|Year : 2013 | Volume
| Issue : 1 | Page : 3-6
Progress in blindness prevention in North Sudan (2003-2010)
Kamal Hashim Binnawi
National Program for Prevention of Blindness, Alneelain University, Khartoum, Sudan
|Date of Web Publication||21-Sep-2013|
Kamal Hashim Binnawi
National Program for Prevention of Blindness, Alneelain University, Khartoum
Source of Support: None, Conflict of Interest: None
Objectives: (1) To review progress in the prevention of blindness in Sudan compared to Vision 2020 targets. (2) To show gaps and shortfalls. Materials and Methods: Reports of national Vision 2020 program covering the period 2003-2010 are reviewed, including data generated from six RAAB surveys conducted in 2009-2010.
Results: Prevalence of blindness is 1% compared to 1.5% in 2003. Cataract surgical out-put, cataract surgical rate (CSR), and IOL implantation rate increased steadily. It is estimated that 70% of the population are covered with refractive errors services. Low vision services are provided by four centers. Trachoma mapping completed for Northern Sudan except Darfur. SAFE strategy is implemented. Prevalence of childhood blindness is not known. Two centers provide specialized pediatric eye services. There is community-directed treatment with Ivermectin (CDTI) in 3 out the 4 onchocerciasis foci. Ophthalmologists tripled in number. Optometists exceeded 1000, compared to less than 500 in 2003. Secondary and tertiary level facilities increased in major cities. There is no primary eye-care program. Conclusion: Northern Sudan shows good progress in most of the components of Vision 2020, namely cataract, trachoma, onchocerciasis, refractive errors, and low vision. However, scaling up and attention to diabetic retinopathy and glaucoma are still needed to reach all the targets by the year 2020.
Keywords: Blindness prevention, Sudan, vision 2020
|How to cite this article:|
Binnawi KH. Progress in blindness prevention in North Sudan (2003-2010). Sudanese J Ophthalmol 2013;5:3-6
| Introduction|| |
The World Health Organization (WHO) estimates that there are 45 million people in the world who are blind (vision worse than 3/60 in the better eye with presenting vision). , This is expected to rise to 76 million by 2020 if current services are not improved. VISION 2020 is a joint initiative by the WHO and the International Association for the Prevention of Blindness that aims to eliminate avoidable blindness by the year 2020. ,,, The priority diseases in the first phase of Vision 2020 are cataract, refractive error and low vision, childhood blindness, onchocerciasis, and trachoma. These conditions constitute more than 75% of blinding diseases  and are amenable to effective preventive and curative interventions.
In 2003, Sudan launched Vision 2020 program. The first national committee for prevention of blindness was established and the first five-year plan was adopted. At that time, the prevalence of blindness was estimated to be 1.5%. The main causes were cataract, glaucoma, trachoma, and other causes of blindness including onchocerciasis. These causes were responsible for 60%, 20%, 15%, and 5% of blindness, respectively.
The objectives of this study are to review progress inprevention of blindness in Sudan since 2003, to compare different targets set by WHO/ Vision 2020 to the current situation in Sudan and to show gaps and shortfalls.
| Materials and Methods|| |
Reports of national Vision 2020 program covering the period 2003-2010 are reviewed, including data generated from rapid assessment of avoidable blindness (RAAB) surveys conducted in 2009-2010 in six states (Kassala, Northern state, North Kordofan, Sinnar, White Nile, and Gezira). To demonstrate progress and gaps, all the findings were compared to the targets set by WHO for Vision 2020.
| Results|| |
Prevalence and Causes of Blindness
Extrapolating from six RAAB surveys in Northern Sudan, the prevalence of blindness in 2010 is estimated to be 0.7%.
The causes are shown in [Figure 1].
Disease Control [Table 1]
- Cataract: Cataract surgical out-put and cataract surgical rate (CSR) increased steadily [Figure 2]. In 2010, IOL implantation rate was 98% compared to 20% in 2003. Cataract surgical coverage (CSC) ranged between 64% and 85%.
