Comprehensive school eye health programmes

Child Eye Health course: IAPB General Assembly

Clare Gilbert, ICEH, LSHTM

School eye health programme

School eye programmes often focus on refractive errors alone, are vertical, bypass the education and health system, and are not sustainable

They are rarely monitored or evaluated• ? what difference are they making• ? are they cost effective/a good use of resources? Programmes need to be

• comprehensive• integrated within school health programmes• monitored and evaluated• cost effective

Components of comprehensive school eye health programme

Identify children with significant refractive errors and supply spectacles

1.Education about eye conditions and eye health

2.Primary eye care for children

3.Eye care for teachers (e.g. presbyopia)

4.Health promoting school environment

5.Child-to-Child approach

6.Links to control programmes for local endemic diseases

Education about eye conditions and eye health

Engage with Ministries of Education and Health What is taught depends on local epidemiology:• Keeping their eyes healthy (diet; avoid trauma)• Common conditions affecting their age group• Common conditions affecting younger age group• Common conditions affecting the elderly• Promote positive attitudes towards blindness and how to interact

with someone who is blind

Eye health embedded in school curriculum

Education about eye conditions and eye health

Educational materials for children Manuals for teachers

Primary eye care for children

Primary eye care:- identify and treat /refer simple eye complaints- identify children with locally endemic eye conditions

(e.g. trachoma; vitamin A deficiency) and taking action necessary

- identify and refer children with non-RE causes of visual impairment

Primary eye care for children

Developing curriculum for school nurses: Task analysis – what they should be able to do

after training Drives content of training• knowledge• skills• attitudes Drives what they will need to do the job• medication / supplies• visual acuity charts

Primary eye care for children

Focus on common eye problems affecting children

• allergies• conjunctivitis (viral/bacterial)• styes/chalazions etc• foreign bodies and trauma• refractive errors

Rare but more serious problems• cataract

Primary eye care for children

Supplies of topical medication e.g. tetracycline eye ointment

Supplies of eye pads, eye shield etc Know where the nearest eye unit is Communication with parents Record keeping

Eye care for teachers

Spectacles for uncorrected presbyopia Cup:disc ratio assessment for glaucoma Counsel diabetics to have regular retinal

examination

Health promoting school environment

Physical:• clean• water for face and hand washing• appropriate sanitation for boys and girls• water collection• kitchen gardens...how to grow (and cook) nutritious

foods Attitudinal• disability and inclusion

Developed in 1978 by a paediatrician and health educator Builds on natural care-giving and relationships of children Entails a 6 step process• links learning, using fun activities with action at home and in the

community.• participatory learning involving discussion, action and evaluation

e.g. carrots in Mongolia Programmes in many countries for nutrition; HIV etc but

none for eyecare or ear care. Unpublished pilot studies in India and Nigeria

Peer education is inherently sustainable

Child-to-Child: children as agents of change

Link to programmes for control of locally endemic conditions

Primary schoolvitamin a deficiencymeasles infection

All agesMDA for trachoma

Integration

Work with Ministries of health / education so that• eye health is part of broader school and child health• schools are safe and healthy places• children learn about eye health• school nurses can deliver primary eyecare

Should not be a stand alone, vertical program that only deals with refractive error