Leeds Health Education Database 2015

Database entries with complete fields

13. Eye health and the prevention of blindness,

September 2015

13.1 Promotion of Vitamin A

13.2 Glaucoma

13.3 Trachoma

13.4 Onchocerciasis

13.5 Screening for vision

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13.1 Promotion of Vitamin A

Hussain, A., Aaro, L.E., and Kvale, G. Impact of a health education programme to promote consumption of vitamin A rich foods in Bangladesh. Health Promotion International 12(2):103-109, 1997.  Ref ID : 6026

Hussain, A., Kvale, G., Ali, K., and Bhuyan, A.H. Determinants of night blindness in Bangladesh. International Journal of Epidemiology 22(6):1119-1126, 1993.  Ref ID : 769

Target Group/Country Promotion of green leafy vegetables in rural Northern Bangladesh.

Intervention Methodology 13 different media and communication methods grouped for analysis into two channels: Channel 1 face-to-face using women volunteers, project workers, health workers and rural leaders and Channel 2 using one way communication through schools, folk media, village movie shows and cinema slides.

Evaluation Method Cross-sectional surveys assessing prevalence of night-blindness and dietary habits prior to intervention in 1986 (2015 households, 11 600 pop. , after 3 years of intervention  (2015 households, 10 456, and 3 years after the termination of active intervention  (2101 households). A control was not used but the data in the post-intervention sample was analysed to determine the association between reported exposure to health education and consumption of green leafy vegetables.

Impact Achieved The prevalence of night-blindness per thousand children decreased from 1986 (50.7 households with night blind children /1000 households to 26.9 in 1989 after intervention and rose to 40 in 1992 still significantly lower than the 1986 prevalence. The reported consumption of green leafy vegetables was higher among households who said that they had been exposed to interpersonal or group communication.The drop in night-blindness in the three years following the intervention was accompanied by drop in consumption of vitamin A containing foods indicating the importance of continuation of health education.

Pant, C.R., Pokharel, G.P., Curtale, F., Pokhrel, R.P., Gross, R.N., Lepkowski, J., Muhilal, Bannister, M., Gorstein, J., Pak-Gorstein, S., Atmarita and Tilda, R.L. (1996) Impact of nutrition education and mega-dose vitamin A supplementation on the health of children in Nepal. Bull. World Health Organ. 74, 533-545. Ref ID 7272

Target Group/Country Rural communities in Nepal

Intervention Methodology Intervention groups received either nutrition education  from village health workers or Vitamin A supplementation. No details are given of the nutrition education except that it involved village health workers and community volunteers

Evaluation Method Approximately 40000 children from 75 locations in 7 districts in 2 ecological settings (lowland and hills) were randomly allocated to a control group receiving examination only, an intervention group receiving Vitamin A supplementation and an intervention group receiving nutrition education. Data was collected by questionnaire and clinical examination at baseline and after 12 and 24 month.

Impact Achieved Both nutrition education and supplementation resulted in reduced prevalence of Bitot spots After two years the reduction was greater among children whose mothers were able to identify vitamin-A-rich foods (relative risk (RR) 0.25; 95% confidence interval (CI) 0.10-0.62) than among children who received supplements (RR 0.59; 95% CI 0.41-0.84). The nutrition education programme was, however, more expensive to deliver than the supplement distribution programme.

Phillips, M., Sanghvi, T., Suarez, R., McKigney, J., and Fiedler, J.  (1996) The costs and effectiveness of three vitamin A interventions in Guatemala. Social Science and Medicine 42(12):1661-1668. Ref ID : 6083 (Borderline for inclusion in database)

Target Group/Country Rural communities in Guatemala

Intervention Methodology Seeds, nutrition education and agronomic technical assistance are provided to participants mostly families, schools and communities who themselves provide the land, labour, water, fertilizer and pesticides.

Evaluation Method Review of unpublished evaluation which does not give the raw data from the original evaluation.  Random sample of 300 households exposed to the intervention and 300 as controls

Impact Achieved 87% of households receiving inputs established gardens and the number of days on which food sources of Vitamin A were consumed in the project area was higher than in the non-project area (p<0.01, but no raw data provided). Economic analysis of secondary sources lead authors to conclude that except when vitamin A deficiency is localised to specific areas, food fortification is a more cost-effective approach than either capsule distribution or nutrition education.

Rahman, M.M., Islam, M.A., Mahalanabis, D., Chowdhury, S., and Biswas, E. Impact of health education on the feeding of green leafy vegetables at home to children of the urban poor mothers of Bangladesh. Public Health 108(3):211-218, 1994. Ref ID : 2119

Target Group/Country Urban poor mothers in Bangladesh

Intervention Methodology Health education within hospital setting and on home visit and a feeding demonstration and sample of cooked green leafy vegetables (GLV) given to their children. The mothers of the first intervention group (n = 44) were given health education including a feeding demonstration, by offering a single meal of cooked GLV to their children.

