REPORT ON
THE MEETING OF THE TECHNICAL CO!4MITTEE ON PREVENTION OF RLINDhTSS
Alexandria. 1 2
-
14 June 1978
The v i e w s expressed in t h i s Report do not necessarily reflect the official polioy o i the World l l e a l t l r Organization.
WHO EMRO
TABLE OF CONTENTS Page I 11 111 INTRODUCTION REVIEW OF ?WE PROBLEM OF BLINDNESS IN THE REGION IIEVIEW OF THE PROBLEM 01' BLINDNESS IN SELECTED COUNTRIES 0 1 1 I'llh HEGlUN
1
1.
2. 3. 4.
5. 6. 7.
Egypt Iraq Kuwait PahiStan Saudi Arabia Sudiln I n t e r p r e t a t i o n of d a t a o n b l i n d n e s s
IV
THE I'RESENT STATUS OF OPHTItALhUlLOGICAL SERVICES
1.
Review o f p o t e n t i a l d e v e l o p m e n t f o r r e g i o n a l s e r v i c e s f o r t h e prevention of blindness
1.1 1.2 1.3
1.4 V
Research Training P r i m a r y e y e care S p e c i a l i z e d eye care
CENTRES FOR TIIE PREVPiTION OF BLINDNESS OUTLINE OF A PROPOSED REGIONAL PILOGRAMME FOR ?WE P R E W T I O N OF BLINDNESS
VI
1. 2. 3. 4.
Situation analysis Approaches O b j e c t i v e s and t a r g e t s a t r e g i o n a l l e v e l O h j p c t i v e s a n d targets a t c o u n t r y l e v e l
VII
RECOrnrnDATIONS AGmDA L I S T OF MEMBERS OF THE COMI7"I'EE
ANNEX 1
ANNEX I 1
WHO EMRO
EM/PBL/4 EM/MTG.TCIi.COM.PREV. BLIND. /I0 page 1
I
INTRODUCTION The Technical Committee nn Prrvantinn of Rlindne.c, rnnv-nod in Pilpmndrl.
from 12 to 14 June 1978 for the purpose of : (a) (b) (c) formulating a Drogramme of work and drnwinz up a plan of action. discussing the feasibility of the proposal to establish a regional centre for the prevention of blindness, identifying the countries interested in this activity,
T ~ P Committee
meet in^
was o~cncdb y
Ilr
A.H. Taba, Director, WIlO Eastern Xediter-
rdnearl 1:ci;ion.
In his opening address Dr T a b . to %he deVe10penLs -1tll;h have
called the attention of the participants He also stressed
led to the identifisation of prevention of
blindness as a priority programme for technical co-operation. and resources within the Region.
the need to develop a programme which would take into account existing needs
The magnitude of the problem on a regional h s i s is not known in its details, but available information indicates that between 1 and 4 per cent of tho population in tho Region is blind. The most affect& p o p s l l r t i n n group. rr-
those living away from ophthalmological care. s o w urban areas.
This includes rural as well as
The proportion of blind is higher and the age oi onset
earlier where living and socio-economic conditions favour the occurrence of infectious diseases and malnutrition. Loss of vision from infectious diseases lndnalnutrition ir w r t l y preventable
and can be coped with at relatively lor cost and does not require the availability of hi~hlysprcia1iz.d services at the peripheral level. The provision of basic eye care at primary health care level, and the
establiahmt of am a w u a t e referral systr, a u l d greatly facilitate the aTt.inRCn; 01 the ultivtc obj~otircof a
dcair-ble level of eye health for all.
At the opening session the Agenda of the meeting was unanimously adoptul without amendments. Rapporteur. It was decided that each participant of the meeting w u l d Dr M.L. Tarizzo was nominated to act as ~uccessivelychair the meeting.
EM/PRL/4 EM/MTC.TCH.CON.PREV. BLIND. ,/LO page 2
I1
REVIEW OF THE PitOBLEM I ' P Ili.ll<l>Ni..i:;
L?:
THi REGl07G
B l i n d n e s s and v i s u a l I r n ~ ~ a f m e nr-rj!resnnf t, a ma,):), t i e a l t h u m h l v m i n t h e E a s t e r n \ledi t z - r r a n c a n Ilf%i.n:\ socio-cconomic cunaequr;r!cr:s
A! st:,
there i s nti dn;rbl
th.,.? t h * a d v e r s e
<if i . 1 1 1 9 tr-w l l h p r r h l e m a r e
nnr,rrni:':.,; x : ;
'I'l$-ic a +,hole.
consequences hil. the indivliiua:
'he
f a m i l y ar,d t h e ,:i;-r.n,nr:lt:
The a v a i l a b l e i n f o r m a t i o r r
..,I
rile I r r v n 1 , : ~ I ~ r r of ':I
!?rlr-:A*:
?:.
; :-
:icgion
i s d e r i v e d from a rrumber oi suivl.,:'s Region.
~l~~i!r*rtakr:r. i n va-,i'.~:s
: fhc I n !ii.mn. rile
P r e v a l e n c e r a t e ? v a r y a~!cordir?Kt o countrbcts.
blindness r a t e w a s found t o vary from 4 l o 4 . 7 p e r c t n t i r : i r i r - l l i>r;cu,lations and 1 t o
1.5 por
ocnt
in urban I ~ v p ~ r l a ~ j . i r ~ lL Lr .l - r i & I r ? trn2h;rnii
rndrc~L- a r e a s .
However,
t h e prevalence r a t e i n o t h e r courltrir-s of the 'irgiun r s re))orted i.i
t o be much l o w e r and v a r i e s from ! ~ . 2 5t o 1 p e r c e r r t , t h e m a j o r i t y b l i n d b e i n g i n t h e a g e g r o u p 41) year3 a e d o v e r .
Lhe
The t o t a l number of b l i n d petipie
irt
t h i s Jleglon i s now r o u g h l y e s t i m a t e d
a t 7.5 m i l l i o n and t h i s r e p r e s e n t i a n ,rrserali sogl.ona1 prevallt?nci! r a t e of aholtl R p a r cent.
I n trachoma endemic a r e a s ,
6 5 p e r c a n t o f cases o f b l i n d n e s s a m c a u s e d
by trachoma and o t h e r i n f e c t i o n s , notab!y
acute. c o n j t m r t i v i t i s and :,chthalmia fir3
neonatorwn, most of which ci;u13 and s l s a i l d
preventutl.
Of c o u r s e , i n a r e a s non-entlenric
f , ~ trachrima r and o t h e r e y ! : i n f e c t i o n s , 2nd m a y basy i r o m i l . l 4 i : p e r cent i r ~
t h e p r e v a l e n c e o f t>'!lndnns.x
i c rnrscn Pra,-,;
r u r a l a r e a s t o 0 . 4 2 p e r c e n t i n ?irhart arras of badly n f f e c t r d c o u r t t r b e s . T h i s i l l u s t r a t e s t h e d e g r e e o f prevalr.ilc.e r e d u c t i o n t h a t couli! b x r nccained
o n c e e x t e n s i v e c o n t r o l mea,5ures a r e P ~ ~ ~ l e m e n t e to c ! redllcri rndrmtbi-l.tj..
A
s p e c l f l c and somewhat l o r - a l l z e d i i i i n d n e s protrlem i s lai,.?rd brr rirrxas TI-l s Is a w i d e s p r e a d and i m p a r t a n t prc'rlem i n nns.
endemic f o r o n c h o c e r c i a s i s . t h e Sudan where a p p r o x i m a t e l y
mi l l i t w parsons a r e th-wht
*i.>
bc i n f c c t e d
with
9,
v o l v u l u s , p a r t i c u l a r l y i n Bahr E l CIhazai and S q u a t o r i a Y'rovinces.
WHO EWIO
CM/PBL/4
OM/MTG. T T H . COM. PIib V. BLIND. / I I paw 3
The p r e v a l e n c e r a t e of b i i n d n e s s i n t h e s a p a r t s of t h e Sudan i s e s t i m a t e d a t 5 . 1 p e r c e n t , of which 4 . 9 p e r c e n t i a d u e ru u!hcliocerciasis. A
more
l o c a l i z e d and less s e v e r e o n c h o c e r c i a s i s problem i s p r e v a l e n t i n t h e Yemen Arab R e p u b l i c ; however, mor? s r u d i r ? and d a t a a r e r e q u i r e d t o b e t t e r d e f i n e
t h e n a t u r e and e x t e n t o f t h i s problem
The p r i n c i p a l c a u s e s of b i t n i i n r s s I n o u r Region are trachoma and o t h e r eye infectic.?s onohocerciaais,
( i n c l u d i n g e p i d e m i c r : r > n , ! u n c t i v i t i $ and o p h t h a l m i a n e o n a t o r u m ) , c a t a r a c t , ~ l a ~ ~ c o nn,i m u trauma
(a~cidenta).
The i m p o r t a n c e o f i n f e c t i v e c a u s e s o f b l i n d n e s s i s p r o g r e s s i v e l y d e c l i n i n ~ a s a r e s u l t of n a t i o n a l programme5 an': m e a s u r e s a g a i n s t trachoma and i n f e c t i v e e y e c o n d t t i o n j a s m l l a 8 t h e i m p r o v m e n t of s o c i o - r c o n a i c standards.
I t i s g r a t i f y i n l : t h a t the rnational hy WHO
trachoma c o n t r o l p r o g r . n l e s ,
supported 111
c o l l a b a r a f iv6.
p r t i j i r * r c s t . ~ ~ . , h : l , r.
;~,:hicrrd tnn(iib1o pori tlrs rnaul l s
t h e l a s t decade.
In t h e 1960s, a m a j o r projiramme f o r t h e c o n t r o l of trachoma and o t h e r communicable e y e d i 3 e a s e s was implemented i n most c o u n t r i e s of t h e Region. m i s programwas a p p l i e d i n r l o . i e r o l i n b r a t l o n r i t h W and UNICQ in
f o u r t e e n c o u n t r i e s up t o dattand t r a i n i n g g r a n t . Region. hmvr k
17 a c i d i t i o n , technical s u p p o r t , i e l l o s s h i p s t o l l a o s t a 1 1 o t h e r c o u n t r i e s of the
n provided
E v a l u a t i o n of l o n r t e m trachoma c o n t r o l a c t i v i t i e s in s e v e r a l
c o u n t r i e s has shorn t h e impresslvp r e s u l t s achisved.
D e t a i l s of t h e s e e v a l u a t i o n s and a s s c s v n e ~ ~ ta sp p c a r i n t h e R e g i o n a l P r o g r m e P r o f i l e on t h e P r e v e n t i o n of R l i n d n e s s , which was d i s t r i b u t e d t o t h e Committee, where i t c a n be n o t e d t h a t s u b s t a n t i a l r a l u c t i o n t o f t h e p r e v a lence mta of
tr-rhnu
a n d o t h e r e y e infection:;
-3
a c h i e v e d i n Sudan, 3 y l l a ,
Libya,
I r a q , A f g h a n i s t a n and Kuwait.
No d o u b t many o t h e r member c o u n t r i e s
i n o u r Region have a c h i e v e d c o m p a r a b l e r e s u l t s .
