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   Table of Contents      
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 1-5

Management plan for childhood visual impairment in traditional quranic boarding schools in Al-Gazira State of Sudan


1 Binocular Vision, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan
2 Contact Lens, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan; Department of Optometry, College of Applied Medical Sciences, Jeddah University, Saudi Arabia
3 Binocular Vision, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan; Department of Optometry, College of Applied Medical Sciences, Qassim University, Saudi Arabia

Date of Submission02-Sep-2018
Date of Acceptance14-Apr-2020
Date of Web Publication11-Jul-2020

Correspondence Address:
Dr. Zoelfigar Dafalla Mohamed
Department of Pediatric Optometry, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum
Sudan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bijo.bijo_8_18

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  Abstract 


Background: Childhood blindness and visual impairment (VI) in poor nations is a public health concern. It has a serious effect on the education and social, the VI could lead to poverty, in spite of that most causes childhood VI could be treated when early diagnosed.
Objective: This study aimed to recommend a management plan to prevent childhood VI for Quranic boarding schools in Al-Gazira state.
Materials and Methods: The study focused first on direct action taken on cases of VI among the children. Second, the study created a management plan for childhood blindness and VI in Quranic boarding school children in Al-Gazira state of Sudan. The Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis is used to help in evaluate and reinforce this plan.
Results: The finding depends on a study conducted in 2017 to detect the prevalence and causes of childhood blindness and VI in Quranic boarding school children in Al-Gazira state of Sudan, and the action has taken for children after full eye examinations and diagnosis. The main action took to prevent VI was a correction of refractive errors, which was 42%, followed by 18% of children referred to specialized hospitals to operation because of cataract, corneal opacity, and glaucoma for follow-up. The study recommended a management plan for this community, and it targeted the avoidable cause of childhood blindness in the Quranic schools. The management plan designed in four levels as follows: a pre-primary level, which depends on trained Quranic teachers, then primary level, this level designed for actions or interventions should be taken to prevent the onset of the disorders. The secondary level planned to combat the progression of visual disorders due to an existing disease or refractive errors, finally, tertiary level for complicated eye disorder and follow-up.
Conclusion: Regular checkup and good primary, secondary, and tertiary eye care and personnel trained in primary eye care are important for the management of avoidable causes of blindness and VI in traditional Quranic boarding schools in Al-Gazira state of Sudan.

Keywords: Avoidable causes, blindness, management plan, visual impairment


How to cite this article:
Mohamed ZD, Abdu M, Alrasheed SH. Management plan for childhood visual impairment in traditional quranic boarding schools in Al-Gazira State of Sudan. Albasar Int J Ophthalmol 2018;5:1-5

How to cite this URL:
Mohamed ZD, Abdu M, Alrasheed SH. Management plan for childhood visual impairment in traditional quranic boarding schools in Al-Gazira State of Sudan. Albasar Int J Ophthalmol [serial online] 2018 [cited 2022 Aug 14];5:1-5. Available from: https://www.bijojournal.org/text.asp?2018/5/1/1/289597




  Introduction Top


Current data estimated that about 19 million children worldwide have visual impairment (VI).[1] The VI has a significant effect on children's lifestyle.[2] The estimated prevalence of childhood VI according to a recent study conducted by Mohamed et al. in the Quranic boarding school children in Al-Gazira state of Sudan was 1.5%, which is slightly higher than global estimation.[3]

The major causes of childhood VI are varied regionally, being largely affected by socioeconomic development and the primary eye care delivery as well as eye care services delivering.[4] A study conducted by Pascolini and Mariotti (2012) indicates that VI is a major health issue that is unequally distributed among the WHO regions; the preventable causes are as high as 80% of the total global burden.[5] In Nepal, the most common cause of blindness was amblyopia, followed by congenital cataract, and corneal opacity was the most common cause of unilateral blindness.[6]

