When David Bimenyimana, a resident of Musanze District, was in primary school, one of his eyes suffered difficulty. When his parents realised this, they took him to herbalist for treatment, and not a health centre. The eye continued to get complications. Now 20 years old, Bimenyimana, a Senior Six student at G.S Bisate in Musanze, is visually impaired. Bimenyimana is one of the many children who lack access to primary eye care due to lack of parents’ awareness about eye care in health facilities, while doctors specialised in treating eye problems are also scarce. According to Dr John Nkurikiye, an ophthalmologist and associate professor of ophthalmology, many parents take their children to herbalists and in the end, the eyes get perforated due to lack of primary care at health facilities. “When babies are born, their parents do not easily detect that their children have eye complications. Which later becomes difficult to correct because they didn’t get primary eye care at an early stage,” he says.An estimated 19 million children are visually impaired worldwide, of which 12 million are due to an uncorrected refractive error, Nkurikiye says. At least 1.1 million children worldwide are irreversibly blind and up to 60 per cent of children die within a year of going blind. Three-quarters of vision-impaired and blind children live in the poorest regions of Asia and Africa as most lack access to treatment, he says. He says that often, the causes include easily-treatable conditions such as refractive error (near-sightedness, far-sightedness and astigmatism), for which over half of all cases in the world remain undetected and untreated, like congenital cataract and glaucoma. He says that poor vision in childhood may affect performance in school and has a negative influence on the future of the child. WHY EARLY SCREENING IS PARAMOUNT Nkurikiye says that countrywide screening will soon be carried out across all primary schools in Rwanda to detect eye problems among young children. He says this is because refractive error is only priority for many but it is not the most prevalent for people aged 6 to 39. Allergic conjunctivitis, he says, is the most prevalent problem in that age group making close to 28 per cent of them. Allergic conjunctivitis is an eye inflammation caused by an allergic reaction to substances like pollen or mould spores. He says strabismus can lead to amblyopia which can be addressed if caught early. This is abnormal alignment of the eyes as the condition of having a squint. “Keratoconus is a rare condition according to existing literature, but it is the number one cause of blindness in under 20 in my clinic. We can stabilise the condition and avoid cornea transplant which is costly and more difficult to follow up,” Nkurikiye says. Keratoconus is a disorder of the eye which results in progressive thinning of the cornea. This may result in blurry vision, double vision, near-sightedness, astigmatism, and light sensitivity. So far, Nkurikiye says 16 schools were screened in Gasabo District and three schools in Bugesera. “More than 24,000 have been screened so far,” he says. WHAT DO HOSPITALS SAY? Dr Pascal Ngiruwonsanga is the director of Gakoma Hospital located in the small zone with five health centres in Gisagara District. “Every year we receive about 325 patients with eye problems, especially allergic conjunctivitis. Most of them are children aged 15. Those with eye problems such as refractive errors that need reading glasses are aged between 30 and 45,” he says. He says people are still unaware of eye care services. “They are not even aware that health insurance — Mutuelle de Sante — can cover the treatment cost of eye illness. With awareness campaigns, people will massively come for screening at an early stage,” he says. “Even in district hospitals, ophthalmologists are few. However, measures were taken whereby nurses and other medical doctors are also trained on providing the same services. Two nurses at every health centre have been trained to provide primary eye care,” Ngiruwonsanga says. “We urge people to embrace check-up so as to prevent visual impairment,” he says. Dr Rose Baguma, Director General of Education Policy & Planning in the Ministry of Education, says that eye problems affect pupil’s performance and later on the human capital when they finish school. “Visual impairment affects a lot the achievements of our education goals. The synergy comes as a response to implement special needs policy,” she says. Thierry Mungakuzwe, the project manager at Fondazione Leonardo Del Vechio-Rwanda that supports the eye care programme implementation, says that they will carry out eye screening for primary school children and those starting secondary school. “This will be an annual exercise whenever the academic year starts and children who will be found with eye complications will access primary eye care. We want that in the next 10 years, primary eye care will have been scaled up, and visual impairment for children starting school decreased,” he says. 10 YEAR STRATEGIC PLAN The efforts are part of implementing National Strategic Plan for eye health running from 2018 to 2019. Data from the Rwanda Health Management Information System (RHMIS, 2016) showed that in health centres, eye diseases are the forth cause of morbidity with a total of 638,080 consultations. In Rwanda, the major causes of blindness are untreated cataract, glaucoma, age-related macular degeneration, and other posterior segment causes. Data shows that 3473 cataract cases were treated in 2015 and a total of 2973 cataract cases were treated in 2016. During the same period, a total of 629 and 594 of glaucoma cases were treated by surgery in 2015 and 2016respectively. A 2018 study by Health ministry showed that over a third (34.0%) of the population with eye health problems could benefit from Primary Eye Care offered in health centres, and the most common cause was conjunctivitis. Allergic conjunctivitis is one of the leading causes of consultation in health centres and district hospitals (80% of total eye cases) and affects mainly children, while 30% of people aged 40 and above had a need for reading glasses.
