|Year : 2014 | Volume
| Issue : 1 | Page : 19-23
Finding children with blindness and visual impairment in five local government areas of Sokoto state using the key informant method
Nasiru Muhammad1, Zainab Mohammed Ali2
1 Department of Surgery, Ophthalmology Unit, Usmanu Danfodiyo University, Sokoto, Nigeria
2 Department of Ophthalmology, Specialist Hospital, Sokoto, Nigeria
|Date of Web Publication||16-Aug-2014|
Ophthalmology unit, Surgery department, College of Health Sciences, Usmanu Danfodiyo University, Sokoto
Background: Pilot inclusive education program that provide education to blind children in routine schools have been implemented in 1 local government area (LGA) of Sokoto state in 2009. Encouraged by the success recorded in the initiative, the Sokoto state Ministry of Education through the State Universal Basic Education Board (SUBEB) decided to expand the programme to other LGAs across the three senatorial districts. This study was conducted to trace blind/visually-impaired children in 5 LGAs of the state in order to link them with clinical, educational or rehabilitative services. Materials and Methods: Primary health care workers (PHCWs) and volunteers were used as key informants over a 10-day period to trace visually impaired/blind and bring them to an examination venue. This followed mobilization and sensitization of the community leaders. A team of an ophthalmologist, optometrist and ophthalmic nurse conducted the eye examination in each LGA on a fixed date including refraction. Results: A total of 107 children were reviewed as children having eye problems. Girls constituted 45% of the children. Twenty-seven children (25%) were found blind using a VA of <3/60 or failure to fixate a penlight in the better eye; and 19 (18%) were visually impaired. Eleven children needed glasses while 18 others were referred for refraction at base hospital. Eighteen children needed cataract surgery. Twenty-five percent of the children were not enrolled in any school, only one child was enrolled in School for the multiple handicapped and 31% need to be enrolled in formal school. Sixteen children need enrolment into an inclusive education school, as they were irreversible blind. Conclusion: The major causes of childhood blindness in Sokoto state are either preventable or curable.
Keywords: Childhood blindness, inclusive education, key informant survey, Nigeria
|How to cite this article:|
Muhammad N, Ali ZM. Finding children with blindness and visual impairment in five local government areas of Sokoto state using the key informant method. Sudanese J Ophthalmol 2014;6:19-23
|How to cite this URL:|
Muhammad N, Ali ZM. Finding children with blindness and visual impairment in five local government areas of Sokoto state using the key informant method. Sudanese J Ophthalmol [serial online] 2014 [cited 2019 Jun 19];6:19-23. Available from: http://www.sjopthal.net/text.asp?2014/6/1/19/138846
| Introduction|| |
Due to rarity of blindness in children, population-based surveys to determine the prevalence of blindness require very large sample sizes and are very costly. Most data for making estimates of the prevalence and causes of childhood blindness have come from surveys in schools for the blind or annexes. It has been recognized that children enrolled in schools for the blind make up only a small proportion of the total blind in the community. The shift to integrated education in some countries has led to reduced numbers of children in schools for the blind and a focus on multiple disabilities at these institutions.  The use of key informant (KI) surveys, to generate data on childhood blindness, has gained popularity in several countries following its success in Bangladesh. 
An Inclusive Education Programme (IEP) was piloted in Gwadabawa local government area (LGA) of Sokoto state as part of VISION 2020: The Right to Sight-compliant comprehensive eye care services programme. An evaluation report at the end of the first phase (2008-2010) reported that the project have been successful in screening and placing children in local schools in the area. The state Ministry of Education through the Universal Basic Education (UBE) Programme has decided to expand the programme to other LGAs across the three senatorial districts of Sokoto state. This is aimed at ensuring the implementation of the national policy on education concerning children with disabilities in the affected LGAs. This study was conducted to trace children with blindness and visual impairment for treatment and/or enrolment into inclusive education in their respective community schools. The LGAs surveyed were Bodinga, Isah, Kware, Tambuwal and Wamakko. The aim of this paper is to report the findings of the KI survey conducted in these LGAs. The specific objectives were: to find children who are blind/visually impaired and need services, whether clinical, educational or rehabilitative; and to provide data on the prevalence and causes of blindness and visual impairment in the five LGAs.
| Materials and methods|| |
Using KIs residing in the respective LGAs between May and June 2012 children with blindness and visual impairments were traced and examined in their respective LGAs.
KI survey method  was used, as it is community based and has a participatory approach. The method involved using Community Health Extension Workers (CHEWS) and volunteers who know the community well, as KIs. The KIs were trained and then mobilized to actively look for children believed to be blind or visually impaired by parents and guardians in the communities. Sokoto State Eye Care Programme (SECP) has already trained some CHEWS in these LGAs as integrated eye care workers.
The following steps were implemented over a period of 2 weeks in each LGA.
Each of the LGA was mapped to determine the number of wards in each LGA. All the LGAs have 12 wards except Wamakko that have 11 wards.
An ophthalmic nurse was appointed as the community mobilizer for each LGA. The LGA authorities identified two CHEWs per ward as KIs. Nearby general hospitals/PHCs were used for the training.
This was carried out concurrently across the LGAs between May and June 2012 by staff from SECP, IEP, Community mobilizer and the SECP programme ophthalmologist.
The following groups were targeted:
- Political leaders
- Traditional/Religious leaders
- Health workers in the Local Government
A meeting was held between the Local Government council and traditional leaders in which they were sensitized on the mission of the survey and their support and participation were solicited.
The community mobilizer had a follow-up discussion with the local health authorities after which with the selected KIs (CHEWs) were contacted and a date was then fixed for the training.
Training of key informants
An ophthalmologist and community mobilizer in each LGA conducted the training.
The content of the training included:
- Blindness and causes in children.