Evaluation Method The mothers in the second intervention group (n = 36) received health education.160 mothers of children  6-35 months. 1st group (n=44) received health education and feeding demonstration, 2nd group (n=36) received health education only. Controls (n=80) were mothers from immediate neighbourhood with child of same age range. A baseline interview was carried out (details not provided) and mothers were visited at home after 8 weeks of intervention without prior notice and observation/interviews used to explore perceptions of GLV and find out if children had been fed GLV that day.

Impact Achieved The percentages of mothers who fed their children GLV were 57%, 64%, and 26% in groups 1, 2, and comparison group respectively (p < 0.001) but no baseline data provided. The influence of health education on GLV feeding persisted after controlling for the effect of maternal literacy (Mantel Haenszel chi-square = 16.99; P<0.0001).

Yusuf, H.K.M. and Islam, N.M. (1994) Improvement of nightblindness situation in children through simple nutrition education intervention with the parents. Ecology of Food and Nutrition 31, 247-256. .Ref ID : 6560

Target Group/Country Parents of children <6 years old in a coastal area of Bangladesh.

Intervention Methodology An 18 month health education intervention using group meetings in schools, mosques and community settings supplemented with posters, leaflets and a calendar. Announcements were given on market days that free treatment would be given to children with night blindness.

Design of intervention Baseline survey and follow-up survey measured food production,. consumption and night blindness in children of 830 families 18 months after the intervention. There were no controls.

Impact Achieved Knowledge of presence of vitamin in vegetables increased from from 61.4  to 88% (p<0.005%) and of benefits of vitamin A capsules from 7% to 83%. Vegetable consumption by children increased from 15.1 g/day to 46.4g/day (p<0.001). The prevalence of night blindness amongst children <6 years old decreased from 4.1 to 0.47% (p<0.005%)


13.2 Glaucoma

Cintra,F.A., Costa,V.P., Tonussi,J.A.G. and José,N.K. (1998)  Avaliaçäo de programa educativo para portadores de glaucoma [Evaluation of an educational program for patients with glaucoma].  Revista Saúde Pública  32, 495-501. Reference ID: 8688

Target Group/Country: Patients at the Glaucoma service of the University of Campinas, Brazil: Educational methods:

Intervention Methodology Fifty glaucoma patients were given information about the disease and its treatment by an experienced nurse

Evaluation Method: They were given the same questionnaire before and 2.7 months after the initial explanation. The technique of eyedrop instillation was compared before and after the educational program. There were no controls.

Impact There was no significant improvement concerning the knowledge of the identification of the ocular disease, the side effects, the meaning of glaucoma, the importance of treatment, the purpose of medications and the normal value of intraocular pressure. There was a significant improvement in all steps of eyedrop instillation (p<0.01) and in knowledge regarding the importance of heredity (p <0.001) and the purpose of perimetry (p=0. 033). Although a significant improvement was observed in the technique of eyedrop instillation, the authors conclude that this plan was not complete enough for its contents fully to be understood. It also highlighted the difficult nature of the information to be communicated and the complexity of control/treatment of glaucoma.


13.3 Trachoma

Face-washing and prevention of trachoma

De Sole, G. and Martel, E. Test of the prevention of blindness health education programme for Ethiopian primary schools. International Ophthalmology 11(4):255-259, 1988. Ref ID 1465

Target Group/Country Primary school children in the rural town of Metahara, Ethiopia.

Intervention Methodology The health education programme consisted of a multiple choice followed by corrections, explanations and discussions. The students were given the assignment of writing a story and drawing pictures about a family where one does everything wrong and some of its members become blind; the other does everything right and all of its members have healthy eyes.

Evaluation Method Written test with nine multiple choice questions scored as one point per correct answer given to 239 children . A baseline test given and repeated one month later.. Students were given eye examinations before the programme and one year later. There were no controls.

Impact Achieved Student’s  knowledge improved from a mean score of 4.3/9 to 6.2/9 (p <0.005). The prevalence of moderate and severe Trachoma decreased from 12.1% to 3.3% (p <0.001) in one year, and the prevalence of conjunctivitis from 7.5% to 0.4% (p<0.001). Schoolchildren with dirty faces decreased from 88 out of 239 at the start of the programme to 4  out of 214 six months later.