W110 EMRO
.
The a n t i - t r a c h o m a on c o n j u n c t i v i t i s .
r a m p l i p usually h a s a cimultnncous h e a l i n g eftect t h e p r e v a l e n c e r a t e of c o n j u n c t i v i t i s
In p a r t i c u l a r ,
d e c r e a s e d when b l a n k e t t r e a t m e n t was u s e d , and when t h e t r e a t m e n t c a m p a i ~ n was s c h e d u l e d t o c o i n c i d e w i t h t h e s e a s o n a l a c u t e c o n j u n c t i v i t i s , in
e l i m i n a t i n g e p i d e m i c s of t h i s d i s e a s e s i n a r r a s where i n t e n s i v e trachoma c u l ~ r r o la c r i v l t i e s were a p p l i e d p a r t i c u l a r l y i n I r a n , Sudan. I r a q , Kuwait and
I t was a l s o n o t e d t h a t t h e p r e v a l e n c e r a t e of b l i n d n e s s d u e t o commun i c a b l e e y e d i s e a s e s d e c l i n e d s i g n i f i c a n t l y a s a r e s u l t of t h e s e c o n t r o l programmes. T h i s d e c l i n e w a s a p p r o x i m a t e l y one t h i r d t o one q u a r t e r on
t h e b a s e l i n e f i g u r e i n f i v e t o seven y e a r s .
The m a j o r i t y of c a s e s o f b l i n d n e s s i n t h e Region a r e p r o b a b l y due t o d c l a y e d o p h t h a l m o l o g i c a l a t t e n t i o n and c a r e . P a t i e n t s s t r f f e r i n g from e y e
d i s e a s e s a r e not t r e a t e d i n time t o prevent blindness.
Specialized ophthalmological
s e r v i c e s a r e g e n e r a l l y l i m i t e d t o urban
a r e a s and a t t h e same time most c o u n t r i e s o f t h e Region l a c k a p r a c t i c a l programme f o r t h c p r c v c n t i o n of b l i n 4 n r . s vlrlcll Could D e Implemented on a
large-scale basis to cover rural a r e a s . p o l i c y and a c o m p r e h e n s i v e c o - o r d i n a t c d
The f o r m u l a t i o n o f a n a t i o n a l l o n g - t e r m programme f o r t h e c o n t r o l
o f communicable e y e d i s e a s e s and p r e v e n t i o n of b l i n d n e s s i n e v e r y c o u n t r y o f o u r Region i s of t h e h ~ g h e s ti m p o r t a n c e .
I n view o f
t h e g e n e r a l l a c k of s k i l l e d h e a l t h manpower i n c o u n t r i e s o f
t h e R ~ g i o n , s u c h n programme f o r t h e p r e v e n t i o n uf blirxdness s n o u l a r e l y on
a u x i l i a r y h e a l t h w o r k e r s and on p r i m a r y h e a l t h w o r k e r s and s h o u l d b e o r i e n t e d t o d e a l b a s i c a l l y w i t h t h e more common e y e c o n d i t i o n s f o r which e f f e c t i v e , s i m p l e and economic m e t h o d o l o g i e s o f c o n t r o l a r e a v a i l a b l e , i n p a r t i c u l a r trachoma and o t h e r e y e i n f e c t i o n s .
R a s i c components o f s u c h programmes would be e p i d e m i o l o g i c a l s t u d i e s , s t a n d a r r l i r a t i o n of d i a g n o s t i c o r i t o r i n , t r a i n i n g of n m t i v t l a l a L a f l D L all
l e v e l s , p r o v i s i o n o f s i m p l e and e f f e c t i v e t r e a t m e n t and h e a l t h e d u c a t i o n .
WHO
EMRO
I t was found t h a t s u c h c o n t r o l programmes were most s u c c e s s f u l when implemented
as s p e c i a l i z e d mass programmes.
However, t h e i r i n t e g r a t i o n
i n t o t h e general h e a l t h s e r v i c e s , p a r t i c u l a r l y a t peripheral l e v e l , is e s s e r l t i r l f o r mllirltairiin& t h e i r i m p a c t on t h e i n t e r r u p t i o n o r d i s e a s e t r a n s m i s s i o n and r e d u c i n g e n d e m i c i t y . Therefore, t h e p r e v e n t i o n and
e a r l y t r e a t m e n t o f communicable e y e d i s e a s e s s h o u l d be i n t r o d u c e d a s a n i n t e g r a l p a r t o f p r i m a r y h e a l t h c a r e progranmes i n o u r Region. Unless
p e o p l e c a n be t r e a t e d i n t h e i r own l o c a l i t i e s , m i l l i o n s w i l l c o n t i n u e t o lose their sight.
The c f f o r t s t o c o n t r o l o n c h o c c r c i a o i s m c c t
with
important d i f f i c u l t i e o ,
p a r t i c u l a r l y b e c a u s e no f u l l y e f f e c t i v e c o n t r o l m e t h o d o l o g i e s a r e y e t developed. However, c e r t a i n m e a s u r e s c o u l d be u n d e r t a k e n t o g i v e some A t t h e same t i m e , r e s e a r c h i n methodo-
r e l i e f t o t h e a f f e c t e d population.
l o g i e s f o r o n c h o c e r c i a s i s c o n t r o l s h o u l d be e n c o u r a g e d and n e e d s s p e c i a l and c o n t i n u o u s s u p p o r t .
? o r o t h e r cases o f b l i n d n e s s which a r e n o t c a u s e d by c o n t r o l l a b l e i n f e c t i o n s , s u c h a s c a t a r a c t , glaucoma and t r a u m a t i c e y e l e s i o n s , e a r l y d i a g n o s i s and t r e a t m e n t by s p e c i a l i z e d o p h t h a l m o l o g i c a l i n s t i t u t i o n s a r e most important.
\Vhile t h e c o s t o f a c a s e of b l i n d n e s s t o t h e community i s h i g h o n c e i t
i s e s t a b l i s h e d , i t s p r e v e n t i o n and c o n t r o l a r e t h o u g h t t o c o s t no more t h a n f i v e p e r o o n t o f t h o eooriomic l o s s d u e t o d e f e c t i v e v i s i o n . firthemore,
t h e h u m a n i t a r i a n v a l u e o f p r e v e n t i n g a s i n g l e c a s e o f b l i n d n e s s i s beyond t r a n s l a t i o n i n t o f i n a n c i a l terms.
111
REVIEW OF THE PROBLEM OF BLINDNESS IN SELECTED COUNTRIES OF THE REGION
1. The t o t a l number o f b l i n d i n t h e c o u n t r y i s e s t i m a t e d t o be a p p r o x i m a t e l y one m i l l i o n . The main c a u s e s o f b l i n d n e s s a r e r e c m i x e d t o be trachoma and of tho c o n d i t i o n i n 5 0 p e r
o y o i n f o c t i o n n , u h i e h n r o c o n s i d e r e d t o b t h o eaun.
WHO EM20
c e n t i n r u r a l a r e a s and 33 p e r c e n t i n u r b a n a r e a s . i s b e i n g c a r r i e d u u t on trachvl!ar artd u z r
Considerable research
Llra
a r u s a L i v e OrganlSmS Of e y e
infections.
Glaucoma i s t h e n e x t c a u s e o f b l i n d n e s s b u t s t u d i e s and s u r v e y s would b e r e q u i r e d t o d e f i n e t h e s i z e of
t h e problem.
Poor h y g i e n i c c o n d i t i o n s a n d l o w l i v i n g s t a n d a r d s a r e b e l i e v e d t o be f a c t o r s c o n t r i b u t i n g t o t h e s e v e r i t y of trachomn and u l t i m a t e l y , t h r o u g h r e p e a t e d a s s o c i a t e d b a c t e r i a l i n f e c t i o n s , t o c o r n e a l s c a r r i n g and b l i n d n e s s .
The p r e s e n c e o f h i g h d e n s i t y o f f l i e s i s a l s o b e l i e v e d t o c o n t r i b u t e t o t h e endemicity of eye i n f e c t i o n s .
2.
Iraq
The main c a u s e s o f b l i n d n e s s are c o n s i d e r e d t o be glaucoma, c a t a r a c t and r e t i n a l l e s i o n s i n a d u l t s and i n f e c t i o n s and t r a u m a s i n c h i l d r e n .
Trachoma, which was k n o w t o a f f e c t 90 p e r c e n t o f t h e p o p u l a t i o n more t h a n t e n y e a r s ago, i s now r e d u c e d t o a b o u t 5 p e r c e n t o f t h e t o t a l p o p u l a t i o n and t o a b o u t 1 p e r c e n t among s c h o o l c h i l d r e n . ment c o n t i n u e s a s n e c e s s a r y . There i s an active
Standard i n t e r m i t t e n t t r e a t s t , r v P l l l e n r e prouramme and
t r e a t m e n t i s i n s t i t u t e d when i n d i c a t e d . The c o n t r o l o f f l i e s i s c o n s i d e r e d t o be a n e s s e n t i a l e l e m e n t f o r t h e c o n t r o l of eye i n f e c t i o n s .
T h e r e i s a good l e v e l of a w a r e n e s s o f e y e problems among t h e p o p u l a t i o n and f u r t h e r development o f a c t i v i t i e s i s p l a n n e d .
A f t e r a n e f f e c t i v e trachoma c o n t r o l programme c a r r i e d o u t o v e r a p e r i o d o r ten years,
me p r e v a l e n c e rates i n s c n o o l s n a v e been r e d u c e d from
80 p e r
c e n t t o 1 5 p e r c e n t w i t h p r a c t i c a l d i s a p p e a r a n c e of trachoma i n t h e c i t y .
WHO EMRO
Ehl/PBL/4 EM/hlTG.TCH.COM.PREV. B L I N D . /10 page 7
The d i s e a s e i s s t i l l p r e s e n t i n some a r e a s where less s a t i s f a c t o r y h y g i e n i c conditions a r e present.
The c a u s e s o f b l i n d n e s s i n t h e c o u n t r y have been i n v e s t i g a t e d and t h e o b s e r v a t i o n s have heen p u b l i s h e d . Infectious diseases, including
trachoma,
a r e l a s t i n t h e l i s t which i s now topped by glaucoma, f o l l o w e d by c o n g e n i t a l a n o m a l i e s and trauma. I t i s e x p e c t e d t h a t trauma w i l l assume e v e n g r e a t e r
i m p o r t a n c e i n view o f t h e i n d u s t r i a l e x p a n s i o n and i n c r e a s s e d t r a f f i c . G e n e t i c c o u n s e l l i n g i s now b e i n g promoted i n o r d e r t o r e d u c e c o n g e n i t a l anomalies.
4.
Pakistan
I t i s e s t i m a t e d t h a t 1 . 5 m i l l i o n p e o p l e a r e b l i n d i n t h e c o u n t r y (approximately 2 per c e n t ) . The most f r e q u e n t c a u s e s of b l i n d n e s s a r e c o r n e a l T h i s Is a t t r i b u t e d t o
i n f e c t i o n s , glaucoma, c a t a r a c t and r e t i n a l l e s i o n s .
l n a a e q u a t e e y e c a r e , e s p e c i a l l y i n r u r a l a r e a s where a p p r o x i m a t e l y 80 p e r c e n t of t h e population l i v e s . some a r e a s and need t o he Trachoma c o n t r o l a c t i v i t i e s a r e i n o p e r a t i o n i n evalllatarl.