A study conducted in Nallasamy et al., Botswana, indicates that uncorrected refractive error was a major cause of childhood VI, which is easily correctable with glasses, followed by cataracts.[7] Alrasheed et al. (2016) reported that uncorrected refractive error was the leading cause of childhood VI in the South Darfur State of Sudan.[8]

The control and prevention of childhood blindness and VI in poor countries are one of the key components of major global prevention of avoidable blindness initiative. Vision 2020 (the right to sight) strategies need to be region specific, based on activities to prevent blindness in the community through measles immunization, health education, and control of Vitamin A deficiency and the provision of tertiary-level eye care facilities for conditions that require specialist management.[4] Early detection of affected children at the household and community level is critical in reducing the global burden of VI and childhood blindness.[9]

Mohamed et al. indicated that the most causes of childhood VI in traditional Quranic boarding schools in Al-Gezira state of Sudan were avoidable. Uncorrected refractive errors were a major cause of VI among children, followed by Vitamin A deficiency.[3] Thus, this study aimed to recommend a comprehensive child eye care plan focusing on the reduction of uncorrected refractive errors through cooperation between key stakeholders and government.


  Materials and Methods Top


Study design

The study focused first on direct action taken on cases of VI among the children according to treatable conditions which were mentioned in a recent study conducted by Mohamed et al.[3] Second, the study aimed to recommend a management plan for childhood blindness and VI in traditional Quranic boarding primary school children in Al-Gazira state of Sudan.

Study population

A total of 99 children who were affected among a sample of 822 children mentioned in a recent study conducted by Mohamed et al. in the boarding Quranic schools (Maseeds) were treated according to causes.[3]

The clinical management

The mechanism of this study depended on direct action took for visually impaired children to manage the avoidable causes, which found in a study designed in Quranic boarding schools in Al-Gazira state[3] and recommended of a management plan for this community.

Strengths, Weaknesses, Opportunities, and Threats analysis

The Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis is a planning tool used to understand the SWOT involved in a project.[10] The practitioners use this analysis to assess an organization's SWOT.[11] The analysis is coming as follows;

  • (S) Strengths: Positive attributes inside the Quranic schools
  • (W) Weakness: Negative factors within the Quranic schools
  • (O) Opportunities: External attractive factors
  • (T) Threats: External negative factors.


In the current study, we used SWOT analysis to assess our management plan according to their SWOT involved in implementation of this plan.


  Results Top


Direct treatment of affected children

The action took for children after full eye examinations according to the diagnosis of ocular conditions. The uncorrected refractive errors represented major of causes of childhood VI in this community for that 41 (42%) of children corrected with eyeglasses. According to an investigation, about 18 (18%) of children were referred to specialized eye hospitals to the operation because of cataract, corneal opacity, and glaucoma for follow-up [Figure 1].
Figure 1: The figure explained what the Action took for affected children in this study

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Childhood management plan

Results denote an imperious need for developing a comprehensive childhood eye care plan for accessing eye care services for Quranic boarding schools. There should be coordination between governmental, private sectors, stakeholders, and nongovernmental organizations working in preventing avoidable childhood VI and blindness. On the other hand, Vitamin A periodic supplementation and improvement of diet regimen were very important to avoid the progression of corneal blindness due to Vitamin A deficiency. Because of the importance of this problem, major global initiatives taken for prevention of blindness are:

  • Global program for prevention of blindness
  • Vision 2020: The right to sight
  • Vision for the future.


International organizations and national health programs should address all preventable causes of childhood blindness through primary prevention. They include universal immunization against measles and rubella and preventing and treating Vitamin A deficiencies.[12]

Objectives

  • To provide correction for children with refractive errors in Quranic boarding schools
  • To reduce corneal scarring and visual loss from Vitamin A deficiency, measles, infections, and eye injuries
  • To provide services to treat children with cataract, glaucoma, retinopathy of prematurity, and corneal ulcer or scarring
  • To provide services for children with low vision.


