The Rwanda National Blindness Survey: Trends and use of the evidence to change practice and policy

Wanjiku C Mathenge,Egide Gisagara,Parfait Uwaliraye,Olivia Hess,Alessandra Intili,John Nkurikiye,Tessa Hillgrove,Alex Nyemazi,Emmanuel Byamukama

doi:10.4102/aveh.v80i1.576

Abstract

Background: In order to gather evidence to guide eye care policy changes in Rwanda, a national population-based blindness and visual impairment survey was undertaken in 2015.Aim: To influence and direct policy changes using blindness survey findings.Setting: Nationwide sampling.Methods: Standard Rapid Assessment of Avoidable Blindness (RAAB) survey methodology was used across to examine 5065 (97.5% response rate) people aged 50 years and older. This is a case report of how the government used the evidence from the survey.Results: The age- and sex-adjusted prevalence of blindness was 1.1% (0.7–1.4) of which 83.9% was avoidable, with cataract being the major cause. The age- and sex-adjusted prevalence of visual impairment at the 6/18 level is 4.4% (3.7–5.1), with refractive errors and cataract being the major causes. The prevalence of all refractive errors was 4.3%, the majority of which was uncorrected. The cataract surgical coverage (CSC) was 68.4%, with 45.4% of surgeries performed at the secondary level. Difficulty in reaching surgical facilities (33.3%) was the main barrier to surgery. These results informed policy changes aimed towards an increase in the number of cataract surgeons, the volume of cataract surgery performed and broader spectacle provision.Conclusion: The prevalence of blindness in Rwanda is low compared to the previous estimates, although a considerable proportion is avoidable and the majority of refractive errors were uncorrected. The CSC and surgical outcomes are improving. The government, informed by this evidence, has introduced targeted initiatives to improve eye-care delivery in Rwanda.

Highlights

Worldwide, an estimated 253 million people have visual impairment or blindness with presenting visual acuity (PVA) < 6/18, and this figure may rise to 700 million by 2050
In 1999, the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) launched the global initiative known as ‘VISION 2020: The Right to Sight’, which calls for the elimination of avoidable blindness by 2020.2 Three years later, the initiative was launched in Rwanda
The results showed a downward trend in the prevalence of blindness, improved cataract surgical coverage (CSC) and improved outcomes of cataract surgery

Summary

Introduction

An estimated 253 million people have visual impairment or blindness with presenting visual acuity (PVA) < 6/18, and this figure may rise to 700 million by 2050. When an assessment of the existing PEC programmes revealed gaps in the competency of general health workers in PEC and their ability to accurately identify and refer patients with eye complaints,[21,22] the MOH determined the requirement of a better programme. This led to the development of a national curriculum for PEC in Rwanda between 2012 and 2013, which was adapted from the WHO PEC Manual.[23]

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