Though t h e r e a r e l i m i t e d s t a t i s t i c s i n r u r a l a r e a s , t h e main p r o b l e m s
are d e l a y s i n t h e t r e a t m e n t of e y e c o n d i t i o n s , d i f f i c u l t y o f communications and l i m i t e d a a r a r e n e s s and h e a l t h e d u c a t i o n a t c o r n u n i t y l e v e l .
T r a u m a t i c e y e l e s i o n s a r e an i m p o r t a n t c a u s e o f l o s s o f v i s i o n . c u r a t i v e s i d e t h e r e i s a s h o r t a n e of donor material fnr
On t h e
corneat g r a f t .
5.
Saudi Arabia
The t o t a l number of b l i n d i s e s t i m a t e d t o be more t h a n 250 000. main c a u s e s a r c c o n s i d e r e d t o be trachoma and e y e i n f e c t i o n s .
The
I t is further
e s t i m a t e d t h a t more t h a n 60 p e r c e n t o f a l l cases o f b l i n d n e s s a r e d u e t o p r e v e n t a b l e c a u s e s and a v o i d a b l e i f a p p r o D r i a t e care i s p r o v i d e d i n t i m e .
EM/PBL/I EM/MTC. TCH. COM. PREV. BLIND. /10 page 8
WHO
EMRO
The most i m p o r t a n t
c a u s e o f b l i n d n e s s i n t h e whole o f t h e c o u n t r y
I s t r a c h o m a , and p r e v a l e n c e r a t e s of u p to 99 p e r oont havc bccn rooordod
i n the past.
Very good r e s u l t s h a v e been o b t a i n e d by t h e mass trachoma
c o n t r o l programme which s t a r t e d i n t h e n o r t h and which i s being g r a d u a l l y extended t o o t h e r regions. i n t h e G e z i r a area.
Hates o f 25 t o 70 p e r c e n t a r e s t i l l p r e s e n t
Mass t r e a t m e n t i s now b e i n g p r o p o s e d .
In o t h e r a r e a s , c o n t r o l o f trachoma i s c o n t i n u e d t h r o u g h t h e t r e a t m e n t of p r i m a r y s c h o o l c h i l d r e n .
The problem of o n c h o c e r c i a s i s i s f o c a l i n n a t u r e but i t i n v o l v e s t h e e i g h t major t r i b u t a r i e s o f t h e N i l e and a r e a s which a r e e c o n o m i c a l l y most I t is
i m p o r t a n t i n t h e s o u t h a s w e l l a s some f o c a l a r e a s i n t h e n o r t h . e s t i m a t e d t h a t more t h a n 1 . 5 m l l l i u r l p e r s o n s a r e a f f e c t e d .
Mealcal t r e a t On
ment h a s g i v e n o n l y t r a n s i e n t r e l i e f and r e q u i r e s s t r i c t s u p e r v i s i o n . t h e o t h e r hand t h e number o f b l i n d c o n t i n u e s t o i n c r e a s e even among children.
The c o n t r o l o f o n c h o c e r c i a s i s r e q u i r e s c o n s i d e r a b l e r e s o u r c e s
i n terms o f s t a f f , t r a n s p o r t a t i o n and s u p p l i e s .
7.
I n t e r p r e t a t i o n o f d a t a on b l i n d n e s s
I t was p o i n t e d o u t t h a t t h e r e i s a need t o promote u n i f o r m i t y o f d a t a c o l l e c t i o n so t h a t d a t a r c p o r t e d o r c o l l e c t e d from v a r i o u s s o u r c e s have t h e same v a l u e and a r e comparable.
T h e r e are i n f a c t d i f f e r e n c e s d u e t o t h e methodology o f d a t a c o l l e c t i o n , t o observers, t o t h e i n t e r p r e t a t i o n a n d e x t r a p o l a t i o n o f d a t a , t o t h e populaSuch v a r i a t i o n s
t i o n b a s e used and f i n a l l y t o c r i t e r i a i n g r a d i n g b l i n d n e s s , o f t e n r e s u l t i n g r o s s u n d e r e s t i m a t i o n o f t h e problem.
Uniform c r i t e r i a o f d a t a c o l l e c t i o n and p r o c e s s i n g need t o be e s t a b l i s h e d t o allow p l a n n i n g and programming on a sound b a s i s . C r i t e r i a f o r t h e classi-
WHO EMRO
EM/PBL/4 EM/WTC. TCII.COM. PREV. BLIND. /lo page 9
f i c a t i o n of b l i n d n e s s a r e a l r e a d y e s t a b l i s h e d and a r e i n c o r p n r a t r d i n t h e l a t e s t e d i t i o n of t h e I n t e r n a t i o n a l C l a s s i f i c a t i o n o f D i s e a s e s , a n d s h o u l d be f o l l o w e d .
1 t was s t a t e d t h a t o n c e a p p r o p r i a t e d a t a a r e c o l l e c t e d , p r i o r i t i e s can be c o r r e c t l y e s t a b l i s h e d and plamnirrg cprl
be d o n e On a sound b a s i s .
The more p r i v i l e g e d c o u n t r i e s o f t h e Region a r e r e a d y t o s u p p o r t programmes i n o t h e r c o u n t r i e s of t h e Region. T h e r e was t h e r e f o r e c o n s e n s u s v o i c e d by
t h e P r e s i d e n t o f t h e R e g i o n a l Bureau of t h e Middle E a s t Committee f o r t h e W e l f a r e o f t h e B l i n d t h a t t h e t i m e h a s come f o r t h e p r e s e n t a t i o n of a compreh e n s i v e programme o f work and a p p r o p r i a t e f u n d i n g f o r i t s i m p l e m e n t a t i o n by t h e Governments o f t h e Region.
IV
TIlE PRESWT STARIS OF OPHTHALMLOGICAL SERVICES
1.
Review o f p o t e n t i a l development f o r r e g i o n a l s e r v i c e s f o r t h e p r e v e n t i o n of blindness
Most of t h e c o u n t r i e s o f t h e Region h a v e c e n t r a l i z e d c u r a t i v e s e r v i c e s o f h i g h t e c h n i c a l s t a n d a r d a v a i l a b l e b u t t h e r e i s g e n e r a l a g r e e m e n t that r u r a l p o p u l a t i o n s a r e m o s t l y underserved o r deprived of a p p r o p r i a t e f a c i l i t i e s . I n Pakistan, t h e problem i s m o t through tho establishment o f mobile eye r r r v l c e s .
Eye camps a r e p e r i o d i c a l l y e s t a b l i s h e d , and o p h t h a l m i c care i s b r o u g h t where i t i s needed.
In I r a q , t h e r e a r e f i f t y m o b i l e teams which v i s i t v i l l a g e s and p r o v i d e a s s i s t a n c e on
a
house-to-house
b a s i s a t i n t e r v a l s of o n e y e a r .
I n t h e Sudan, w i t h t h e development of tho p r i m a r y h e a l t h c a r e
sl;ltame,
primary e y e c a r e i s brought a t t h e lowest l e v e l .
Furthermore, ophttulmic c a r e i s a l s o brought a t i n t e r m e d i a t e l e v e l through o p h t h a l m o l o g i c a l m e d i c a l a s s i s t a n t s who r e c e i v e a two-year t r a i n i n g and a r e posted a t d i s t r i c t l e v e l . T r a i n i n g o f s c h o o l t e a c h e r s has a l s o been f o u n d t o
EM/PBL/4 EY/MTG.TCA.COM. p a g e 10
WHO EMRO
PREV. BLIND./lO
be v e r y u s e f u l i n I r a q f o r t h e i m p l e m e n t a t i o n o f t h e trachoma programme. p a r t i c u l a r l y t h e follow-up and t r e a t m e n t o f c a s e s among s t u d e n t s . u s e of a u x i l i a r i e s i s a l s o e n v i s a g e d i n Kuwait, where, mological s p e c l a l l a e d s e r v i c e s a r e well-developed The
though o p h t h a l - .
and s t a f f e d by e x p a t r i a t e
s p e c i a l i s t s , t h e r e i s a need f o r e y e c a r e and r e f e r r a l a t i n t e r m e d i a t e and ~ r i m a r yl e v e l s .
I n t h i s c o n t e x t , c o u r s e s h a v e been h e l d i n Kuwait t o t r a i n s c h o o l n u r s e s and t h e i r c u r r i c u l a c o n t a i n a good p o r t i o n of o p h t h a l m o l o g i c a l c a r e . Also i n I r a q t r a i n i n g of medical a s s i s t a n t s i n c l u d e s ophthalmological d s s i ~ ~ a z ~ ~ os nl . y t e n nave Dren t r a i n e a t h i s y e a r , b u t i t i s e x p e c t e d t h e :
a t l e a s t two t h o u s a n d w i l l be t r a i n e d i n t h e n e x t t e n y e a r s .
T h e r e was g e n e r a l c o n c e r n t h a t p r i m a r y and i n t e r m e d i a t e o p h t h a l m o l o g i c a l t r a i n i n g n e e d s t o be expanded t o c o n s t i t u t e t h e b a s i s o f a programme o f p r e v e n t i o n of b l i n d n e s s c a p a b l e of a c t i n g a t t h e v e r y p r i m a r y l e v e l where services a r e a t present deficient. N o t e was t a k e n o f t h e e n c o u r a g i n g
training programme being implruionted 18, Sudan t o r m e a l c a l a s s i s t a n t s and
other auxiliary staff.
S p e c i a l i z e d t r a i n i n g f a c i l i t i e s a r e a v a i l a b l e i n Egypt,
Iraq, Pakistan
and Sudan, though i t i s n o t e d t h a t s t i l l a good p a r t o f t h e t r a i n i n g of p o s t - g r a d u a t e s p e c i a l i s t s i s done o u t s i d e t h e Region. The s h o r t a g e o f
o p h t h a l m o l o g i s t s was a l s o n o t e d , and t h i s problem i s e x p e c t e d t o p e r s i s t f o r aomo t i m e .
Bctter use of the t r a l n l l l l : f a ~ i l l l l e s r v a l l a u l e l n cne Xeginn
c o u l d be made t h r o u g h c o - o r d i n a t e d
t r a l n l n g programmes.
The n e e d f o r
p u b l i c h e a l t h and p r e v e n t i v e o r i e n t a t i o n o f o p h t h a l m o l o ~ i s t swas a l s o stressed.