Lynch, M., West, S.K., Munoz, B., Kayongoya, A., Taylor, H.R., and Mmbaga, B.B. Testing a participatory strategy to change hygiene behaviour: face washing in central Tanzania. Transactions of the Royal Society of Tropical Medicine & Hygiene 88(5):513-517, 1994. Ref ID : 3076

Target Group/Country Parents washing faces of pre-school children in Central Tanzania.

Intervention Methodology A participatory strategy using non-formal adult education techniques such as drama at neighbourhood level meetings to build a community consensus to keep children's faces clean for the prevention of eye disease. Men, women, schoolchildren, traditional leaders, traditional healers and village social groups participated in the intervention and locally recruited facilitators were selected and trained. (Note: an excellent description of participatory methodology used)

Evaluation Method Changes observed in numbers of clean faces using both visual markers (nasal discharge, food on face, flies on face and ‘sleep’) and fluorescent marker applied to the forehead of 264 pre-school children . Observations were made at baseline, 4, 6 and 12 months after start of the strategy. There were no controls.

Impact Achieved Clean faces increased from 4% to 27% over the course of a year (no significant tests reported). Children with no flies on their face increased from 12% to 63%. Factors which were associated with children's clean faces included low (less than 2hr round trip) distance to water, age of the child above 3 years, and presence of a corrugated metal roof. Note that this was a very intensive strategy involving daily visits by the trained facilitators. Set against this heavy investment in resources was the observation that the participatory approach led to the community addressing another priority of setting up a village drug store (details not provided). Lack of controls, significance testing for the increase in facewashing and the resource intensive nature of the programme limit the value of this study.

Resnikoff,S., Peyramaure,F., Bagayogo,C.O. and Huguet,P. (1995) Health education and antibiotic therapy in trachoma control. Revue internationale du Trachome et Patholgie oculaire subtropical et de Sante Publique 72, 101-110. Ref ID: 8569

Target Group/Country Rural population of four villages in District of Oulessebougou in Mali

Intervention Methodology The health education programme consisted of 'repeated information' concerning personal and family hygiene, including household sanitation. The information also covered trachoma and its complications as well as elements of primary eye care. It was carried out for one week a month over a period of six months. The health education was 'based on community participation' amd directed particularly towards school children and women by involvement of teachers, health workers and village leaders and was supported by posers and booklets. Minimal information is provided on the health education methods used.

Evaluation Method Four villages, matched for size and epidemiological, economic and social conditions, were included in the study. The first village received mass treatment with 1% oxytetracycline eye drops combined with a specific health education programme. The second village received only a health education programme. The third village received only mass treatment and the fourth village did not receive any intervention during the study (control village). 1810 subjects were enrolled of whom 76% were successfully followed for 6 months.

Impact Achieved The best results were obtained in the village where antibiotic treatment was used alone, both in terms of cure rate (82%) and reduction of C trachomatis transmission. The combination of a health education programme with mass treatment failed to increase the cure rate over and above that of the mass treatment. There was even a negative interaction (P = 0.03). Incidence of trachoma was significantly reduced in the village receiving health education (p<0.05) but the effect was less than that achieved in the village receiving mass treatment. The combination of health education and mass treatment did not have a greater impact than that of mass treatment alone. These results suggest that the addition of a health education programme does not systematically improve the performances of a mass treatment campaign. The authors advance a range of explanations for the disappointing lack of effect of health education; a differential response to health education in the different villages, an unidentified confounding variable or a tendency of communities to take behaviour change less seriously when treatments are available. However, a serious problem with this study is the lack of any information on the quality of implementation of the health education, the community response to the health education especially behaviour change.

(Borderline)West, S., Munoz, B., Lynch, M., Kayongoya, A., Chilangwa, Z., Mmbaga, B.B. and Taylor, H.R. (1995) Impact of face-washing on trachoma in Kongwa, Tanzania. Lancet 345, 155-158. Ref ID : 4307

Target Group/Country Parents and children in Kongwa, Tanzania

Intervention Methodology Community-based participatory approach to face-washing intervention

Evaluation Method A community-based randomised trial in three pairs of . Six villages in Kongwa, Tanzania, were randomly assigned mass treatment plus the face-washing programme or treatment only. 1417 children aged 1-7 years in these villages were randomly selected and followed up for trachoma status and observations of facial cleanliness at baseline and 2, 6, and 12 months

Impact Achieved At 12 months, children in the intervention villages were 60% more likely to have had clean faces at two or more follow-up visits than children in the control villages. The odds of having severe trachoma in the intervention villages were 0.62 (95% Cl 0.40-0.97) compared with control villages. However the intervention was only effective in improving facial cleanliness in two of the three villages. The study supports the view that without health education, children receiving treatment for trachoma will become re-infected. However concern is raised for the labour-intensive nature of the participatory methods used.

