Reducing vision impairment in children through health system assessment and strengthening approach in Papua New Guinea.

Abstract

ABSTRACT A strong and efficient integrated health system is able to contribute to the reduction of vision impairment among children by ensuring preventive measures are implemented and timely access to care is done in case of morbidity. Children in Papua New Guinea presenting late for congenital cataract surgery, incurring avoidable eye injuries, living with uncorrected refractive error and some presenting with advanced retinoblastoma were of concern to the researcher. The overall aim of the study was to assess how the current health system in Papua New Guinea is addressing child eye health using Port Moresby General Hospital and Goroka hospital as case studies. It is envisaged that a health strengthening approach benefits children’s eye health in the community. Methods Both quantitative and qualitative methods were employed. Retrospective medical records review of children seen at the eye clinic in Port Moresby and Goroka Hospitals from January 2015 to December 2017 was conducted. In the qualitative method service providers and caregivers were interviewed to obtain their perspectives regarding performance of the health system. Results At Port Moresby General Hospital trauma, conjunctivitis and corneal ulcers accounted for 21.6%, 18.9% and 9% respectively of all the diagnoses among children. Trauma was in the ratio of 1:1 (p= 0.264) male to female. And 7.3% (n=51) of the children were blind (according to the WHO definition). Among the blind children optic nerve disorders accounted for 20.5 %( n=14) followed by both un-operated cataracts and uncorrected refractive error each at 13.2% (n=9). Retinoblastoma presented at mean age 5.869 (SD4.5) and 6.02(SD 2.4) years for girls and boys respectively. The main causes of ocular morbidity observed at Goroka Hospital were corneal ulcers (24.9%), uveitis (9.3%) and foreign bodies (9.2%). Service provider interviews revealed lack of policy on child eye health, shortage of health personnel and limited community eye health services. But among care givers lack of eye health information in the community, concerns about long waiting time at the hospitals and inadequate explanation about conditions affecting the children featured prominently. Conclusion Findings show a higher percentage of blind children compared to similar hospital based studies elsewhere. To achieve universal eye health coverage, raising awareness about child eye health needs among leaders in health is urgent. Successes registered in the past in Papua New Guinea in other child health efforts like immunisation suggest that a consistent and focused health system strengthening approach with greater integration may contribute to reduction of vision impairment among children. A proposed child eye health strategy based on the findings from this study is included in this thesis.