- Benefit of treatment (surgical, medical or optical)
- Benefit of inclusive education
- Access to other services
- Recording data of identified children
- Team work
One day was used for the training of all the KIs in each LGA and they were supplied with file jackets and data recording forms. At the end of the training in each LGA, a date was fixed for the eye examination of the identified children in nearby General hospital or PHC.
Case finding and health communication
KIs used 10 days for case finding in their respective wards. They were responsible for two tasks: to spread message that case detection of blind children is on-going in the community and parents should cooperate by reporting to the ward head or the KI, any child that is believed to be blind/visually impaired; and compiling a list of the names, age and addresses of all the children reported as having visual problems.
Other personnel used were town criers (one from each ward) to spread the message.
Both the ophthalmologist and community mobilizer conducted supervision and monitoring visit to all the wards to discuss progress and problems with the KI's during the days of active case finding. They also selected some households on the list and visited them to ascertain use of guidelines.
KIs also informed parents of the day and venue chosen for eye examination. Parents were promised reimbursement of transport fees spent once they arrive for examination.
This was conducted on the agreed date at a nearby general hospital/PHC. The team comprised of one ophthalmologist, one optometrist and 1 ophthalmic nurse respectively. Standard WHO/PBL eye examination forms for children were used to collect data on all the children examined.
The principal researcher conducted 1-day training for the examination team to acquaint members with operational definitions of the data collection tool and to ensure agreement between the team members. Two teams collected the data with one team conducting three LGAs.
Detailed contact address of the blind children was recorded and arrangements were made for referral of all low vision patients and those with treatable ailments. Children with hearing impairment were all referred to the specialist hospital Sokoto for further hearing tests. Minor ocular ailments were treated with chloramphenicol eye drops where appropriate. Transport fares to all the parents/guardians were reimbursed as promised.
Consent for the survey was obtained from the Sokoto state ministry of health and provision of Helsinki declaration was observed.
Collected data was entered into pre-designed analysis software in SPSS 16 software and analyzed by the principal researcher.
| Results|| |
0 Demography of the sample
A total of 107 children were reported to have eye problems and all were examined, with Bodinga LGA having the highest (30) and Wamakko having the lowest (8). Girls constituted 45% of the sample as shown in [Table 1]. All the children were examined.
Blindness and visual impairment
Thirty two (30%) of the 107 children were blind using presenting VA of <3/60 or failure to fixate a penlight in the better eye, with Tambuwal having the highest number (12), while 19 were visually impaired (18%) as shown in [Table 2].
Causes of blindness and visual impairment
The causes of blindness and visual impairment are shown in [Figure 1] and [Figure 2], respectively. Cataract and Phthisis bulbi are the major causes of blindness while refractive error and cataract were the major causes of visual impairment. Three children (3%) had an associated mental retardation while one (1%) other had a hearing disability.
Services need of the examined children
[Figure 3] shows the services needed by the children in which optical services constituted the majority (34%-refraction and spectacles). Only one child each has had previous cataract surgery and bilamellar tarsal rotation, respectively.
Educational status of the examined children
Twenty-six percent of the children were not enrolled in any school, and only 1 child (1%) was enrolled in a school for the multiple handicapped as shown in [Figure 4].
Educational needs of the examined children
Forty-six percent of the children need a change in their current school as either they attend no school or attend only an Islamic school as shown in [Table 3]. Sixteen children need to be enrolled into an inclusive education school as they are irreversibly blind.
| Discussion|| |
The findings of this survey further laid support to the use of KI to find children with visual problems as reported in similar surveys. , Efforts were made by all stakeholders to ensure that all identified children were brought for examination or traced and examined.
Although childhood blindness in not a very common problem, it is associated with many years of blindness in the affected individual and is an economic burden to the society. Applying the study finding to the study population (395,671 children aged 0-14 years) gives an estimated prevalence of blindness in these LGAs as 0.008%. The major causes of blindness in this study are cataract, phthisis bulbi and anterior staphyloma that are either treatable or preventable and compares to reports in the literature.  The optic atrophy is those cases with either a complicated uveitis or pale optic discs that the primary cause could not be established in a survey of this nature. The corneal opacity is also largely related to measles and vitamin A deficiency. The burden of corneal opacity is not an unexpected finding as the 2009 WHO World Health Statistics report showed measles immunization coverage of 62% among 1 year olds in Nigeria.  This finding contrasts the report from another LGA of Sokoto state where corneal opacity was the leading cause of blindness;  but compares to the findings in Bangladesh , and Malawi  where there were more treatable causes than preventable causes. Our findings are also consistent with the available literature indicating a changing pattern of major causes of childhood blindness globally from corneal opacities to cataract. 
The causes of low vision in this study were also similar to the causes of blindness as they were either treatable or preventable. The local authorities or the eye care program should support the children in need of surgery or glasses where necessary to assist them live a life with normal vision and potentially a more productive life in the society.
Only 40% of the children are attending school within the regular educational system with an additional 1% attending school for the multiple handicapped. Majority (61%) of the children were in need of support services to either be enrolled into a regular educational school system (46%) or into an inclusive educational system (15%). Inclusive education has been reported to provide the least restrictive environment for blind children to be nurtured to grow, flourish, and achieve greater self and social fulfillment.  The stakeholders (parents, governments, communities) need to further collaborate to provide subsidized or free services to these children. This may give the children a better future as useful members of the society.
| Conclusion|| |
The major causes of childhood blindness in Sokoto state are either preventable or curable. Identified children need to be supported to enroll into formal schools as only 41% are enrolled into conventional schools.
| Acknowledgement|| |
The authors wish to acknowledge the support of Aliyu M. Jabo, Mamuda Galadima and Nuhu M. Maishanu in the planning and conduct of the survey.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]