Ashura Hemed knew soon after her son, Shadrack, was born that there was something wrong with his eyes. They looked larger, were watery and he hardly opened them.
Ashura visited her local reproductive and child health clinic five times over three months. Not knowing how to examine Shadrack, the child health care workers either reassured her without checking his eyes or gave her antibiotic eye drops.
Ashura lives in Tanzania but many mothers face similar problems all over the world.
Primary eye care services for children are patchy at best and non-existent throughout many low- income countries. This leads to many children not being diagnosed in time for effective treatment and going blind needlessly.
Globally more than 70 million children have sight loss, 1.4 million of whom are blind. Yet half of all this blindness is from avoidable causes, and 80% is in low and middle-income countries.
The Global Child Eye Health Project at LSHTM aims to address this through training all health care workers to screen, diagnose and treat eye health problems for children as part of their routine care.

The first stage of the project involved training primary health workers in Tanzania on eye health by including it as a module within the Integrated Management of Newborn and Childhood Illness (IMNCI), a WHO guideline used in at least 100 countries for primary health services for young children. The study was a success, leading the government to include the eye health module within their national guidelines and 3000 workers being trained by the Ministry of Health, enabling thousands of children in Tanzania to receive treatment for eye conditions.
The second stage of the project was using a low-cost device, the Arclight, which allows people in remote or low-resource areas to assess eye conditions. Training videos were used during supported supervision to train health workers and 40,000 children were screened over 6 months.
A new grant of £4m from the UK National Institute of Health and Research will now build on the previous work of the project to carry out 5 studies in Tanzania and Nepal, including a randomised controlled trial and economic analysis. The studies will test a set of health system interventions such as training within IMNCI, strengthening data collection and using the Arclight, which will collectively assess the impact on eye care screening and diagnosis.
This will lead to a validated approach that can be taken up by governments around the world, integrating eye care into child health in their countries and ensuring every health care worker providing primary care for children can detect eye problems. This would benefit hundreds of millions of children globally.
Shadrack was lucky to have a determined mother. Ashura travelled to the capital, Dar es Salaam, and managed to get him seen at an eye clinic where he was diagnosed with congenital glaucoma. He received follow-up care and is now doing well.
We hope that in the future all children will have access to primary eye care services where they can be seen and treated – so no child will be needlessly left behind.