Project Description

Project ID

07BPK002

Project Type

Funded Project - Time-Critical Project

Project Title

Establishment of pediatric Ophthalmology and Strabismus unit in a tertiary hospital in Eastern region of Nepal

Project Summary

According to WHO bulletin 20011, the number of blind children in the world is approximately 1.4 million. Three-quarters of these children live in the poorest regions of Africa and Asia. In Nepal, most of the childhood eye diseases are prevalent in rural part of Nepal due to poverty and lack of knowledge.

Pediatric eye care facility in Nepal is very few and inadequate. Management of eye diseases in children is different from adults in many ways. Eye surgery in children requires general anesthesia facility, which is not available in most of the eye centers in in Nepal. The Pediatric Ophthalmology and Strabismus Unit will be established in the Department of Ophthalmology, in B. P. Koirala Institute of Health Sciences situated in the eastern region of Nepal. The goal of the unit will be to provide better medical and surgical management of many pediatric eye diseases like congenital and developmental cataracts, xerophthalmia, strabismus, traumatic eye injuries, and congenital glaucoma which are common in this part of Nepal.

The establishment of the first Pediatric Ophthalmology and strabismus Unit in Eastern Nepal will help provide better eye care facilities to the children of this region. This will contribute to some extent in achieving WHO s goal of reducing the magnitude of childhood blindness.

This is an extension of project 06PBK001 Pediatric Ophthalmology

Location

B. P. Koirala Institute of Health Sciences
Ghopa, Dharan

Time Frame

One year

Institution

BP Koirala Institute of Health Sciences
Ghopa, Dharan

Contact

Dr. Srijana Adhikari, MD
Assistant Professor
Department Ophthalmology
B. P. Koirala Institute of Health Sciences
Ghopa, Dharan, Nepal

email: srij_a@yahoo.com
Telephone: 977-98-4204-1454

ANMF/Nepal Project Manager

Shankar Rai, MD
ShankarRai@anmf.net

ANMF/America Project Manager

Dr. Sunil Sharma
SunilSharma@anmf.net

Project Description

Background

Childhood blindness in Nepal.

There are about 5.5 million children in Nepal below 15 years of age.3  The Nepal Blindness Survey conducted in 1981 showed, xerophthalmia ocular infection, and cataract to be the leading causes of blindness in children.2  Other ocular conditions that causes visual morbidity in children are, trauma, uncorrected refractive error, and strabismus.

More than 90% of these diseases are either preventable or treatable. These are the major causes of avoidable childhood blindness in Nepal.

Prevention and treatment of childhood blindness is disease specific.

Xeropthalmia is the condition occurring due to vitamin A deficiency in children. For Vitamin A deficiency, at a cost of only 5 US cents a dose, vitamin A supplements reduce child mortality by up to 34% in areas where Vitamin A deficiency is a public health problem.

The causes of Congenital and developmental cataract in children are idiopathic, hereditary, traumatic congenital rubella etc4.Cataract in children differs in many ways from adults . The intra operative technique and the post operative management of childhood cataract is still a challenge in ophthalmologists s community. Timely diagnosis and surgery is very important in these cases to acquire good visual potential.

Other diseases like congenital glaucoma, ocular malignancy like retinoblastoma, and other congenital and developmental eye diseases are common in the children.  One of the most common cause of ocular morbidity in school going children in Nepal is the uncorrected refractive error which cause amblyopia (lazy Eye)5  The most important factor contributing to this burden of childhood blindness in the community is the lack of health care facility and the lack of awareness about these diseases. Most of the children brought to the hospital are already in very late stage.

A brief introduction of institute.

B. P. Koirala Institute of health sciences is a post graduate medical institute located in a city called Dharan in the eastern region of Nepal; about 600 km away from the capital city Kathmandu.. Apart from the College of Medicine and the Allied Health Profession, there are college of Dental Science, College of nursing and school of public health run by the institute. The department of Ophthalmology in the Institute has five ophthalmologists, 10 ophthalmology residents, 2 optometrists, 5 ophthalmic technicians and 5 ophthalmic nurses. working in the department. There are no other subspecialty units in the department.