WHO IJIRO
EM/PBL/4
EM/MTG.TCH.COM.PREV. BLIND./LO page 11
1.1
Research
The Eye R e s e a r c h U n i t i n A l e x a n d r i a has been c o n d u c t i n g r e s e a r c h on trachoma i n r u r a l a r e a s , stlpportnd by
m i c r o b i o l o g i r a l studierr
fur
Llle
i s o l a t i o n o f s e r o t y p i n g o f chlamydia and o t h e r c a u s a t i v e a g e n t s o f e y e disease. E p i d e m i o l o g i c a l r e s e a r c h h a s a l s o been implemented, such as Therapeutic
t h e s t u d y o f t h e i d e n t i f i c a t i o n o f t h e c a u s e s of v i s u a l l o s s . t r i a l s have a l s o been c a r r i e d o u t .
The U n i t , which i s w e l l s t a f f e d w i t h
o p n t n a l m o l o g i s t s , m i c r o b i o l o g i s t s , e p i d e m i o l o g i s t s and b i o s t a t i s t i c i a n s , o f f e r s t h e p o s s i b i l i t y of i m p l m e n t i n g r e s e a r c h a s w e l l a s t r a i n i n g o f research w o r k e r . ; a t i n s t i t ? m t i o n a l a * w e l l an
at
f i e l d lovol.
The N a t i o n a l R e s e a r c h C e n t r e i n C a i r o h a s an o p h t h a l m i c b r a n c h w i t h c l i n i c a l and l a b o r a t o r y f a c i l i t i e s .
I t would r e q u i r e a c e r t a i n i n v e s t m e n t Once c o m p l e t e d , t h i s C e n t r e c a n training.
t o c o m p l e t e t h e s e r v i c e s and f a c i l i t i e s .
be u t l l l z e d f o r u n d e r g r a d u a t e a s w e l L a s p o s t - g r a d u a t e
The Eye H o s ~ i t a l . i n Khartoum h a s a c e n t r a l m i r r n h f o l n g i c a l l a b o r a t o r y which i s w e l l s t a f f e d and c a n engage i n r e s e a r c h c o n n e c t e d w i t h histopathology, bacteriology, virology, immunology and o t h e r f i e l d s o f
m i c r o b i o l o g y , p a r t i c u l a r l y f o r diseases o f t r o p i c a l r e g i o n s .
I n p a k l s t a n , e x t e n s i v e e x p e r i e n c e b a s been a c q u i r e d i n t h e d e l i v e r y o f m e d i c a l and o p h t h a l m i c c a r e a t r u r a l l e v e l and t h e r e i s r e a d i n e s s t o implement f i e l d r e s e a r c h i n t h e d e l i v e r y of e y e c a r e a t p r i m a r y l e v e l . Psrticulnrly
i m p o r t a n t i n t h i s c o n t e x t r o u l d be a s t u d y on t h e a p p l i c a b i l i t y a t f i e l d l e v e l of r e f e r r a l of complicated c a s e s t o e i t h e r mobile o r s t a t i c treatment c e n t r e s .
I n Saudi A r a b i a , t h e r e i s g r e a t i n t e r e s t i n r e s e a r c h o r i e n t e d t o w a r d s ~lar l m p l e m e r l ~ a ~ o i~ r ~ tn l e proyrarma f o r Lhe p r e v e n r l o n OX D l l n d n e s s ,
md
i n c o - o r d i n a t i o n w i t h o t h e r c e n t r e s o f t h e Regiun.
R e s e a r c h a c t i v i t i e s w e r e a l s o mentioned by e x p e r t s from o t h e r c o u n t r i e s .
T h i s p o i n t s t o t h e need f o r c o - o r d i n a t i o n and c u l l a h ,
on among t h e v a r i o u s
i n s t i t u t i o n s and w o r k e r s implementing r e s e a r c h w i t h i n t h e s u e broad o b j e c t i v e s
of t h e p r e v e n t i o n o f b l i n d n e s s programme.
RM/PR1./4
EM/MTG.XH.COM.PREV.BLIND./lO page 1 2
1.2
Training In Sudan, t h e Eye H o s p i t a l i n Khartoum h a s been implementing t r a i n i n g
c o u r s e s f o r ophthalmic medical a s s i s t a n t s (two y e a r s ) . ophthalmic t h e a t r e a s s i s t a n t s (two y e a r s ) , c o ~ l r s e sf o r optometry and o r t h o p t i c s (two y e a r s ) , m a s t e r d e g r e e c o u r s e s i n ophthalmic s u r g e r y and medicine ( t h r e e y e a r s w i t h t h e U n i v e r s i t y of Khartoum), v a r i o u s r e f r e s h e r c o u r s e s f o r medical p r a c t i t i o n e r s and s h o r t c o u r s e s f o r s t u d e n t s of t h e Nursing C o l l e g e . A s s i s t a n t s can be undertaken w i t h The P a k i s t a n t r a i n i n g o f ( l ~ h t h a l m i c t h e e x i s t i n g f a c i l i t i e s i n Karachi. The ophthalmic branch of t h e N a t i o n a l Research C e n t r e i n C a i r o h a s c o n s i d e r a b l e t e a c h i n g f a c i l i tics, w i t h a l e c t u r e h a l l f o r 250 p e r s o n s , c l ~ ~ e - c i rt c i~ el ie v 1 s i ~ 1 1 , slrnirl Lartrous
LrartslaLivr1, e t c .
The Eye Research Unit i n Alexandria can p r o v i d e t r a i n i n g f a c i l i t i e s 101. r e s e a r c h workers.
1.3
Primary e y e c a r e
With t h e e x c e p t i o n of P a k i s t a n , and I r a q , w h e r e primary e y e c a r e i s d e l i v e r e d through mobile e y e u n i t s , t h e r u r a l p o p u l a t i o n a p p r o p r i a t e c a r e a t primary l e v e l . i l l
t h e Region d o e s n o t seem t o r e c e i v e
Q u i t e a number of c o u n t r i e s i n t h e
Region a r e p l a n n i n g t h e e s t a b l i s h m e n t of a primary h e a l t h c a r e network c a p a b l e of d e l i v e r i n g s i m p l e s e r v i c e s a t v i l l a g e l e v e l a s w e l l a s r e f e r r a l t o specialized services. I t i s d e s i r a b l e t h a t t r e a t m e n t of trachoma, which
a t p r e s e n t i s i n some c o u n t r i e s implementea a t s c n o o l l e v e l , t m expanded through primary h e a l t h workers t o pre-school c h i l d r e n a t d o m i c i l i a r y l e v e l . Furthermore, e a r l y r e f e r r a l of e y e a f f e c t i o n s such a s glaucoma and c a t a r a c t f o r t r e a t m e n t i n s p e c i a l i z e d i n s t i t u t i o n s by primary h e a l t h c a r e workers through i n t e r m e d i a t e b a s i c h e a l t h s e r v i c e s i s a l s o d e s i r a b l e . I t i s there-
f o r e n e c e s s a r y t o i n c l u d e primary e y e c a r e i n t h e t r a i n i n g c u r r i c u l u m f o r primary h e a l t h c a r e workers a n well a s a t i n t e r a e d i a t e l e v e l i n r u r a l h e a l t h o s n t r o a and d i s p o n s a r i a s .
WHO EMRO
EU/PBL/4
EM/MTC. TCIl.COM. I'REV. BLIND. / 1 0 paxe 1 3
I n t h e inter'
p = r i o d . wnzln thr: p r i m a r y h e a l t h c a r e network i s
organized, i t I s i e l t ttlar, ahanever a p p r o p r i a t e , mobile eye s e r v i c e s could s e r v e a v e r y u s e f u l purpo.ii. U~hlLe e v e s e r v i r . ~ c ,nnce p r i m a r y e y e c a ~ r
i s well-established, eye c a r e
c o u l d k trailsformed i n t o s t a t i c u n i t s f o r s p e c i a l i z e d !ocation.
in
t h e a p p r o p r i a t e gaogr;io:lical
1.4
S p e c i a l i z e d e y e ca-re
F a c i l i t i e s f o r s p e c i a l i x r d e y e c a r e e x i s t i n most o f t h e countries. Such s e r v i c e s a r e l o c a t e t l needs. ill
the
?,is c l t 1 ~ 3and
5 n r v e turban x s w e l l
ns
rural
I t i s n e v e r t h e l e s s underilable t h a t a c o n s i d e r a b l e p r o p o r t i o n of
c a n d i d a t e s t o b l i n d n e s s r e c r l r f , 5 1 - e c l a l l s e d c a r e a t a v e r y L a t e s t a g e when ; ~ l i n d n e s si s u n a v o i d a b l e .
I n some c o u n t r i e s t h r r r i r
*
rl..ud f o r
Incrrasin~L I L i :~ a p a o ~ l l t yof
s u c h s p e c i a l i z e d c e n t r e s so a s to cope xi1,Il t,he n e e d s a r i s i n g from t h e e x p e c t e d i n c r e a s e o f r e f e r r a l s frtirn p r i m a r y and auxiliary h e a l t h w o r k e r s . Some i n s t i t u t i o n s r e q u i r e s t r e n g t h n r u n g o f t h e c a p a h i l l t y and s k i l l s of their
own s t a f f t o d e l l v e r s p e c i a l l z e d s e r v i c e s . , I ! t
Therefore a s s i s t a n c e
may be r e q u i r e d t o d e v e l o p s p e c i a i :mi t s f o r c o r n e a l g r a f t s , p h o t o c o a g u l a t i o n t t . c l i -
i
s
d e p a r t m e n t s of h y s t o p n t h o l o g y , ltnprnvv
b a c t e r i o l o ~ yand v i r o l o g y i n
their laboratories to
i l i a e ~ ~ o s t ito cchniquc~.
O t h e r s p e c i a l i z e d i n s t i t u t i o r i s r e q u i r e t h e s t r e n g t h e n i n g of r e s e a r c h u n i t s i n r e l a t i o n t o t h e development of prevention of blindness.
their
t h e programme f o r t h e
In t h e Arabian P c n i r ~ s u l a , t h e r e f o r eye care. includinn dlagnnstlr..
1s
a riiortaKe o f s p e c i a l i z e d i n s t i t u t i o n s r c s c a r c h u r ~ l L ~ a i n l n gf a c i l i t i e s . t h e Arabian
rsdrative,
The e s t a b l i s h m e n t of s u c h a c e n t r e i n one o f t h e c o u n t r i e s of
P e n i n s u l a i s c o n s i d e r e d t o be n o t % ) n l y desirable but n e c e s s a r y f o r t h e d e v e l o p m e n t o f a programme f o r t h * p r a v o n t l o n o f b l i n d n e s s i n t h e a r e a .
