Conclusions:

							                               Conclusions




The whole project of rapid cataract assessment in the village of Pakha Ghulam was

based on the four agreed objectives during the pre survey planning. Based on these

objectives certain conclusions were drawn which are as;
    1) A total of 330 eligible individuals of calculated/ adjusted sample were examined

        by the survey team .Out of these 330 individuals twenty six (26) persons were

        cataract blind with the over all prevalence of cataract blindness 7.8% in this

        sample.

    2) The estimated No of cataract blind persons calculated for the target population

        was 79, individuals.

    3) The distribution of the twenty six (26) cataract blind persons was found out for

        different age groups in the sample. Which were as follows, there were (3)

        cataract blind persons in the age group (50-59 years) out of the 159 individuals

        examined in this age groups with percentage of 2.1%, three (3) were in age

        group (60-69 years) out of the 90 examined persons in this group with 3.9% ,

        seven (7) were in age group (70-79 years) out of the 45 persons examined in the

        group showing percentage of 15% and 7 were cataract blind subjects in the age

        group (80-89 years) out of the 24 examined individuals in this group with the

        percentage of 28.1% .The number of Bilaterally blind individuals in the age

        group of 90 to 99 were 6 out the total 10 persons examined in this age group with

        a prevalence of 66 percent.

       This pattern of occurrence shows that cataract is a disease of aging population

and its occurrence increases in the population as the age advances.



   There were 8 cataract blind males (32% of total) out of the 170 males examined in the

   sample with prevalence of 4.9% and 18 (68% of total) were cataract blind females out

   of the 160 females examined in the sample with prevalence of 11.25%.
This shows that there were more females with cataract blindness than females.




4) There were 3 (11.5%of total) unilateral cataract blind persons with the prevalence

   of 1% and 23(88% of total) were bilateral cataract blinds with the prevalence of

   6.9% in the sample. The no of unilateral cataract blinds calculated for the target

   population were 9 persons and that of bilateral cataract blinds were 70

   individuals.
Recommendations
After going through the whole process of this “Rapid Cataract Assessment in the

village Pakha Ghulam” and its findings, the following recommendations are made.

These recommendations if implemented may improve the eye health status of the

Population of the North West Frontier Province in general and in its administrative

units specifically.

1. Looking to the huge backlog of cataract blindness in the district (Bilateral

    prevalence 3.5%, 3500 persons and unilateral prevalence 8%, 8000 persons) out

    reach cataract surgical for the village is recommended.

2. Special attention needs to be focused on the selection for training, posting and

    transfer of personnel in the eye care professional cadre. Welling interested

    committed and motivated individuals if selected for training and posting in to the

    cadre will definitely work whole-heartedly.

3. Effective utilization of the already trained staff in the field and proper planning

    for the effective utilization of the future medical professionals who are in the

    process of getting their qualification in field of ophthalmology is one of the strong

    recommendation.

4. District mobile out reach activity needs to be integrated in to the comprehensive

    eye care programme of the districts with input from the tertiary centre to ensure

    the quality of the eye care services provided.

5. Comprehensive training programme for the lady health worker of the Prime

    Minister Programme for primary health care and population welfare, on basic eye

    examination and eye care is the need of the hour. The integration and co-
   ordination on this subject between the two segments of the health department is

   recommended for the country in general and NWFP in particular.

6. Comprehensive Eye Care unit, eye care service provision capacity needs to be

   strengthen by providing adequate trained and motivated human resource to cope

   with the huge blindness back log specially of the avoidable blindness in there

   target areas. This Human Resource includes adequate supporting staff like

   ophthalmic technicians, nurses, operation theatre assistants and anaesthesia

   technicians’ etc is recommended for the district ophthalmologists.

7. Continued medical education for the CEC, staff is recommended as an integral

   part of their carriers. This will improve their professional competency and

   expertise in the field .The eye care professionals may be provided with the

   opportunities of mastering in communication and motivation skills .The eye care

   service provision personals must be trained in the integrated medical management

   subject with the other medical professionals.
                               References




1.   Pakistan population Census Organisation Statistic Division Islamabad, Fifth

     population and housing census result July 1998.

2.   Economic Survey of Pakistan, Finance Division Islamabad 1997-98.

3.   Daud M. Khan, Babar M. Qureshi, Amman M. Khan, Facts about the status of

     blindness in Pakistan, Pakistan Journal of Ophthalmology Volume no 15, 1999.
4.   National Programme for CEC (1999-2003) 3rd draft; Ministry of Health

     government of Pakistan, Islamabad.