Strategies for management

  • Accurate statistical procedure in the number of Quranic boarding schools and the number of children annually
  • Providing comprehensive services for children [Figure 2] at all levels of care which are:
Figure 2: Management plan in traditional Quranic boarding school children

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Preprimary level

Before admission, the student should go through full eye examinations including visual acuity and general observation of the eye symptoms. In this level, the optometrist distributed to train Quranic teachers to do these tests [Table 1].
Table 1: Management plan in Quranic boarding schools

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Quranic schools' general screening

During the reporting period, schoolteachers and mobile teams initially screened all Quranic school children in Al-Gazira state. The mobile teams consist of trained ophthalmologists, optometrists, and ophthalmic assistants.

Quranic teacher training

This training should be collaborating between the Ministry of Education and the Ministry of Health in Al-Gazira state of Sudan. The teachers will train to assess the visual acuity and to know the common sing and symptoms of refractive error and eye diseases, and the training session should be in 7 days.

Teachers of Quranic boarding schools in Al-Gazira state should be trained to check visual acuity and outer eye changes. The students took instruction about the care of their eyes and nutrition through direct advising or general lecture.

Primary level

Increase awareness in the Quranic Schools of Al-Gazira state and encourage primary health care, including specific preventive measures at the primary level, through primary eye care, including:

  • Increases the awareness of students and teachers about infectious diseases such as measles, injuries, Vitamin A supplementation, nutrition culture, food supplementation, and fortification of commonly eaten foods with Vitamin A, to avoid corneal opacities
  • If there was any defect or abnormalities seen by the teachers, they must refer a child to a near primary eye care practitioner
  • Actions or interventions must be taken to prevent the onset of the disorder
  • At this level must be available one ophthalmic assistant.


Secondary Level

  • Actions were taken to combat complications and/or the progression of visual anomalies due to an existing disease or refractive errors in eye hospitals. In this level strengthen diagnosis and management of less complex cases
  • At this level must be an available optometrist and ophthalmic nurse.


Tertiary level

  • Aftercare after the immediate problem has been resolved by intervention or other treatment procedures to restore function or reduce existing disability from disease complications and follow-up to improve the prognosis of the child
  • Provide specialist training and services for the management of surgically remediable visual loss from cataract, congenital glaucoma, and corneal scarring, including long-term follow-up.


Strengths, Weaknesses, Opportunities, and Threats analysis for management plan

The analysis showed high positive Strengthening factors internally and good opportunities to achieve this plan, as shown in [Table 2].
Table 2: Strengths, Weaknesses, Opportunities, and Threats analysis for management plan

Click here to view



  Discussion Top


Early detection of affected children at the community level is important in reducing the global burden of VI and childhood blindness[9] which is the same as a recommendation of Mohamed et al. about the needs of urgent a comprehensive childhood eye care plan to deliver eye care services for the community of Quranic boarding schools in Al-Gazira state of Sudan, through cooperation between governmental, community stakeholders, and nongovernmental organization working in the prevention of childhood blindness.[3] Regular and good primary health care and personnel trained in primary eye care are important for the control of VI in Quranic boarding schools in Al-Gazira state of Sudan to prevent the children from permanent disability because most of the conditions in this region are treatable. The Quranic schools have a shortage of health regimen (diet, health care, and latrines). The lack of baseline data on the magnitude of health problems among Quranic boarding schools' students is considered one of the factors of the unsatisfactory status of children health in Sudan.

Periodic vision screening during the school years is important for school-aged children because refractive errors and other visual disorders may emerge for the first time throughout these years;[14] therefore, the authors suggested annual vision screening before starting of this management plan to discover the visual disorders, and action should be taken directly.