FMJPRI /d
WHO R d R O
EM/~G.TCH.COM.PIaEV.nI,itd~ page 1 4
r
V
CENTRES FOR 1'NF 6 W i : - H ' ? 1 : ) N OP RLlNDNESS
For t h e s p e c i f t i ; ; , qr. b l i n d n e s s t h e rnafci i';.ri- ?,::.I. i n t h e Region w o i i i d : i r ~ r : , l a) rrr
;
-:f i ' , ~ltegional Programme f o r t h e p r e v e n t i o n of thn
. f
i r e n t r e s f o r t h e p r e v e n t i o n of b l i n d n e s s
I hr f o l lowing a r e a s :
T r a i n i n g K ,P: tn pac!ir.ular s t a r r arid piittory rbeiri th
emphasis t o t h e t r a i n i n g of a u x i l i a r y wilrkers; * - e f a r e n c r t o o p e r a t i o n a l r e s e a r c h and
b)
r e s e a r o e , wrt,i\ parI.i.:uAilr
t h o s e rripent a s p e c t s which a r e r e l a t e d t o t h e implementatton o f t h e propramxe, di-! i < : i l-on nf a l s o be pla.;mcI :it
simple methodologies, e t c .
m p h a s i s should
Lltn neeti t o c o - o r d i n a t e
r e s e a r c h a c t i v i t i e s among
t h e variuur; r c g i ~ ~ c si:rrrtri-c r and c e n t r e s o u t s i d e t h e Regionc and on t h e need to i r i i i d up thp n e c e s s a r y r e s e a r c h manpower; O)
epiden$irilogicrr: stizl.es,
*hi. h are
c o n s i d e r e d to be e s s e ~ ~ t i a as l
a b a s e l i n e f o r apprr>lrrt.ate p l a n n i n g and f o r a n e v a l u a t i o n of t h e p r o g r e s s of t.hi. gn.$?.anlrne.
O t h e r i m p o r t a n t furiatloi:!i G P t h e r e g i o n a l c e n t r e s a r e a l s o t h e promotion of p r e v e n t i v e s e r v i c e s , pri.mary e y e c a r e , d i s s e m i n a t i o n o f i n f o r m a t i o n , f o r m u l a t i o n of uniform r r i t e * . i . a , methnds and t e c h n i q u e s . It w a s considered
very important t h x l the m y r o r ; n l oontrco dovclop nnd p r o v i d e t o ~ b i o e lsxportiae:
t o t h e c o u n t r i e s rrf 1:rri. l?.r.ca:": arid tit t h e o t h e r c e n t r e s i n t h e implementation of t h e programme. I t way, a: so emphasized t h a t t h e s e f u n c t i o n s o f t h e c e n t r e s
should be c a r r i e d o u t i t . r!:?,rrc u - o r d i n a t i o n w i t h WHO and w i t h o t h e r governsc t i v e l y i n v o l v e d i n t h i s f i e l d . mental and non-govern inn^-'la1 r b ~ g a a c i + i l t t o na
From t h e Irrf:,mati;.n e w e a l t h of e c * L . r r i t t e s i n
p!
,'I<oed
riy t h e p a r t i c i p a n t s i t
Is c o n s i d e r e d t h a t
Ihrq
cnntaui n l
p r e v e n t i o n of blindness have already
been s t a r t e d i n +.tie
iveg?n:? nn.:
err; a l r e a d y w e l l advanced i n some o f the c o u n t r i e s . easily be expend&
Trainirlg f a c i l L t i c i axe .!t_~J!.il>le i i i xiany C o W t r i , e s and can t o cope w i t h t h e i n c r . e a s l n p r i ~ e d s nf t h e programme.
Research programmes a r e
well under way
3x1
many rs;.nz:is r e l m i a n t t o t h e p r e v e n t i o n of blindness p r o g r w e , (a'
S p e c l a l l z e d persenrtel
a v ~ YaLqle :
i n some o t 'tne countries and methodologies
ri *hx t b r v problem of eye c a r e a t r u r a l Level through have been developed i u l-o&,r
rnollile u n i t s i n l.wo .:)I
:I-
i..i.r::rie~.
I t i s nevertheless f e l t t h a t i n additinn
WHO EMRO
bM/PEn/4 EM/MTC.TL!H.COM. PREV. BLIND./10 page 1 5
t o t h e e x i s t i n g f a c i l i t i e s and t h e o r g a n i z a t i o n a l s t r u c t u r e a l r e a d y e x i s t i n g a t n a t i o n a l l e v e l t h e r e i s a need f o r r e g i o n a l promotion and c o - o r d i n a t i o n of activities.
There i s a l s o a need f o r s t r e n g t h e n i n g some n a t i o n a l a c t i v i t i e s and upgrading them i n t o r e g i o n a l s e r v i c e s . T h i s would r e q u i r e t h e m o b i l i z a t i o n
of c o n s i d e r a b l e a d d i t i o n a l r e s o u r c e s to be a l l o c a t e d by Governments of t h e Region t o s p e c i f i c a r e a s of expansion. T h i s o b j e c t i v e c o u l d be a t t a i n e d
through t h e e s t a b l i s h m e n t of a network o f a s s o c i a t e d c e n t r e s d i s t r i b u t e d i n t h e Region, which could s h a r e t h e s p e c i f i c f u n c t i o n s and r e s p o n s i b i l i t i e s f o r t h e o v e r a l l programme. I t i s c o n s i d e r e d t h a t some of t h e s e o o n t r c s could bc u t i l i z e d f o r r e s e a r c h , some f o r t r a i n i n g , p a r t i c u l a r l y where emphasis can be placed on a c t i v i t i e s o r i e n t e d towards t h e d e l i v e r y of t h e programme a t primary l e v e l f o r t h e b e n e f i t of t h e most a f f e c t e d t a r g e t p o p u l a t i o n g r o u p s .
I n o r d e r t o maxe
t n l s programme p o s s i b l e , a f i r m commitment should be
made c o n c e r n i n g t h e f u n d i n g of t h e programme by Governments o f t h e Region.
From t h e i n f o r m a t i o n a v a i l a b l e , i t i s b e l i e v e d t h a t some of t h e c o u n t r i e s of t h e Region, p a r t i c u l a r l y i n t h e Arabian P e n i n s u l a , r e q u i r e t o have a c c e s s
t o a. s p e c i a l i z e d c e n t r e i n t h e a r e a having t h e f o l l o w i n g a t t r i b u t e s :
-
-
Co-ordination of t h e p r e v e n t i o n of b l i n d n e s s programme T r a i n i n g of s t a f f O p e r a t i o n a l r e s e a r c h and s p e c i a l i z e d e y e c a r e
Such a new c e n t r e needs t o be e s t a b l i s h e d a s soon a s p o s s i b l e and work i n c o - o p e r a t i o n w i t h t h e n e t w r k of t h e o t h e r c e n t r e s and w i t h WHO. i n t h e i n i t i a l stages,
I t is f o r e s e e n t h a t ,
L l s w r e may be a n e e a l o r
me r e c r u i t -
ment of t e c h n i c a l s t a f f from t h e e x i s t i n g c e n t r e s and e l s e w h e r e , a s re11 a s f o r t r a i n i n g progranmes i n t h e o t h e r r e g i o n a l c e n t r e s f o r t h e s t a f f i n g of t h e p r e v e n t i o n of b l i n d n e s s programmes a t n a t i o n a l l e v e l .
I t i s understood t h a t some of t h e Arab c o u n t r i e s w i l l a c t i v e l y p a r t i c i p a t e i n t h e promotion of t h e r e g i o n a l programme and c o n t r i b u t e t o t h e f u n d s r e q u i r e d f o r i t s implementation.
EM/PBL/4 EM/MTC.TCH.COM. PREV. BLIND. /10 Dane 1 6
WHO EWlO
VI
OUTLINE OF A PRnMSEn REGIONAL PROORAWE F O R THE PREVmTION
OF BLINDNESS 1. Situation analysis
The prevalence 01 n l l n a n e s s I n c o u n t r i e s of t h e Region has n o t been
measured w i t h p r e c i s i o n i n a l l c o u n t r i e s , b u t r a t e s a s high a s f o u r p e r c e n t of t h e population have been recorded i n some c o u n t r i e s of t h e Region. The
m a j o r i t y of o t h e r c o u n t r i e s have r e f l e c t e d a r a t e ranging between .25 and 1 p e r c e n t .
The t o t a l number of b l i n d h a s been e s t i m a t e d t o be about 7 . 5 m i l l i o n , o u t of a p o p u l a t i o n of 250 m i l l i o n i n t h e Region. T h i s g i v e s a r e g i o n a l p r e v a l e n c e r a t e of t h r e e p e r a c n t v i s u a l impairment (less than 3/60 a c c o r d i n g l o t n e i n t e r n a t i o n a l
c l a s s i f i c a t i o n of d i s e a s e s ,
category 3 ) .
The s i n g l e most f r e q u e n t c a u s e of
b l i n d n e s s i n t h e Region i s undoubtedly trachoma, followed by c a t a r a c t and glaucoma. In Sudan, p a r t i c u l a r l y r e l e v a n t i s o n c h o c e r c i a s i s , which is a l s o p r e s e n t i n Yemen. A l a r g e number of c a s e s of b l i n d n e s s i n theRegion i s due t o t h e s c a r e c i t y
of e a r l y ophthalmological c a r e b e f o r e t h e a f f e c t i o n l e a d s t o u n - r e v e r s i b l e blindness. nnrl
The e x t e n t of s p e c i a l i z e d ophthalmological c a r e i s extremely l i m i t e d urban
confined mostly t o
sroso.
F r n o t i o n l o o n a i d s r a t i v n a auKKest f h a l
me
programme should be implenented e s s e n t i a l l y by a u x i l i a r y and primary h e a l t h worker. and should c o n c e n t r a t e on t h o s e eye c o n d i t i o n s f o r which a methodology
of c o n t r o l i s a v a i l a b l e , i n p a r t i c u l a r trachoma.
Tne programme of o n c h o c e r c i a s i s needs to be t a c k l e d w i t h urgency i n view of t h e d e v a s t a t i n g e f f e c t on t h e h e a l t h of t h e people l i v i n g i n t h e a r e a s of e n d e a i c i t y a s vsll a s on the economy of
t h e area.
C l e a r ~ n o t h o d o l o g i e sf o r the
c o n t r o l of t h e d i s e a s e have n o t y e t been f u l l y developed, b u t t h e r e i s an urgent need t o t a k e such i n t e r i m measures which may be f e a s i b l e a t p r e s e n t t o give r o w r e l i e f t o t h e affected populations.
A s l o r those c a u s e s O r Dllnaness which a r e n o t due t o c o n t r o l l a b l e
i n f e c t i o u s d i s e a s e s , such a s glaucoma and c a t a r a c t . t h e importance of e a r l y d i a g n o s i s and r e f e r r a l f o r t r e a t m e n t t o s p n c t a l i z n d n p h t h a l m l q @ i c a l e e r v i a a s
i s evident.
I n t h e c o n t e x t of primary h e a l t h c a r e , e a r l y d i a g n o s i s and r e f e r r a l This a p p l i e s
w u l d a p p e a r t o be a t p r e s e n t t h e o n l y s o l u t i o n t o t h i s problem.
a l s o t o t h e e a r l y t r e a t m e n t of t r a u m a t i c eye l e s i o n s , which a r e a l s o very frequent i n t h e Region.
WHO EMRO
2.
Approaches
The e x t e n t of WHO involvement w i l l depend on t h e p r i o r i t i e s f i x e d a t t h e n a t i o n a l and r e g i o n a l l e v e l s and on t h e a v a i l a b i l i t y o f funds.