- Refractive Errors and low vision: It is estimated that 70% of the population are covered with refractive errors services. In 2010, the cumulative number of functioning graduates from college of Optometry (established in1958) exceeded 1000, compared to less than 500 in 2003. Screening of more than 2 million school children (aged 6-15) was conducted between 2003 and 2008. Low vision services are provided by four centers, all of them in Khartoum. More than 50 optometrists completed training in low vision.
- Trachoma: From 2006 to 2009, in collaboration with The Carter Center, 190 000 individuals were examined in 88 districts surveyed for trachoma. The survey covered all Northern Sudan except Darfur due to security concerns. In 76 districts, TF prevalence was below 5%. Nine districts had prevalence between 5% and 9%. Only three districts showed the prevalence of 10% or more. Trichiasis is below 1/1000 in adults in 50% of districts. SAFE strategy is implemented. Impact surveys show success. Target date for elimination of blinding trachoma from Northern Sudan is 2015.
- Childhood Blindness: Prevalence of CHB is not known in Sudan. Two centers provide specialized pediatric eye services. Both of them are in Khartoum. The number of cataract surgeries for children below 15 year of age, performed in 2009, exceeds 3600. Midwives got training on basic eye care for neonates in 2005. There is no screening program for retinopathy of prematurity.
- Onchocerciasis: In Northern Sudan, onchocerciasis is known to be endemic in four areas. There is community-directed treatment with ivermectin (CDTI) in Abu Hamad, Galabat, and south Darfur (Radom) foci. The major change in the program was the shifting from control to elimination in Abu- Hamad focus, by adopting twice-per-year mass drug administration of ivermectin. Last 3 years witnessed high rates of geographical and therapeutic coverage as shown in [Figure 3].
|Figure 3: Mass treatment for onchocerciasis in Northern Sudan (2003-2010)|
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|Table 1: Disease control (comparison between V2020 targets and situation in Northern Sudan)|
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Human Resource Development
[Table 2] shows human resource development. Ophthalmologists increased from 90 in 2003 to 260 in 2010. Additional 120 are expected to graduate locally in the coming four years. Northern Sudan has good number of qualified optometrists. Mid level ophthalmic personnel are decreasing in number due to suspending intake to ophthalmic medical assistants' school. The majority of eye-care providers are in urban areas.
|Table 2: Human resource development (2003-2010) compared to vision 2020 targets|
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Infrastructure and Technology
[Table 3] shows development in infrastructure since 2003 compared to vision 2020 targets. Despite good progress, eye-care facilities exist only in major cities.
|Table 3: Infrastructure development (2003-2010) compared to vision 2020 targets|
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| Discussion|| |
Northern Sudan shows good progress in most of the components of Vision 2020. Cataract still is the main cause of blindness as it is everywhere in the developing world. Cataract surgical rate has increased four times exceeding the level of 2000 operations per million population recommended by WHO. Despite the good achievement in CSR, it is not clear whether it has improved all over the country or in major cities only. The big gap in coverage reflects unequal distribution and/or access to cataract services. Another important factor not shown here is the quality of cataract surgery or surgical outcome.
In relation to trachoma, the district based mapping done between 2006 and 2009 may be the largest survey for trachoma since the start of Vision 2020 initiative. Exclusion of Darfur due to insecurity makes a major set back to an otherwise successful program. Reducing trichiasis backlog is mandatory to achieve elimination of trachoma by 2015.
Onchocerciasis is witnessing major change by starting twice per year distribution and the remarkable improvement in geographic and therapeutic coverage rates. The good quality and adequate number of graduates of optometry school in Sudan privilege refractive errors and low vision services. However, scaling upand attention to diabetic retinopathy and glaucoma are still needed. There is also need to complete data related to eye-care. Gaps in mid-level human resources are to be filled. Developing a primary eye-care program is a priority. Extension to underserved areas is another priority. Separate detailed studies for blinding diseases, human resources, and infrastructure are needed to better illustrate the situation in Sudan.
| References|| |
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]