5.   Memon M. Saleh, Prevalence and causes of blindness in Pakistan, PMA Journal

     Aug; 1994; page No 196-198.

6.   First five year plan, National committee for prevention of blindness, Pakistan

     National Programme for prevention of blindness, Ministry of health Government

     of Pakistan.

7.   World Health Organisation Geneva, Management of cataract in Primary health

     care services. 2nd Ed. 1996.

8.   World Health Organisation Geneva, Cataract Strategies for the prevention of

     blindness in National Programmes 2nd; 1997.

9.   Thylefors Bjorn, A Global Initiative for the Elimination of Avoidable Blindness,

     Journal of Community Eye Health ,Vol.; 11 issue No 25,1998: 1-3.

10. FAAL H,MINASSIAN D ,SOWA S,AND FOSTER A ,National survey of

     Blindness and low Vision in Gambia; Results, British Journal of Ophthalmology

     1989, page 73 and 82-87.

11. Moll A C,Linden A J H Vander, Hogeweg M ,Schader W E, Hermans J, Keizer

     R J W de ;Prevalence of blindness and low vision of people over 30years in the

     Wenchi district, Ghana, in relation to eye care programmes, British Journal of

     Ophthalmology 1994.

12. Limburg Hans , Kumar Raj, indrayan Abhaya and sundaram k r, Rapid

     assessment of prevalence of cataract blindness at district level , International

     Journal of Epidemiology 1997 vol.; 26 no;5.
13. Zhao jialiang, Jia Lijan ,Sui ruifang and Elwein Leon P, prevalence of blindness

    and cataract surgery in Shunyi county China, American Journal of

    Ophthalmology , 1998.

14. Pokharel G P,Ragmi g, Shevestha S K , Negrel A D, Elwein L B ,Prevalence of

    blindness and cataract surgery in Nepal, British Journal of ophthalmology 1998;

    82 :600-605.

15. Chaudhri D N, Vaidyanathan K, Limburg Hans, Prevalence of blindness in Una

    district Himachal pardesh, India August 1998.

16. Limburg Hans (DANCB, Report; Feb; 1997, New Delhi)

17. Gujjarat State ophthalmic Cell, Rapid assessment of Cataract Blindness in

    districts of Gujjarat State , Summary Results, Government of Gujjarat ,Gandhi

    agar ;1998.

18. Khan M. Amman, Gulab Arifa, Khan M. Daud, Prevalence of blindness and low

    vision in N.W.F.P, Pakistan; Pakistan Journal of ophthalmology vol; 10 no 2&3;

    1994.

19. Dolin Paul, Epidemiology of Cataract, The Epidemiology of Eye diseases,

    Chapman and Hall; 1998, page 105-106.

20. Mariani G et al Risk factor for age related cortical. Nuclear and posterior sub

    capsular cataract, American journal of ophthalmology; 1991; 541-551.

21. Taylor Hugh et al, Effects of Ultra-violet radiation on cataract formation, The

    New England Journal of Medicine vol. 319 no 22; 1988; 1429-1433.
22. Mohan Madan, Sperduto Robert, Dangra Surendar k, et al, India_ US case

    control Study of age related cataract. Arch Ophthalmic. Vol. 107- May 1989,

    670-676.

23. Limburg Hans, Foster Allen, Cataract Surgical Coverage: An Indicator to

    measure the impact of cataract intervention programme, Journal of Community

    Eye Health vol. 11no. 25; 1998; 3-6.

24. Sasikumar, Naved Muhammad, S J Sasikumar Cataract Surgical Coverage in

    Kolenchery, Kerala, India, Journal of Community Eye Health vol. 11, issue no

    25, 1998, page 1-3.

25. Prajna N., Venkalsh, Rehmatullah Rahim, Changing trends in the intra-occular

    lens acceptance in rural Tamil Nadu, Indian J. Ophthalmol; 44:177-179; 1995.

26. Prof. Malik S.R.K., Eye Camps—Are They Needed? Afro-Asian J.

    Ophthalmology June 1987.

27. District census report of Swabi, 1998, Population Census Organisation Statistics

    Division Islamabad, Government of Pakistan, April 2000.