Tha garler.1
o b j e c t i v e s and t a r g e t s may be achieved i n a phased programme of p r o g r e s s i v e expansion. For an a p p r o p r i a t e p l a n n i n g and programming, q u i s i t e s nave t o be s a t i s f i e d : t h e f o l l o w i n g main p r e r e -
a) b) c)
knowledge of t h e
pravalanra and cPttoes o f eye d i a e n s e s and b l i n d n c ~ s
d e f i n i t i o n of most s u i t a b l e methods of c o n t r o l ; expansion of a primary h e a l t h c a r e network c a p a b l e of d e l i v e r i n g
p r e v e n t i v e measures a t t h e most p e r i p h e r a l l e v e l .
The medium-termprogramme i n t h e a r e a concerned w i t h p r e v e n t i o n of b l i n d n e s s w i l l t h e r e f o r e comprise t h e f o l l o w i n g :
1.
Epidemiological s t u d y of trachoma, p a r t i c u l a r l y i n t h e young a g e group,
and e p i d e m i o l o g i c a l s t u d y of t h e o t h e r c a u s e s of b l i n d n e s s f o r t h e e s t a blishment o f r e g l o n a l and c o u n t r y p r i o r i t i e s and t o s e r v e a s a b a s e l i n e i n f o r m a t i o n f o r t h e f o r m u l a t i o n o f c o u n t r y and r e g i o n a l p l a n s o f o p e r a t i o n .
2.
Broad programming f o r t h e development of o p h t h a l m o l o g i c a l s e r v i c e s i n
t h e c o n t e x t of primary h e a l t h c a r e aiming a t t h e d e l i v e r y of b a s i c e y e c a r e a t r u r a l and urban primary h e a l t h l e v e l . T h i s should i n c l u d e a system
of e a r l y r e f e r r a l of e y e c o n d i t i o n s r e q u i r i n g s p e c i a l i z e d t r e a t m e n t .
3.
D e t a i l e d programming a t c o u n t r y l e v e l s e t t i n g s p e c i f i c o b j e c t i v e s ,
approaches, t a r g e t s , methods, a c t i v i t i e s , manpower f a o i l i ties and other requirements, a s well a s output i n d i c a t o r s f o r evaluation.
The t a r g e t s d e f i n e d i n t h i s medium-term programm belong t o two s e c t i o n s : t h e f i r s t s e c t i o n r e f e r s t o a c t i v i t i e s a t r e g i o n a l l e v e l , and t h e second s e c t i o n
c o m p r i s e s s p e c i f i c c o u n t r y t a r g e t s t o be n e g o t i a t e d and i n t e g r a t e d i n t h e h e a l t h p l a n s of t h e c o u n t r i e s concerned. ~ ~ b j e c t ot t h e agreement of
The a c t i v i t i e s l i s t e d a g a i n s t t h e t a r g e t s and of tho c o u n t r i e s
are
t h e governing b o d i e o
interested. WHO s u p p o r t .
h e a l t h manparer r e s o u r c e s would h b a s i c a l l y n a t i o n a l , w i t h
EM/PBL/4 EM/MTG.TCH.COM. PREV.BLIND./lO page 18
WHO EMRO
3.
Objectives and tarnets at reeional level The specific programme objectives at regional level would be:
a.
tho provision of technical co-ordination and support,
b. c, d. e . f . g .
the implementation of epidemiological studies on prevalence and causes of eye diseases and blindness; the establishment of uniform criteria and methodologies related to the progrnmme; the training of national staff at different levels; the promotion of the utilization of auxiliary and primary health care personnel for d i a p o s i s , prevention and ourc of cyo diseases;
the promotion of public awareness and community participation through health education; the co-ordination with other related programmes.
For m e provision of tecrmtcal co-ordination and support, the target would be the creation of a regional technical group made up of experts of the Recion. The proposed activities would include the convening of
meatjngs
of the technical groups; the drafting of a regional medium-term programme and of guidelines for country mediwn-term programmes; the approval of the regional medium-term programme by the WHO Regional Committee and the drafting of country medium-term programmes for inclusion into the regional programme (1379-1980).
Other propserl
a l ; L l v i L i r s w u l d lrrclulle
the mo0111zaT1on OI
human, material and financial resources for the implementation of the mediumterm programme (1979-1980); the designation of associated reKional centres; the provision of technical material assistance in implementation of country medium-tern programme (1980-1983) and the evaluation of the prevention of blindness prograarme at regional and country level (1960-1983). ey~daluiulvgicalsturllrt~o l r prevalence an0
For the implemsntation of
causes of eye diseases and blindness, the target possibly to be achieved by 1979 would be the compilation of baseline information to assist in country planning.
WHO
mno
EY/PQL/4
EM/MTG.TCH.COM. PREV. Q L l ~ l l . / 1 0 page 1 9
The p r o p o s e d a c t i v i t ' i - i --Id
h e t h e d e s i g n a t i o n of
r e s e a r c h and epidemio-
l o g i c a l s t u d y C e n t r e s o r p r o j e c t s : t h e s t u d y o f t h e c a u s e s of b l i n d n e s s , c o u n t r y - w i s e and r e g i o n - v l s e , on t h e b a s i s o f e x i s t i n g s u r v e y s and r e p o r t s
and c o m p l e t i n g t h e g a p s o f knowledge t h r o u g h ad of t h e p o p u l a t i o n g r o u p s a t r i s k ; and e n v l r u n m r r l l a l f a c t o r s ;
&
studies;
determination
d e t e r m i n a t i o n of r e l a t e d s o c i a l , economic
i n v e n t o r y of i n s t i t u t i o n a l r e s o u r c e s a t c o u n t r y
and r e g i o n a l l e v e l s ;
d e s i g n a t i o n of r e g i o n a l c e n t r e s f o r s p e c i a l i z e d i nd ;
o p h t h a l m o l o g i c a l c a r e and f o r r e h a b i l i t a t i u n o f t h e h l the cost:
e s t i m a t e of
e s t i m a t e o f a d m i n i s t r a t i v e and u p e r a t i o n a l . n e e d s .
For t h e establishment t o t h e programme,
,if
u n i f o r m c r i t e r i a and m e t h o d o l o g i e s r e l a t e d
t h e t a r g e t possibly t o be a c h i e v e d by e n d 1 9 7 9 would be
t h e d e f i n i t i o n of t e t i l u r i c a l Uasls f o r I m p l e m e n t a t i o n o f a m e d i u m - t e r m programme. The p r o p o s e d a c t i v i t i i ? ~ would be t h e c o n v e n i n g o f a r e g i o n a l
m e e t i n g of e x p e r t s t o r e v i e w and drILrre s t a n d a r d d e f i n i t i n n r , c r i t e r i a and ~ a l e t h o d o l o g i e sf o r d i a g n o s i s , t r e a t m e n t and p r e v e n t i o n of e y e d i s e a s e s and blindness;
t h e p r e p a r a t i o n of s i m p l e g u i d e l i n e s detailing d e f i n i t i o n s ,
c r i t e r i a and m e t h o d o l o g i e s f o r d i a g r r o s l s , t r e a t m e n t and p r e v e n t i o n o f e y e d i s e a s e s and b l i n d n e s s ; t h e dissemination of t h e t r a n s l a t i o n i n t o Arabic of t h e s e g u i d e l i n e s ;
technical information.
For t h e t r a i n i n g o f n a t l o n a l s t a f f a t d i f f e r e n t l e v e l s ,
t h e target
p o s s i b l y t o be a c h i e v e d by 1979-19Ni would be t o c o m p l e t e t h e n e t w o r k of e y e care s e r v i c e s a t c e n t r a l , i n t e r m e d i a t e and p e r i p h e r a l l e v e l s w i t h appropriately trained staff. The p r o p o s e d a c t i v i t i e s m u l d be t h e d e s i g n a -
t i o n of regional t r a i n i n g c e n t r e s ;
a f e l l o w s h i p programme f o r t h e t r a i n i n g ~ ~ u b l ih re : alth trainlng or the t r a i n i n g of
o f t h e r e q u i r e d number of o p h t h n l m o l o g i s t s ,
ophthalmologists,
t h r o u g h n a t i o n a l and r e g i o n a l s e m i n a r s ;
a u x i l i a r y personnel i n s c r e e n i n g techniques f o r trachoma, o n c h o c e r c i a s i s (where r e q u i r e d ) , glaucoma, c a t a r a c t , e t c . ; t i o n of t r a i n i n g m a t e r i a l r e l a t p d o r t h i s material i n t o Arabic. t h e p r e p a r a t i o n and d i s s s a r i n a -
t o p r e v e n t i o n o f b l i n d n e s s and t r a n s l a t i o n
EM/PBL/4 EM/MTG.TCH.COM.PREV. page 20
WHO MRO
BLIND. /1O
For t h e promotion o f t h e u t i l i z a t i o n of a u x i l i a r y and primary h e a l t h c a r e p e r s o n n e l f o r d i a g n o s i s , p r e v e n t i o n and c u r e of e y e d i s e a s e s , t h e t a r g e t would be t h e i n t e g r a t i o n of p r e v e n t i o n o f b l i n d n e s s a c t i v i t i e s 121 Like C O I ~ L I X ~
VI primary h e a l t h
Gnus.
The propored a c t i v i t i e s would
bo
t h e o r g a n i z a t i o n of c o u r s e s and seminar i n p r e v e n t i o n o f b l i n d n e s s f o r medical personnel r e s p o n s i b l e f o r t h e o r g a n i z a t i o n of primary h e a l t h c a r e (1979); t h e p a r t i c i p a t i o n o f o p h t h a l m o l o g i s t s i n m e e t i n g s and s e m i n a r s the
d e a l i n g w i t h t h e p l a n n i n g and implementation of primary e y e c a r e ; p r e p a r a t i o n of g u i d e l i n e s f o r primary e y e c a r e ; t i o n of primary eye c a r e and r e f e r r a l a c t i v i t i e s .
t h e follow-up and evalua-
For t h e promotion of p u b l i c awareness and community p a r t i c i p a t i o n through h e a l t h e d u c a t i o n , t h e t a r g e t would be t h e achievement of p u b l i c
awareness of t h e b e n e f i t s d e r i v i n g from t h e e a r l y d i a g n o s i s and t r e a t m e n t of c o n d i t i o n s l e a d i n g t o b l i n d n e s s , t h e achievement o f community p a r t i c i p a t i o n through h e a l t h e d u c a t i o n and information ana t h e s t r e n g t n e n l n g of e x i s t i n g h e a l t h e d u c a t i o n u n i t s and a c t i v i t i e s o r t h e e s t a b l i s h m e n t of new ones i n tho
rnl8ntriaa i n t h e n o n t e v t of t h e primary h e a l t h c a r e scheme.
