Presenter Gail M Ormsby – CBM Australia; Centre for Eye Research AustraliaNoela Prasad – Centre for Eye Research AustraliaManfred Mörchen – Takeo Eye Hospital, CambodiaTe Serey Bonn – Takeo Eye HospitalNgeth Sarun – Takeo Eye Hospital Evangeline Dunton – Takeo Eye HospitalMyrna Porto – Takeo Eye HospitalNatalie Maggay – CBM Viet Nam Nguyen Hong Nga – CBM Viet Nam Nguyen Ngoc Anh – CBM Viet NamJill Keeffe – Centre for Eye Research Australia

Symposium – The World Report on Disability: Implications for Asia and the PacificUniversity of Sydney, 5-6 December, 2011

Establishing an evidence-base for disability inclusion in eye

health programmes

Cambodia and Vietnam

“Disability” inclusive approach tocommunity eye health

• Our experience– Gender– Education– Disability

• As related to eye health knowledge, attitude and practice

• How this informed project implementation

Context: Disability Inclusion

AusAID strategy for disability inclusion - Development for All: Towards a disability inclusive Australian aid program 2009-2014,

– all AusAID funded activities will need to show consideration of disability mainstreaming,

– so disability inclusion training and guidelines were included under AusAID Avoidable Blindness Initiative.

Field research included Rapid Assessment of Avoidable Blindness (RAAB) and surveys of Knowledge, Attitude and Practice (KAP) to

– Provide baseline data on blindness and vision impairment– Provide a picture of the community’s perception of eye healthso that the project responds to needs of the community being served.

Baseline information

Results of RAAB surveyPrevalence of vision impairment in people over 50 years of age• Cambodia (conducted in 2007)

• Vietnam (conducted in 2010)

Region Prevalence of blindness <3/60

Prevalence of severe visual impairment<6/60 – 3/60

Prevalence of moderate visual impairment <6 / 18 – 6/60

Cambodia 2.8 % 17.61 %

Viet Nam 3.1 %

Son La 2010 1.7 % 1.3 % 7.1 %

Thanh Hoa 2011 5.44 % 3.48 % 12.24 %

Baseline information

Areas of focus for KAP surveyKnowledge and attitude of the community regarding their eye

health.Current practices and attitudes regarding uptake of eye care

services.Perception and practices on the inclusion of women, children

and persons with disability in community eye care programmes.

Survey LocationsThanh Hoa and Nghe An Provinces

Bati

Takeo

Kiri Vong

• 600 people surveyed from across 3 districts 200 people per district

• 30 randomly selected villages from across districts 10 villages per district

• 20 people surveyed from each village– 6 or 7 people from each age

group surveyed from each village (At least 1 or 2 people with a disability)

• Random walk to find people – Random lank mark chosen, called

in at consecutive houses until number of participants reached

– If people with disability not in this sample, convenient sampling used where village leader was asked where person with disability lives (was not found necessary)

• 4 cities & districts in each province selected according to the following criteria:

2 districts that will be sites of project implementation,

1 urban area where available eye services are linked to the project,

1 district adjacent to site of project implementation.

• Quota: people from each district75% of the total number of respondents in a province from each project district (94 people per district),15% from urban areas (37 people from each area),10% from adjacent sites (25 per site).

Ensure at least 1 or 2 people with a disability are included at each site.

SamplingCambodia Vietnam

Results

Potential service users surveyed 1130 people over 25 years of age

• 599 from one province in Cambodia• 531 from two adjacent provinces in Vietnam

Men Women

Cambodia 214 385

Vietnam 254 277

Education

Cambodia

DisabilityType Cambodia Vietnam Total

Seeing 110 174 284Hearing 21 19 40Walking 33 100 133Understanding 4 39 43Other 8 15 23TOTAL 176 347 523Vision disability reported in

18% (Cambodia) & 33% (Vietnam)

39% (443/1130) of the surveyed population reported SOME disability.

Multiple disability

Cambodia VietnamTotal

Males Females Males Females

Single disability 61 70 122 133 386Two ‘disabilities’ 8 5 20 11 44Three or more ‘disabilities’ 3 2 4 4 13

12% (18/149) in Cambodia, and 13% (39/294) in Vietnam reported having more than one ‘disability’.

Knowledge: heard about eye conditions

Knowledge: know treatment for cataracts

AttitudeCan a child with Vision Impairment or Seeing Difficulty attend school?

Practice: getting eyes examined

CAMBODIA38% of all respondents (142 of the 370 that responded) and40% of people who reported having a disability (46 of the 116 that responded)

VIETNAM85% of all respondents (354 of the 419 that responded) and84% of people who reported having a disability (210 of the 249 that responded)

said that they ‘went for examination of an eye problem’

Conclusions• Self-reported ‘Disability’ is common among the sampled

population.• Inclusive planning can be achieved even without positive

discrimination towards persons with disability.– through integration into existing eye programmes– at minimal additional cost

• Some people with disability report accessing access eye care services if available.

• But people with disability have less access to eye health information.

• Evaluation at end of the project period will assess outcomes of a disability inclusive approach to community eye heath programme.