Know-how of primary eye care among Health Extension Workers (HEWs) in Southern Ethiopia

Abstract

Background/ Aim: Frontline health personnel can play key role in preventing and controlling blindness if they have good understanding of primary eye care (PEC). This study determined knowledge, attitude and practice of PEC among health extension workers (HEWs) in southern Ethiopia. Methods: A cross sectional community based study was conducted between June and July 2007 in five randomly selected woredas of Gurage Zone. Quantitative data were collected using a questionnaire completed in a face-faceinterview with 111 HEWs. And this was supported with qualitative information from two focus group discussions. Result: HEWs (87%) had poor understanding of the functional definition of blindness. They identified cataract (85%), trachoma (96%) and trauma (64%) as causes of blindness. Although most (89%) correctly mentioned signs and symptoms of trachoma, but only 10% could describe its control strategy. Refractive error was wrongly perceived by most (77%) as only a near vision problem. Glaucoma was barely known but causes of childhood blindness were well identified.. Their main source of information for eye health care was pre-service training (50%) and refresher trainings by international organizations (46%). HEWs practiced mainly preventive aspects of PEC. Group discussions revealed that HEWs have good will to participate in PEC but barriers such as inadequate knowledge and lack of basic supplies are limiting their contribution. Conclusion: Know-how of blinding eye disease among HEWs is too low to enable them contribute meaningfully towards prevention of blindness. It is recommended that PEC be incorporated in their training curriculum.

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

“…Task sharing can contribute to strengthening the health system, by enabling general health care personnel, if they have the appropriate skills, to provide eye care as part of primary health care [74-79]. If too much is added to their routine practice, they may not be able to complete additional tasks [80].…”

“…In general however, documented longer-term outcomes for eye health training have been less encouraging [14,30,74-76,100]. Evidence from evaluations of the quality of these interventions is sparse: for example whether the skills and knowledge presented in the initial training are appropriate to the context to which health personnel return, or are indeed acquired or retained.…”

“…Furthermore, evidence is lacking about the delivery of comprehensive eye health services or of the effectiveness of eye care service provision within either vertical or horizontal approaches [14,30,58,74-76,99,100] or the procurement, management and maintenance systems for equipment and supplies. This may be due to a lack of documentation, sufficient research, application of available research for planning [173], or to the genuine lack of effective eye care interventions at primary level.…”

Primary Eye Care in Eastern Nepal

“…This is higher when compared to other similar studies: 56% in Tanzania, Malawi and Kenya, 49.5% in Ethiopia and 72.3% in Nigeria. [12][13][14] This number is still low, however, considering cataract remains the leading cause of blindness in the Sagarmatha region despite surgical provision by SCEH and suggests that recognition at the community level needs to be improved in order to reduce cataract blindness.…”

“…12 Similar results were found in Ethiopia and Nigeria. 13,14 Other studies have evaluated the effectiveness and long-term impact of PEC training. In Tanzania an evaluation of PEC knowledge and skills pre and post PEC training showed an improvement in knowledge in the short-term, but without long term sustainability.…”