Children who are blind and disabled are often hidden in the society because of stigma, prejudice and negative attitudes of the able-bodied members of the family and community
Bangladesh is one of the world's poorest countries, with more than a third of the country's 144 million population living below the poverty line. It is estimated that approximately eight in every 10,000 children in Bangladesh are blind and this number needs to be halved by 2020 to meet VISION 2020's goal of just four children in every 10,000.
A recent large-scale study by Muhit, Shah, Gilbert and Foster1 examined the causes of severe visual impairment and blindness and found congenital or developmental cataracts and corneal scars to be the worst offenders, with cataracts alone accounting for a third of all cases.
The study findings led to the launch of the Bangladesh Childhood Cataract Campaign (BCCC). We spoke with Dr Mohammad Muhit, Clinical Research Fellow at the International Centre for Eye Health (ICEH), London, UK and BCCC consultant, who was able to provide insight into the harsh realities in Bangladesh and how he hopes this initiative can make a real difference.
ICEH & CSF also developed a model of public health intervention2 to reverse blindness in children in Bangladesh through a pilot project in five districts of the Rajshahi division of Bangladesh - the Childhood Cataract Control Programme in 2003-4, which was funded by a British charity Muslim Aid UK. "This model involves the development/enhancement of a paediatric eye unit for every 10 million population and linking eye care services to rural communities by using community volunteers (key informants) for case detection and referral" Dr Muhit explained.
In response to the startling statistics presented and the identified need for immediate action, the BCCC scaled up this successful public health ophthalmology intervention model to control childhood blindness due to cataract in all 64 districts of Bangladesh. By adapting a strategy of partnerships with eye hospitals, community based NGOs, government departments, other international NGOs and academic institutions, the BCCC set about reversing blindness in at least 10,000 children blinded by cataract by the year 2010 and in 20,000 by 2020.
The importance of key informants
Put simply, the prime objective of the campaign is to eliminate cataract blindness in children in Bangladesh by firstly identifying the sufferers and secondly, by ensuring the provision of adequate medical care. This is no easy task and is one that requires meticulous organization, planning and cooperation. "Blind children who are suffering from cataract and living in remote and rural communities are identified by trained community volunteers (key informants) and health workers who received training from the campaign partners in detection of children with cataract and blindness," explained Dr Muhit.
Key informants3 are local people who volunteer to receive simple training in order to recognize major eye and vision problems in children. These people could be school teachers, Imams, village leaders, NGO and government staff providing services at grassroots level, or an enthusiastic community member. They usually have a social or occupational role which brings them in contact with people on a day-to-day basis.
"Involvement of key informants in the campaign was critical for the success of case-detection and the referral system for childhood cataract," stressed Dr Muhit. "The Key Informant scheme has been the main case-detection method of the BCCC. Over 6,000 blind children have been identified by these volunteers who have been trained by the Child Sight Foundation," he said.