The suggested management plan was designed for four levels matching with needs in this community. This management plan was the same as a prevention strategy in the Ministry of Health in Khartoum state which was conducted in 2016 depending on the training of schoolteachers,[13] but was different compared to the prevention of blindness in South Africa in the fourth levels.[15]

The SWOT analysis showed critical strength because the children live in the same positions that help on accessibility to deliver the services, also the urgent need of children to eye care due to the spreading of avoidable VI causes. The biggest weakness concentrates in the restriction of children and the lack of children's record,[3] but the opportunities focus in the availability of governmental and nongovernmental organization which is work in the prevention of blindness and VI in Sudan and there was same program achieved before in Khartoum state in the country.[13] The major threat is weak of governmental supervision over the traditional Quranic boarding schools in Sudan.

The health-care provider is different from level to level in the management plan. The optometrists and ophthalmologists should be available in the secondary and tertiary level same as South Africa strategy for prevention.[15]


  Conclusion Top


The plan was designed in four levels of management, which were preprimary, primary, secondary, and tertiary. Each level contained procedures and required special practitioners to combat avoidable causes of blindness and VI separately. The children's age is critical because of eye development and learning. Early intervention helps to avoid permanent impairment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012;96:614–8. doi: 10.1136/bjophthalmol-2011-300539.  Back to cited text no. 1
    
2.
Solebo AL, Rahi J. Epidemiology, aetiology and management of visual impairment in children. Arch Dis Child 2014;99:375-9.  Back to cited text no. 2
    
3.
Mohamed ZD, Binnawi KH, Abdu M. Prevalence and causes of childhood blindness and visual impairment in Quranic Boarding Schools in Al-Gazira state of Sudan. Sudanese J Ophthalmol 2017;9:44-9. Available from: http://www.sjopthal.net/text.asp?2017/9/2/44/226143. [Last accessed on 2018 Feb 28].  Back to cited text no. 3
    
4.
Gilbert C, Foster A. Childhood blindness in the context of vision 2020-the right to sight. Bull World Health Organ 2001;79:227-32.  Back to cited text no. 4
    
5.
Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012;96:614-8.  Back to cited text no. 5
    
6.
Adhikari S, Shrestha MK, Adhikari K, Maharjan N, & Shrestha UD Causes of visual impairment and blindness in children in three ecological regions of Nepal: Nepal pediatric ocular diseases study. Clin Ophthalmol 2015;9:1543-7.  Back to cited text no. 6
    
7.
Nallasmy S, Anninger WV, Quinn GE, Kroener B, Zetola NM & Nkomazana O, Survey of childhood blindness and visual impairment in Botswana. Br J Ophthalmol 2011;95:1365-70.  Back to cited text no. 7
    
8.
Alrasheed HA, Kovin SN, Peter CC. Prevalence of visual impairment and refractive error in school-aged children in South Darfur State of Sudan. Afr Vis Health 2016;75:9.   Back to cited text no. 8
    
9.
Muhit MA, Shahjahan M, Hassan A, Wazed A, Ahmed N. Parental knowledge, attitude and practice related to blindness of children in some selected Upazilla of Bangladesh. Mymensingh Med J 2011;20:671-9.  Back to cited text no. 9
    
10.
Morrison M, SWOT Analysis Made Simple – History, Definition, Tools, Templates and Worksheets; 2016. p. 1.   Back to cited text no. 10
    
11.
Blanyney D W, Strengths, weaknesses, opportunities, and threats. J Oncol Pract 2008;4:53.  Back to cited text no. 11
    
12.
Khandekar R. Visual disabilities in children including childhood blindness. Middle East Afr J Ophthalmol 2008;15:129-34.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Ministry of health-Khartoum state, Overview of school eye health program in Khartoum state; 2015-2016.  Back to cited text no. 13
    
14.
Vitale SC. Prevalence of visual impairment in the United States. JAMA 2006;295:2158-63.  Back to cited text no. 14
    
15.
Ministry of Health, South Africa, National Guidelines of Blindness in South Africa; 2002.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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