14 8 6/9 6/12 Refractive error

Zekana Biketi M 12 6 6/18 6/9 Refractive error

Zivian Chepkoech F 15 8 6/6 6/6 Refractive error

Lydia Chelimo F 5 1 6/6 6/12 Refractive error

Enock Rono M 13 7 6/12 6/12 Refractive error

Cecelia Chepkoskei F 11 5 6/12 6/12 Refractive error

Petronila Ayuma F 16 F1 6/12 6/15 Refractive error

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Following this report from Cosmas, he wrote they following email:

Cosmas Bunywera

9:39 PM (10 hours ago)

to

me

Hi sorry for the delay, here is the list of all the children with refractive errors. it is very difficult to trace the prescriptions because most of them went with their books and getting them is difficult. The Optometrist who was performing refraction on them said that most of their spectacles do not go beyond -2. I hope this information is helpful, am usually out of the office because its January and lots of planning for the year takes place around this time. Please not that this information has been compiled from different sources and most of the children have not turned up yet for their refraction to be done. If possible you can request for more time so that through the contact teachers in school I will trace all the children now that the schools have reopened so that we can get the specific prescription of their glasses. Just a quick question though, DO YOU HAVE READY MADE GLASSES OR YOU HAVE TO CUSTOMIZE ACCORDING TO PRESCRIPTION? I am still waiting for a list from mitoto primary if you guys are will to support them with low vision devices. Thanks -- Dev. Cosmas Bunywera.

Feedback from Kisumu (19/01/2018)

Hello Sir. I'm yet to get the names from Sondu Union. I've waited since Thursday, they gave the

forms to the children who were referred to JOOTRH. So, getting the names is a problem. Otherwise I

have 2 cataract cases, 24 refraction cases and 26 ophthalmic cases that vary from idiopathy, trauma,

uveitis, conjunctivitis, retinal problems, ptosis, aesthenopia, suspected glaucoma, allergies, squints

and preceptal cellulitis.

Forward from:Mr Obare -Sondu <+254720207977>