The proposed a c t i v i t i e s would be t h e i d e n t i f i c a t i o n o f r e l a t e d s p e c i f i c problems both i n t h e a r e a s o f h e a l t h and s o c i o - c u l t u r a l a s p e c t s ; t h e formu-
l a t i o n of t h e sub-programme f o r h e a l t h e d u c a t i o n r e l a t e d t o p r e v e n t a b l e l o s s of v i s i o n and t o e y e d i s e a s e s ; t h e co-ordination a t c e n t r a l , intermediate
and p e r i p n e r a l l e v e l s i n e a c h cullllLry r r r c l a ~ s l y t ~ u ~ e & ufr C r-rpurrsibili b l e s ; t h e p r e p a r a t i o n and f i e l d t e s t i n g of s u i t a b l e m a t e r i a l and t h e i r d i s t r i b u t i o n and u t i l i z a t i o n : c a r r y i n g o u t of r e l a t e d t r a i n i n g programmes; t h e continua-
t i o n of e v a l u a t i o n and p e r i o d i c a s s e s s m e n t of o u t p u t s .
For t h e c o - o r d i n a t i o n w i t h o t h e r r e l a t e d programmes, t h e t a r g e t would b e t h e achievement of c o n c u r r e n t development of r e l a t e d programmes a t r e g i o n a l and c o u n t r y l o v o l s . The
proposed a c t i v i t i e s would
be
the
c o - o r d i n a t i o n of t h e r o l e of primary h e a l t h c a r e i n p r e v e n t i o n of b l i n d n e s s a t peripheral level; t h e c o - o r d i n a t i o n o f t h e r o l e of m a t e r n a l and c h i l d
h e a l t h and school h e a l t h s e r v i c e s f o r t h e p r e v e n t i o n of communicable e y e d i s e a s e s among c h i l d r e n ; t h e c o - o r d i n a t i o n of t h e r o l e o f c u r a t i v k s e r v i c e s
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f o r t h e e a r l y t r e a t m e n t o f p r e v e n t a b l e c a u s e s of b l i n d n e s s ;
the co-ordination t h e correc-
o f t h e r o l e of v e c t o r b i o l o g y c o n t r o l and e n v i r o n m e n t a l h e a l t h i n
t i o n o f e n v i r o n m e n t a l f a c t o r s f a v o u r i n g communicable e y e d i s e a s e s s u c h a s trachoma and o n c h o c e r c i a s i s ; t h e promotion o f t h e p a r t i c i p a t i o n of r e l a t e d o r g a n i z a t i o n s and b i - l a t e r a l agencies
i n t e r n a t i o n a l a g e n c i e s , non-governmental i n t h e i m p l e m e n t a t i o n o f t h e programme.
4.
O b j e c t i v e s and t a r g e t s a t c o u n t r y l e v e l
The s p e c i f i c o b j e c t i v e s a t c o u n t r y l e v e l would be:
a. b.
t h e i d e n t i f i c a t i o n o f p r e v a l e n t communicable e y e d i s e a s e . common c a u s e s o f l o s s o f v i s i o n ;
and o t h e r
t h e i d o n t i f i e a t i o n of s p e c i a l i r e d manpower r e r o u r o e a m d t h e i r adequnsy i n r e l a t i o n t o l o c a l needs;
C.
t h e i d e n t i f i c a t i o n o f s u i t a b l e and economic methods f o r t h e c o n t r o l o f e y e d i s e a s e s and f o r t h e p r e v e n t i o n o f b l i n d n e s s i n r e l a t i o n t o local conditions:
d.
t h e i d e n t i f i c a t i o n o f p h y s i c a l and i n s t i t u t i o n a l r e s o u r c e s and t h e i r adequacy i n r e l a t i o n t o t h e l o c a l n e e d s ;
e.
t h e d r a f t i n g o f a p l a n f o r t h e c o n t r o l o f communicable eye d 1 a e a . r ~ and p r e v e n t i o n o f b l i n d n e s s i n c l u d i n g t h e h e a l t h e d u c a t i o n component w i t h i n t h e framework o f t h e p r i m a r y h e a l t h c a r e programme;
f.
t h e i m p l e m e n t a t i o n of a medium-ten, progrblindness;
f o r t h e p r e v e n t i o n of
g.
t h e evaluation o r resulrs.
l o r t h e i d e n t i f i c a t i o n o f p r e v a l e n t communicable a y e d i s e a s e a and o t h e r common c a u s e s o f l o s s o f v i s i o n , t h e t a r g e t r o u l d be t h e d e f i n i t i o n of p r i o r i t i e s and t h e d r a f t i n g o f b a s e l i n e i n f o r m a t i o n f o r t h e p r e p a r a t i o n o f t h e m e d i w t e m programme f o r t h e p r e v e n t i o n o f b l i n d n e s s ( f i r s t y e a r ) . ?he p r o p o s e d a c t i v i t i e s
w u l d be t h e c o m p a r a t i v a s t u d y of p r i o r i t i e s and s f tuatton analyaia concerning c o r m u n i c a b l e e y e d i s e a s e s and o t h e r s o n d i t i o n s l e a d i n g t o loaa o f v i s i o n ; i m p l e m e n t a t i o n o f t h e a p p r o p r i a t e e p i d e m i o l o g i c a l at&iil.% tn c o m p l e t e t h e information gaps, a p r e - i n v e s t m e n t a n a l y s i s c o m p r i s i n g s r u d i e s o f economic the
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losses due to eye diseases and blindness as well as economic damage to productivity; a study of behaviour and attitudes of the population to the problems related to prevention of blindness and definition of priorities to aohieve community pnrticipation.
For the identification of specialized manpower resources and their adequacy in relation to local needs, the target aould be the development of health manpower requirements for the programme of prevention of blindness and related aspects (first and second years). The proposed activities would be the establishment of health manpower requirements; the implementation of training courses, seminars and technical meetings at national level the participation in inter-country meetings; of related technical knowledge. and
the promotion of dissemination
For the identification of suitable and economic methods for the control of
eyo disoacos nnd for thc prevention of blindrxes* 1x8 ralaLlon to local
conditions, the target would be to define methodologies for the screening, diagnosis, referral and treatment of eye conditions leading to blindness (first and second years). The proposed activities would be to introduce
and evaluate suitable screeding and diagnostic methodologies applicable at primary health care level according to the local conditions; to introduce and evaluate appropriate methodologies for referral, treatment and follow-up of eye conditions leadine level; t o h l i n d n ~ s s~t
specialized ophthalmologiool care
to implenent field studies and operational research aiming at
imprJving knowledge on control and prevention methodologies under local conditions.
Por the identif1r;aLiulr of ~l~yslcnl and lnstlrurlonal resources and their
adequacy in relation to the local needs, the target would be to complete the network of eye care facilities, including surgical. laboratory and diagnostic centres required for the implementation of the programme for the prevention
of blindness (third year).
The proposed
activities would be an inventory
of institutional resources at country level including intermediate and central ophthalmological curative services and related laboratory facilities: the
provi3ion nf supplies and equipment required for completing the network US
-
--
WHO D(R0
EM/PBL/4
EM/MTG.TCH.COM.PREV.BLIND./lO oage 2 3 i n t e r m e d i a t e and c e n t r a l r e f e r r a l s e r v i c e s ; the of s u p p l i e s as
provision
and equlpmenL r e q u i r e d f o r t n e Implementation of t h e programme a t primary l e v e l , including a n t i b i o t i c s , vitamins, chemotherapeutlcals, e t c . , r e q u i r e d by t h e programme.
POr t h e d r a f t i n g o f a p l a n f o r t h e c o n t r o l of communicable e y e d i s e a s e s and p r e v e n t i o n of b l i n d n e s s , i n c l u d i n g t h e h e a l t h e d u c a t i o n component w i t h l n t h e f r a m e w r k of t h e primary h e a l t h c a r e programme, t h e t a r g e t would
be to p z r p a r a n plum f o r rne p r e v e n t i o n of b l i n d n e s s w i t h i n t h e a v a i l a b l e
manpower, m a t e r i a l and f i n a n c i a l r e s o u r c e s a c c o r d i n g t o t h e l o c a l needs and p r i o r i t i e s , and i n p a r a l l e l w i t h t h e dnvalnprant of t h e primary hc.1 t h omre programme (second y e a r ) .
The proposed a c t i v i t i e s r o u l d bs the d r f i n i t i o n
o f a t t r i b u t i o n s and r e s p o n s i b i l i t l e s of t h e primary h e a l t h worker i n r e l a t i o n
to s c r e e n i n g and r e f e r r a l of e y e c o n d i t i o n s a t primary l e v e l , i n c l u d i n g a d m i n i s t r a t i o n of t o p i c a n t i b i o t i c s and v i t a m i n s t o p o p u l a t i o n groups a t risk, the p l a n n i n g and u s g a r i i z a r l o n o r a network o f peripheral r e f e r r a l
c e n t r e s f o r t h e d i a g n o s i s and t r e a t m e n t of eye c o n d i t i o n s r e f e r r e d by t h e primary h e a l t h c a r e workers; t h e p l a n n i n a and o r g a n i z a t i o n of a system of
r e f e r r a l and t r e a t m e n t of eye conditions r e q u i r i n g s p e c i a l i z e d c a r e ( t h l s may i n c l u d e rehabilitation of t h e b l l n d and r e f e r r a l t o r e g i o n a l c e n t r e s ) , t h e p l a n n i n g and o r g a n i z a t i o n of a system of environmental h e a l t h s e r v i c e s f o r v e c t o r - b o r n e communicable e y e d i s e a s e s and f o r m o n i t o r i n g o f v e c t o r dansitles (where r e q u i r e d ) , the
p l a n n i n g and o l g a n i z a t i v n 01 h e a l t h e a u c a t i o n the s e c u r i n g
activities r e l a t e d t o t h e programme of p r e v e n t i o n of blindness.
of firrancing from i n t e r n a l and/or e x t e r n a l s o u r c e s .
F O r t h e implementation of a medium-term progr-
f o r the prevention
o f b l i n d n e s s , t h e t a r g e t would be t o implement a programme f o r t h e p r e v m t i o n of b l i n d n e s s i n a l l i t s m u l t l - d i s c i p l i n a r y a s p e c t s (second t o s i x t h jar).
The proposed a c t i v i t i e s would b e a system of primary e y e c a r e a t d o m i c i l l y l e v e l f o r t h e d e t e c t i o n , primary c a r e and r e f e r r a l of e y e c o n d i t i o n s l i k e l y t o lead t o blindness;
a system of i n t e m d i a t e l e v e l f o r d i a e n a s ( * mnd
managamant o f c a s e s which d o n o t r e q u i l r spacial o p h t h a l m o l o g i c a l c a r e ;
L
WHO
EMRO
a s y s t e m of s p e c i a l i z e d ophthalmologrcal c a r e a t i n s t i t u t i o r r a i l e v e l ; a system o f v e c t o r c o n t r o l o p e r a t i o n s where r e q u i r e d ; ray
any o t h e r system t h a t
h e required depending o n local cnnditions.
For t h e e v a l u a t i o n o f r e s u l t s ,
t h e proposed a c t i v i t i e s would be t h e ;mplemci.r:ailr,;i
comparison of i n c i d e n c e and p r e v a l e n c e b e f o r e , d u r i n g arid a f t - r
of
t h e programme;
the evaluation
# x i
economic b e n e f i t s ;
t h e r e v ~ s i o n; l f
programme t a r g e t s ano o b j e c t i v e s as r e q u i r e d t h r o u g h a p p r o p r l a r e c o n t i n u o u s feedback.