Sutter, E.E. and Ballard, R.C. Community participation in the control of trachoma in Gazankulu. Social Science & Medicine 17(22):1813-1817, 1983.Ref ID : 7546

Target Group/Country Rural community in Gazankulu, South Africa

Intervention Methodology Participatory community based approach using care groups and volunteers providing education and support to their members and others in the community (programme carried out between 1976 and 1979).

Evaluation Method Survey of practices three years after programme comparing - three groups households with care group members (n=78), non-care group households from same community (n=92) and control households in settlements with no care groups (n=70). Pre-and post-intervention survey of trachoma survey.

Impact Achieved Significant increase in acquisition of refuse pits (p<0.01) and face cloths (p<0.001) between care group and control but no significant difference in pit latrine construction. Prevalence of trachoma among pre-school children in the care group declined from 39% to 15% compared to a static level of 46% to 44% but significance data not provided.


13.4 Onchocerciasis

Brieger,W.R., Ramakrishna,J., Adeniyi,J.D. and Kale,O.O. (1988)  Health education interventions to control onchocerciasis in the context of primary health care. In: Carlaw,R. and Ward,B., (Eds.)  Primary health care: the African experience, pp. 341-371.  Oakland, California:  Third Party Publishing Company Ref ID: 8658

Target Group/Country Rural communities in South West Nigeria

Intervention Methodology A base line survey was carried out in 1981 on local beliefs and the resulting intervention was developed  based on principles of health belief synthesis, community organisation, primary health care worker training and resource linkage. 70 Village Health Workers (55 from villages and 15 from towns) selected from 18 hamlets in Idere, Nigeria and provided 12 two-hour lessons on onchocerciasis. The methods used included stories, proverbs and practical demonstration sessions looking at microfilariae in their own skin snip and a booklet consisting of pictures

Evaluation Method Initial baseline survey of 187 villagers (details of data collection not provided). The training was evaluated though an end of course test of knowledge of prevention and treatment of Onchocerciasis (25 VHWs). There was also a nine month follow-up test of trainees and of 223 villagers in communities served by the village health workers (1984).

Impact Achieved The average score on the end of course test was 64.7% (the pass mark was 40). Knowledge declined over the nine-month follow-up. Residents in the villages surveyed had only slight increases in knowledge from the baseline study and 60% of the residents said that while their PHW had given a talk on his return, these were not sustained. There was an increase in the number of villagers who could identify tablets as a form of treatment (1.6% to 19.3%) showing the bias of the PHW to concentrate on the treatment aspect of their job. Significance tests were not presented. Sampling data on the base-line data/follow-up not provided and % only - not raw data - provided )

Oladepo, O., Okunade, A., Brieger, W.R., Oshiname, F.O. and Ajuwon, A.J. (1996) Outcome of two patient education methods on recruitment and compliance with ivermectin in the treatment of onchocerciasis. Patient Education and Counseling 29, 237-245.  Ref ID : 7278

Target Group/Country Rural communities in South West Nigeria

Intervention Methodology The programme explored the use of two educational approaches in supporting passive ivermectin distribution from primary health care clinics. Information Media (IM) approach used posters, hand megaphones at markets, meeting places and mosques/churches and town criers and Social Network (SN) approach worked through existing organizations including churches, farmers associations and cooperatives.Evaluation MethodTwo communities each were randomly assigned to the IM intervention group (n=679), 2 to the SN group (n=505) , and 2 served as controls (n=81). Data was collected on persons presenting themselves to the clinics for ivermectin after the interventions and for follow-up six months later.

Impact Achieved The percentages of eligible persons presenting for ivermectin after initial education were SN group 30.3% (n=679), IM group 29.9% (n=679) and control 7.3%(n=88) but the differences between intervention groups were not significant. The drop-off in attendance at the 2nd round of ivermectin distribution. From the original attenders was 43.3% n=219 for SN and 47.4% n=322 for IM), while few control patients came back for their 2nd dose (12.3%).

Richards, F.O., Jr., Klein, R.E., Gonzales Peralta, C., Zea Flores, R., Gongora Roman, S., Castro Ramirez, J. and Zea Flores, G. (1995) Knowledge, attitudes and practices during a community-level ivermectin distribution campaign in Guatemala. Health Policy and Planning 10, 404-414.Ref ID: 6620

Target Group/Country Ivermectin distribution in four communities in Guatemala consisting mainly of Mayan Indians.

