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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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Number of Treated
Number of Treated
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>
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