Eye care, Bangladesh

Objectives

Non-communicable diseases are increasing rapidly in Bangladesh. Diabetes constitutes one of the main health threats in the country and the rural areas are no exception. The prevalence is estimated to be well above 6% corresponding to more than 5,6 million people between the ages of 20 and 79. Complication rates are extremely high due to a lack of access to quality services.

Diabetic Association of Bangladesh (BADAS) is the main organiser of diabetes care in Bangladesh and the association serves now more than 25% of the diabetic population through its 80 health care facilities and affiliated associations across the country. At present, diabetes care hardly exists in government or other private institutions outside BADAS.

The Vision 2020 programme of the Government of Bangladesh recognises diabetic retinopathy as one of the main causes of preventable blindness. However, eye care and screening is centralised resulting in very limited access to services especially in rural areas. Furthermore, primary health care facilities lack even the most basic screening equipment and skills resulting in high complication rates.

The aim of the project is to prevent blindness due to diabetic retinopathy in underserved areas of Bangladesh by increasing access to eye care, screening and treatment services.

Approach

This project wishes to act as a role model for delivering quality and comprehensive eye care throughout the country. WDF has previously supported three other projects carried out by BADAS, WDF05-131(nutrition), WDF06-193 (primary prevention) and WDF06-195 (diabetes education).

So far, BADAS has trained 2000 GPs in diabetes care throughout the country - many of them working at district level facilities. Modern diagnostic and treatment services are not yet available in these facilities and the health care providers are not well trained in regards to diagnosis and treatment of diabetic retinopathy.

The current project will carry out screening for diabetic retinopathy at the primary care level through 58 BADAS affiliated associations all located in district centres. The project is the first of its kind in Bangladesh in terms of providing eye care at district level. BADAS will conduct training for the health care professionals and provide the centres with basic equipment for primary eye examination and screening for retinopathy.

Two mobile eye screening and treatment units will be established to support the primary centres by providing mostly secondary and tertiary care. The vans will be fully equipped to perform proper diagnostic tests and provide sight saving laser treatment. The vans will do outreach activities at each of the 58 district centres twice a month. A minimal service fee will be charged, however, the services will be free for poor patients. Two ophthalmologists, two nurses and two paramedics will be trained to operate each van. Patients requiring vitreo retinal surgery will be referred to one of the tertiary centres of BADAS.

In each of the affiliated associations, one ophthalmic physician, two nurses, two paramedics and one health educator will be trained to provide support to the van staff. The patients will be monitored by the ophthalmologist at the centres as well as by the van staff.

VIIO (Vittala International Institute of Ophthalmology), an important WDF partner, will collaborate with BADAS and assist in setting up and equipping the mobile vans, sharing protocols of their extensive experience in creating mobile diabetic retinopathy clinics (WDF05-110, WDF09-456). Furthermore, BADAS collaborates with Helen Keller International which has an ongoing eye project in Chittagong (WDF08-397), also supported by WDF.

Results at completion

• 2 eye clinics have been established (CEITC in Chittagong and Feni Diabetes Hospital (FDH)).
• 20,519 people with diabetes have been screened for diabetic retinopathy (DR). 6,100 people detected with DR and 3,296 treated with laser.
• 4 ophthalmologists have been trained in laser procedures and additional 11 ophthalmologist have received short training in skills development. In addition, 1 paramedic, 4 counsellors and 3 photographers have been trained
• 12,238 people have been reached through health education and counselling sessions.