Primary Eye Care for Children

Our vision is that every child health worker globally knows how to detect and manage eye conditions in children, and that eye health becomes an essential part of every child health programme. This will:

1. Save or restore the sight of millions of young children
2. Enable children to achieve their full potential, and improve the quality of life of the child and whole family
3. Save lives, as some interventions which prevent blindness also reduce mortality

All our programmes are part of our Global Child Eye Health Project.

Initial research

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 strategy 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 training 3000 workers (and counting!), enabling thousands of children in Tanzania to receive treatment for eye conditions.

The second stage of the project was training primary healthcare workers how to use 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.

Expanding the programme and creating a model

A grant of £4m from the UK National Institute of Health and Research (NIHR) will now build on this previous work to carry out 5 studies in Tanzania and Nepal, including a health system readiness study, randomised controlled trial, process evaluation, policy study and economic analysis. The studies will test a set of health system interventions such as training within IMNCI, strengthening data collection and screening using the Arclight.

This will lead to a validated health systems 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. If successful, this would benefit hundreds of millions of children globally.

Learn more and access materials including training videos and other resources: https://www.lshtm.ac.uk/research/centres-projects-groups/gcehp

Acknowledgements

We would like to thank the USAID Child Blindness Program, Christian Blind Mission, the Vision Catalyst Fund, and the UK National Institute of Health and Research for funding for this work.

We would also like to thank the Fred Hollows Foundation, Ministry of Health Tanzania and Kilimanjaro Christian Medical Centre for their collaboration on this project.

Publications

Malik ANJ, Evans JR, Gupta S, Mariotti S, Gordon I, Bowman R, Gilbert C. Universal newborn eye screening: a systematic review of the literature and review of international guidelines. J Glob Health. October 2022. https://doi.org/10.7189/jogh.12.12003

Malik ANJ, Gilbert C. Cochrane corner: interventions for preventing ophthalmia neonatorum. Eye (Lond). Feb 2022 Feb;36(2):356-357. doi: https://doi.org/10.1038/s41433-021-01803-8

Malik ANJ, Mafwiri M, Gilbert C, Kim MJ, Joanna Schellenberg – Integrating eye health training into the primary child healthcare programme in Tanzania: a pre-training and post-training study. BMJ Paediatrics Open. July 2020. https://doi.org/10.1136/bmjpo-2019-000629

Malik ANJ, Mafwiri M, Gilbert C. Integrating primary eye care into global child health policies. Arch Dis Child. February 2018. https://doi.org/10.1136/archdischild-2017-313536.

Malik, ANJ. Integrating primary eye care into child health policies and programmes: A case study from Tanzania. PhD thesis, London School of Hygiene & Tropical Medicine. https://doi.org/10.17037/PUBS.04670989