Having c o n s i d e r e d t h e i n f o n n a t i r ~ np r o v i d e d hy t h e members o f t h i s T e c h n i c a l Committee; tv
i n view of 'the mandate r e c e i v e d by t h e Committee Iran,
s t u d y p r e v e n t i o n of blindnc:;:~ i n t h c Ilcgion, which m e t . i n T c h c m n , r e a l i z i n g t h a t p r e v e n t i o r t of b l i n d n e s s i s a p r i o r i t y
I n March 1 9 7 8 ;
problem i n t h e Begion,
t h e Technical Committee p r e s e n t s , f o r t h e c o n s i d e r a t i o n the
of t h e Committee t o s t u d y p r e v e n t i o n o f b l i n d n e s s i n t h e Ilegion, f o l l o w i n g recommendations:
i
A r e g i o n a l programme s h o u l d
Dl?
developed according t o t h e b w i d e l l z ~ r i
given i n t h i s Report.
2.
A n Advisory Group composed of e x p e r t s from t h e Hsglon s h o u l d be
~6tabl~she fd o r t h e development o f t h e programme.
3 .
Current a c t i v i t i e s a t national
l e v e l s h o u l d be d e v e l o p e d i n t h e l i g h t reorganized bllndncs~.
o f t h e e x i s t i n g n e e d s and r e s o u r c e s and, wherever a p p r o p r i a t e , a n d reetructured into n a t i o n a l prngmrnma- f o r t h e p m v e n t i n n of
T h e s e programmes s h o u l d i n c l u d e c l e a r l y d e f i n e d o b j e c t i v e s , t a r g e t s and activities.
4.
F o r t h e i m p l e m e n t a t i o n o f n a t i m a l programmes i t wo~rld be n e c e s s a r y
'0 i d o n t l r y
ana
a e s l g n a t e n a r l o n a l e x e c u r l n g a g e n c l e s o r conunlrrres wnlnn
s h o u l d be g i v e n t h e n e c e s s a r y a u t h o r i t y and s u p p o r t .
WHO EMRO
M/PBL/4
EM/MTC.TCH.COM. PIiEV. ELIND./10 page 2 5
5.
A n i n v e n t o r y of a l l r o s o u r c r s s u c h a s c e n t r e s , l n s t i t u t l o n s and organizations for traininz, r e s e a r c h , c o n t r o l and r r h a b l l i be made and c o - o r d i n a t i o n
gnv-rnmsntal
t a t i o n , s p e c i a l i z e d e y e c a r e , e t c . , ,hould t h e i r a c t i v i t i e s promoted.
of
6.
Whenever a p p r o p r i a t e , e x i s t i n g i n s t i t u t i o n s s h o u l d be s t r e n g t h e n e d
and t h e e s t a b l i s h m e n t o i new c e l k t r e s e n c o u r a g e d w n e r t ? r e q u l r e a .
7.
S p e c i a l n m ~ h a s i ss h o u l d b e p u t on t h e a p p l i c a t i o n o f e x i s t i n u knowledge
on t h e p r e v e n t i o n o f b l i n d n e s s t h r o u g h t h e d e l l v e r y o f n e c e s s a r y s e r v i c e s
st t h e most p e r i p h e r a l l e v e l , s u p p o r t e d by a d e q u a t e r e f e r r a l systems. 8. P r e v e n t i o n o f b l i n d n e s s activities s h o u l d be i n t e g r a t e d w i t h and w l ~ r r ~ r vf r e~ a>llrla.
promotea t n r o u g h p r i m a r y h e a l t h c n r r
9.
b h p h a s i s s h o u l d be giver) by t h e p r e v e n t i o n of b l i n d n e s s programme on
t h e t r a i n i n g and u t i l i z a t i o n of a u x i l i a r y p e r s o n n e l .
10.
H c l e v a n t r e s e a r c h s h o u l d be promoted w i t h s p e c i a l e m p h a s i s on t h e of common c a u s e s
development and d e l i v e r y o f s i m p l e mcthods f o r t h e c o ; l t r o l
or 11.
DllndneS5.
H e a l t h e d u c a t i o n , community p d r t l c l p a t i o n and l n f o r m a t l o n o f t h e p u b l i c 5
s h o u l d be
trt%ngth(xned.
12.
C o l l e c t i o n of i n f o r m a t i o n and d a t a on b l l n d n r s s ,
etc.,
s h o u l d be made,
u s i n g uniform c r i t e r i a t o t h r e x t e n t p o s s i b l e .
13.
The S t a t e s o f t h ? A r a b i a n P e n i n s u l a s h o u l d c o n s i d e r t h e c r e a t i o n o f
a c e n t r e f o r t h e p r e v e n t i o n of b l i n d n e s s i n one o f t h e c o u n t r i e s o f t h e Arabian Peninsula t o s e r v e t h e c o u n t r i e s of t h e a r e a . should have t h e following a t t r i b u t e n : Such a c e n t r e
-
Co-ordination c u u n t r i c 3 of
of t h e p r e v e n t i o n of b l i n d n e s s programmes i n t h e t h c oren.
WHO
E W
-
T r a i n i n a of al~rxliiarw s t a f f t h e programme i n t h e a r e a .
r-o~~lr-d f o r thn lmnlamantatinn of
-
Implement o p e r a t x o n a l r e s e a r r h f n r t h o s e a s p e c t s r e l e v a n t f o r t h e e h e c u t i o n of preventlor1 of hlindne-9,
F'rovtde s p e c i a l i z p d e y e car* and s v ~ c i a l i z e dt r a i n i n g f o r t h e c o u n t r i e s o f the a r e a .
I t 1 3 e s t i m a t e d t h a t the C e n t r e may b*= c o n s t i t u t e d a s f o l l o w s :
a)
Technical managerial nucleus f o r the a d m i n i s t r a t i o n and conduct of
t h e p r o g r a m - s of prevention of blindness in t h e a r e a .
b)
T r a i n i f i g f a c l l l t i e . 2 for a i r x l l i s r y v u r k e r s i n c l u d i n g a f i e l d training a r e a .
C )
C l i n i c a l f a c i l i t i e s for the management o f e y e c o n d i t i o n s requiring specialized c a r e
a)
Mobile f a c i l i t i e s f o r d e i i ~ m r wof s p e c i a l i x e d e y e c a r e a t f i e l d
Level a s required.
An Advisory Group under t h e chad.mnnship of Sheikh Abdullah A 1 Ohanim ,s
r c c ~ m u t e n d a d to asal.:#t in t l t r
1 e r ; l u ~ L c a l a - r p r c l s related s o t h e 1mpLemenEatlon
; a c t i w l . t l e s of t h e c e n t r e .
f r
Goverrmants and p n t e n t i a l donors shoulia he urged t o c o n t r i b u t e a d d i t i o n a l nds for +he implemnn t a l i o n r,f t h e nrogramme.
' e:cid
Cu-ordination with governmental stnrl n e n - g o v e m e n t a l should bo developed.
agmcies i n t h i s
WHO OllRO
EM/PBL/4 EM/MTG.TCH.COM. PREV. BLIND. 110 page 27
16.
L e g i s l a t i o n s h o u l d be i s s u e d o r r e i n f o r c e d t o r e d u c e t h e r i s k of l o s s
of v i s i o n a t work, home, p l a y and on t h e r o a d .
17,
F o r t h e exchange o f s c i e n t i f i c and o t h e r i n f o m a t i o n , and i n o r d e r
t o l i n k t o g e t h e r t h e a c t i v i t i e s of v a r i o u s w o r k e r s i n v o l v e d i n t h e programme f o r t h e p r e v e n t i o n o f b l i n d n e s s i n t h e Region, L n c r s l c t t e r o r ncrsbzief Irr
E n g l ~ s hs h o u l d be p u b l i s h e d and c i r c u l a t g d p e r i o d i c a l l y .
A conjoint
rrl~~orla committee l r e p r e s e n t l n [ ; a l l p a r t i e s concerned may h e formed w i t h a general e d i t o r i a l secretary.
Opening of t h e Meeting. Nomination of Off 1ci.r 3.
A d o p t i o n o f t h e Ageniin. iioview of t h e p r o b l e m u f !il t.i!lrre:..; Review of t h e p r e s e n t ;tat!?s i 8 i t t ~ ;: :,&;I<I~I"
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Closini: s e s s i o n .
WHO E M H O
EM/PBL/4 E M m . TCH.COM. PREV. BLIND. /10 Annex I1 page i
ANNEX I 1 MEMBERS OF THE COMITTEE Dr A W u l Hafls A b u Y v u ~ l l
Director Communicable Eye D i s e a s e s and Onchocerciasis Control Divison M i n i s t r y of H e a l t h Khartoum SUDAN
D r H i sham A 1 t a h i r Ophthalmologist D i r e c t o r a t e o f School H e a l t h M i n i s t r y of H e a l t h
D r Hadi A. E l S h e i k h A s s o c i a t e P r o f e s s o r o f Ophthalmology F a c u l t y o f Medicine Khartoum SUDAN Dr Yahis Hnmdon Head o f Eye U n i t S u l a i b e k h a t Hosi t a l Kuwait KUWAIT
-
D r AMus S a t t a r Khan A s s i s t a n t Professar o f Ophthalmology Bolan Medical C o l l e g e
Ouetta PAKISTAN D r AMol-Hamid Mohssenin C h i e f , Communicable Eye Disease. and Trrchomc Control G e n e r a l Department f o r Y n l P r i a E r a d i c a t i o n and Communicable DiseaHI C o n t r o l M i n i s t r y o f H e a l t h and W e l f a r e Teheran IRAN
EM/PBL/4 EM/MTG.TCH.COM.PREV.BLIND./~O Annex I1 page ii
WHO EMRO
~1.0frt~~ulmltyl ~idi~ Sara l Professor of Ophthalmology Faaulty of Medicine Alexandria Universitv Alexandria EGYPT Dr Ali. Mohnmod Shata
Ophthalmologist El Rahed Hospital Mecca SAUDI ARABIA Professor Abdel Mohsen Soliman 1)Irartnr
National Research Centre Cairo EGYPT OBSERVERS Sheikh Abdulian A1 cihanim President Regional Wlreau of the Middle East Committee for the Welfare of the Blind SAUDI ARABIA Profrabul
T.H.
liilrlllillli
Honorary General Secretary National Society for the Prevention of Blindness Karachi PAKISTAN
WHO SECRETARIAT Dr A.M. Taba Director Programme Manager, Prevention of Blindness Public Health Administrator (Communicable Diseases) Eastern Mediterranean Regional Ollica, Alexanaria WHO Headquarters, Geneva Eastern Mediterranean Regional Office, Alexandria
Dr M.L. Tarixao Dr P . Partow Dr V. Parisi
Regional Adviser on Eastern Mediterranean Regional Epidemiological Surveillance Office, Alexandria of Communicable Diseases, Secretary to the Meeting Conference Officer Eastern Mediterranean Regional Offioc, Alexandria
Mrs C. CartoudisDQmdtrio Mrs J. Khadr
Secretary
Eastern Mediterranean Regional Office, Alexandria