Pediatric Ophthalmology is the first subspecialty unit in the department.

Project Justification

In Nepal, pediatric Ophthalmology facility is handful even in the urban areas. There is no formal full time running  pediatric ophthalmology and strabismus unit in any eye centres in the Eastern region of Nepal. Surgery in kids require General anesthesia and in- patient care which is lacking in most of the other eye centres in the eastern region of Nepal. Because of this , we get a large number of referral for the surgery from these eye centres. Also, we get the patients referred fom the neighbouring states ( Bihar and West Bengal) of India In the institute, 20-25% of patients attending ophthalmology OPD and 40-45% of in-patients are of the pediatric age group.The most common eye diseses are the
amblyopia of various etiologies, congenital and developmental cataracts, Xerophthalmia, traumatic eye injuries, congenital glaucoma.

The Institue has the Neonatal intensive care unit in the department of pediatric. Pediatric Ophthalmology unit can run the ROP screening program to the babies who meet this
criteria.

Project Detail:

The pediatric ophthalmology and adult strabismus unit will be based in Department of ophthalmology, B. P. Koirala Institute of health Sciences.  Unit will be involved in the following activities:

In the hospital:

  • Diagnosis and management of pediatric eye diseases like amblyopia, xerophthalmia, infectious eye diseases etc
  • Management of childhood ocular malignancies like retinoblastoma.
  • Surgical management of pediatric cataract, childhood and adult strabismus surgeries
  • Surgery for congenital glaucoma surgical management of traumatic eye diseases.
  • ROP screening program.
  • Proper record keeping of the diseases for future research .

In the community: 

  • Periodic school screening programs

Available resources:

Manpower:

  • Pediatric ophthalmologist 1
  • Optometrist 1
  • Ophthalmic technician 1
  • Anesthesiologist 1
  • Anesthesia nurse 1

Equipments:

  • Pediatric vision screening tools
  • Prism bars.
  • Refraction set
  • Slit lamp and indirect ophthalmoscopes

Needed resources:

Diagnostic tools:

  • Loose plastic prisms

Equipments.

  • A scan (biometry) machine
  • Handheld Keratometer

References:

  1. Gilbert C, Foster A. Childhood blindness in the context of VISION 2020--the right to sight. Bull World Health Organ. 2001;79(3):227-32.
  2. Brilliant LB, Pokhrel RP, Grasset NC, et al. Epidemiology of blindness in Nepal. Bull World Health Organ. 1985;63(2):375-86.
  3. Nepal population census 2001. http://www.mope.gov.np/population/chapter1.php visited on 24th July 2006.
  4. Pediatric cataracts, in BCSC section IV Pediatric ophthalmology and Strabismus
  5. B P Nepal, S Koirala, S Adhikary, and A K Sharma  Br J Ophthalmol 2003; 87: 531-534. doi:10.1136/bjo.87.5.531

Material Requested

Diagnostic tools:

Loose plastic prisms

Equipments:

A scan (biometry) machine
Handheld Keratometer

Training Requested

None

Advisors/Instructors Requested

None

Travel/Expenses Requested

None

Grants/Stipends Requested

None

Other Items Requested

None

Total Funds Requested

$4,250

Budget

Name of the equipments Number of item Estimated cost
  Loose plastic prism set 1 $250
  A-Scan biometry machine (Appasamy India) 1 $2,000
  Hand held keratometer 1 $2,000
Total   $4,250

Additional Information

None

Project Status

12/7/07 Request received by ANMF/Nepal
12/14/07 Project approved by ANMF/Nepal
1/20/08 Project approved by Projects Committee
1/20/08 Project approved by ANMF Board for full funding with Dr. Sunil Sharma as Project Manager
1/28/08 Funds transferred to ANMF/Nepal
3/4/08 Memorandum of understanding signed and funds transferred to B. P. Koirala Institute of Health Sciences
     
5/24/08 Update reporting good progress received from BPK project manager
   
   
6/19/08 Update reporting progress to date
12/29/08 Update received - vitrectomy machine installed at B. P. Koirala Institute of Health Sciences
2/26/09 Update received from BPK - surgeries performed with new equipment

 

April 11, 2009 2:59 PM