…Experts fume over traditional couching of eye lenses with sharp implement
From Jude Dangwam, Jos
New research has uncovered alarming cases of blindness in Plateau State that supercede the national quoted value of 0.7%, a development that calls for serious actions to stop the ravaging menace in the state.
•Community of blind people in Plateau State
Experts says the new discovery across the 17 local government areas had Bokkos LGA leading with the highest prevalence of blindness at 16.3 %, followed by Wase, Langtang North, Langtang South and Jos North, among others.
The principal investigator for the Rapid Assessment of Avoidable Blindness (RAAB) Project 2023 survey in Plateau State and a consultant opthalmologist at the Jos University Teaching Hospital (JUTH) Dr. Alice Ramyil, said the state has a prevalence of 2.7%, which is way higher than the national figure of 0.7%.
She said the survey conducted in 2023 across the 17 LGAs by the state government in partnership with Sightsavers International, Health And Development Support (HANDS) with support from the Christian Blind Mission International was to measure the magnitude as well as causes of visual impairment in people from 50 years and to established the extend at which eye service are reached by the various categories of people in the state.
•Community of blind people in Plateau State
She stated: “We found the prevalence of 2.7%, which is way higher than the 0.7% national figure. And we found that the major cause of blindness was cataract, which is not surprising because that’s the number one cause of blindness and visual impairment globally and in Nigeria also.
“Then we also noticed that glaucoma also featured a very prominent component of the causes of blindness. And the interesting part is that these two conditions are totally avoidable because blindness from cataract is curable and blindness from glaucoma can be prevented by instituting early diagnosis and appropriate treatment.”
The survey further established that those who had mild to moderate visual impairment, refractive error which can easily be corrected with glasses was second leading cause after cataract.
“So, basically, the major causes of blindness and visual impairment in Plateau State are avoidable causes. What is the way forward? It is for us to up our game in the provision of good quality eye care to tackle these conditions.
“There are available surgery for cataract, but it seems enough has not been done over the years leading to the upsurge. Even the coverage that we found out was less than 1/3 of those needing cataract surgery who have had cataract surgery.
“It means that our our surgeries are not enough to cover the population that has cataract. So we need to increase our output and the quality because if you have good quality surgeries, it will also attract more people.”
Poverty and the economic downtown has also played key role negatively to the geometric figure as most of the rural populace can not afford eye care due to out of pocket medical expenditure.
“The major reason why people were not getting cataract surgery done, we found at the survey, was due to cost. And although cataract surgery is relatively cheap here in Plateau State, but still because our population is generally poor, which the survey also revealed that the poverty level is higher than the national average up to 45%. So, that was what we found,” the principal investigator revealed.
The survey further discovered that eye services were not available in the southern senatorial zone of the state at all, except for primary eye care activities that were going in patchy manner. While the central zone was also underserved because almost everything happens in the northern zone of the state and in Jos North because of the presence of Bingham Teaching Hospital, Plateau Specialist Hospital and JUTH.
Among the 17 local government areas of the state with higher prevalence of blindness is “Bokkos LGA 16.3%, Wase 8.1%, Langtang North 6%, Langtang South 5.1%, Jos North 5%, Bassa 5%, Kanam 4.8%, Jos South 4.5%, Kanke 4.4%, Mikang 4.1%, Shendam 4%, Pankshin 3.5%, Qua’an Pan 3.1%, Jos East 2.8% and Barkin-Ladi 1.6%.”
According to the survey, the estimated burden of visual impairment in the state has blindness at 2.7% with severe visual impairment 1.4% and moderate visual impairment at 3% while early visual impairment is 7.8%.
The local government area with the lease average prevalence of all causes of blindness in the state is Barkin-Ladi with 1.6 percent while Bokkos leads with 16.3 percent.
Among the main causes of blindness uncovered in the state was that unoperated cataract is 65% while glaucoma is 17%, cataract surgery implications 7%. Others like onchocerciasis, aphakia, refractive error, trachoma corneal opacity, corneal opacity and other posterior segment is 11%.
The finding maintains that the main causes of severe vision impairment (SVI) is untreated cataract which is 74%, cataract surgical complications 8% and glaucoma 6%. Meanwhile, others like age related macular degeneration, corneal opacity, trachoma corneal opacity, aphakia, posterior segment disease and unaddressed refractive error 12%.
The unaddressed refractive error, which has been established to be responsible for the early visual impairment in Plateau State, covers 43.5 percentage. Less than one third (27.5 percent) of people has cataract and visual acuity, less than 6/12 had undergone surgery while coverage was said to be low among women at 22 percentage to 32.8 percentage among men.
Statistics showed that cataract surgical coverage of persons in Plateau State has 32.8% male while 22% are female. Meanwhile, effective cataract surgical coverage of persons in the state has 12% male and 9.7% female.
Experts expressed concern over the practice of couching, which is a traditional approach of removing the occluded lenses with a sharp implement commonly into practice in Plateau State.
“Thirty-five (12.8%) operated eyes had been couched, of which 80% had poor vision. The higher proportion of poor vision among eyes operated for cataract means that effective cataract surgical coverage is low in Plateau State.
“10.8% of operated eyes visual acuity less than 6/12. The major reason noted for poor post-operative vision was surgical complications including couching forming 65.7%. Unaddressed refractive error 16.7%, long-term complications 10.8% and comorbidity 6.9%,” they survey stated.
For Plateau State to improve the quality and quantity of cataract surgeries in achieving universal health coverage (UHC) targets adopted by the World Health Assembly in 2021. The state government will need to increase its effective cataract surgical coverage from 10.8% to 49.8% by 2030.
This will require an increase in the number of surgeries conducted and an improvement in the post-operative visual acuity experienced by patients.
The Country Director of Sightsavers for Nigeria and Ghana, Dr Sunday Isiyaku, noted that the organization will continue to support the state government in achieving the objective of the survey which is aimed at addressing the problem of blindness bedeviling citizens of the state.
“This year, we think it’s going to be more impactful because this year we now have results from the rapid assessment of avoidable blindness and cataract has come out to be the leading cause of blindness. And as we suspected, it is also very much prevalent in the southern and central parts of the state.
“So, I think we we made a good choice in where we are going to support the programme and we think with the information, now we know where to invest resources to make sure that people have access to the services,” he stated.
The Eye Health Manager with HANDS, Mr. Abalis Dasat, said the meeting was to disseminate the findings from the study and chat a way forward.
He said: “Our concern is that no one needs to be blind needlessly. The survey came out with some hidden facts about the magnitude of blindness in Plateau State.
“So, moving forward, we are going to be guided. We are no longer going to be working based on assumptions but it is going to be work that is statistically directed because of the outcome of the survey.”
Dr. Obiarariaku Ukeme-Edet of Christian Blind Mission International said despite government’s effort of being supportive of the programme by creating a very good environment for the programme to work, there are still gaps that needs to be covered.
He explained: “We are interested in the poor and the vulnerable, especially persons with disabilities and this partnership was an opportunity to reach those persons with disabilities with eye health.
“The government has provided an environment, they have provided the facilities. However, the gap still remains in the distribution of manpower across these facilities.
“The RAAB project has revealed also that there are some areas that more work needs to be done and those areas we hope to focus in 2024, especially Bokkos.”