Intervention Methodology Health workers presented three basic messages to administrators/local leaders and then directly to communities during surveys and while they were gathered together to receive examinations and then when receiving ivermectin at clinics. Also health workers carried out health education using poster-sized diagrams at women’s sewing groups, men’s football teams and village health committees.

Evaluation Method Questionnaire surveys using closed and open-ended questions were given to more than 100 male and female heads of households in four communities (about 30% in each community and 340 interviews in total) after each of three ivermectin treatment rounds. (There was no baseline or control)

Impact Achieved After 3rd round only 33% could name ivermectin, 67% correctly stated that it should be taken twice a year and 46% incorrectly thought that they would still require noduleectomies. Overall 74% of the respondents said that they had taken ivermectin when last offered. In one community over 50% of residents initially refused to take ivermectin Qualitative data showed that respondents did not realise that goal of ivermectin treatment programs was to prevent visual loss. There was confusion about the life cycle and the relationship of microfilaria and filaria.. The principal reason identified for refusal to take ivermectin was anxiety about drug-related adverse reactions

Shu,E.N., Okonkwo,P.O. and Onwujekwe,E.O. (1999)  Health education to school children in Okpatu, Nigeria: impact on onchocerciasis-related knowledge.  Public Health  113, 215-218. Ref ID: 8644

Target Group/Country Pupils aged between 11 and 17 years in a school in Okpatu, Nigeria

Intervention Methodology The pupils received health education in both English and Igbo (local language) for two 45 minute sessions per week for three months on the transmission, clinical manifestations, treatment and prevention of onchocerciasis. The education was given in English by the project investigators with teachers translating into local language. Local language expressions were used for nodules, leopard skin symptom and blindness. Illustrated pictorial materials were used to support and enhance their understanding of the subject matter.

Evaluation Method The level of knowledge of 300 children was evaluated at the beginning of the programme and nine months later using a pre-tested personal interview administered questionnaire. Details of the questions are not provided.  A control school was not used

Impact Achieved A significantly higher proportion of these children knew about onchocerciasis (chi2=260.4, df=1, P<0.0001), and its causative agent (chi2=175.0, df=4, P<0.0001), clinical manifestations (chi2=254.0, df=5, P<0.0001), diagnosis (chi2=123.9, df=2, P<0.0001), treatment (chi2=197.8, df=3, P<0.0001) and prevention (chi2=220.8, df=3, P<0.0001) in the post than in the pre-educational intervention. It is concluded that school-based health education showed an increase in knowledge about onchocerciasis


13.5 Screening for vision

Ajuwon, A.J., Oladepo, O.O., Sati, B. and Otoide, P. (1997) Improving primary school teachers' ability to promote visual health in Ibadan, Nigeria. International Quarterly of Community Health Education 16, 219-227. Ref ID 6860

Target Group/Country A pilot project conducted in a poor community in Ibadan, Nigeria

Intervention Methodology Teachers were provided a 15-hour in-service training course. The objectives of the training were to list correctly the major structures and functions of the eye, demonstrate the steps for assessing visual acuity, record correctly the results of visual assessments, and identify pupils in need of referral.

Evaluation Method Questionnaire given to 19 teachers from 10 schools before and immediately after training and follow-up visit made to schools six months later to repeat the test and examine the teacher’s records. A control of ten schools were visited at the same time as six month follow-up

Impact Achieved 6 month follow-up survey indicated that 322 children had been screened, 42 of whom had confirmed visual acuity problems which were discussed with parents (46% of whom had then taken children to the clinic) No children had been screened in control schools. Teachers modified the classroom seating arrangements of these children.

Murthy, G.V., Verma, L., and Ahuja, S. Evaluation of an innovative school eye health educational mode. Indian Pediatr. 31:553-557, 1994. Ref ID : 4355

Target Group/Country Middle schools in Faridabad, Hayana

Intervention Methodology 8 pupils were given intensive training on eye health  including vitamin A , trachoma, injuries (e.g. from ball games, bows and arrows and fireworks) and refractive errors. Teachers were also briefed and materials provided. One week later each of the 'child health educators' spoke to the rest of their school for 3 minutes on a topic. At the end of the session doctors summarised points.

Evaluation Method 50 randomly selected children (mean age 10.7 years) from classes V to VI were given a pre-and post educational session questionnaire. (no controls).

Impact Achieved Overall eye health knowledge score on responses to all questions increased from 2.32 to 4.2 - max score 10 -  (p < 0.001. Nos. of children who could identify more than one vitamin A source increased from 22%(11/50) to 64% (32/50), children knowing any symptoms of trachoma increased from 16% to 30%. Knowledge of the risk to eye injuries of bow and arrow games increased from 30%(15/50) to 40%(20)


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