A N J Malik, Godfrey Furhini Mnedeme, Nemes Iriya, Philip Bahati, Henry Marealle, Andrew Blaikie, Mlika Mafwiri
{"title":"作为坦桑尼亚新生儿和儿童疾病综合管理(IMNCI)方案的一部分,对初级卫生保健工作者在使用低成本替代直接检眼镜的“Arclight”筛检5岁以下儿童方面的培训进行评估。","authors":"A N J Malik, Godfrey Furhini Mnedeme, Nemes Iriya, Philip Bahati, Henry Marealle, Andrew Blaikie, Mlika Mafwiri","doi":"10.1136/bmjpo-2025-003520","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the integration of childhood eye screening with the Arclight direct ophthalmoscope into an already existing WHO/UNICEF Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania.</p><p><strong>Design: </strong>Prospective interventional study.</p><p><strong>Setting: </strong>Primary healthcare facilities in a semirural district, central Tanzania.</p><p><strong>Participants: </strong>Two IMNCI (Integrated Management of Newborn and Childhood Illness) facilitators received training enhanced with four newly developed videos on using the Arclight. These facilitators then trained 378 primary healthcare workers (PHCWs) who were already familiar with the IMNCI 'Eye Module'. The training covered how to perform red reflex testing with the Arclight device, interpret the results and appropriately refer children who failed the screening.</p><p><strong>Intervention: </strong>'Arclight' direct ophthalmoscope and training of primary healthcare workers.</p><p><strong>Main outcome measures: </strong>Number of children screened and diagnosed with eye conditions.</p><p><strong>Results: </strong>Over 4 months, 2 trained IMNCI facilitators trained 378 PHCWs on how to use the Arclight direct ophthalmoscope to screen children's eyes. Over a 6-month period, 36 000 children were screened in primary care settings with 136 seen at district level facilities and 105 referred to regional and tertiary facilities. The most common diagnoses of children referred were allergic conjunctivitis (37.4%), bacterial conjunctivitis (31.2%) and cataract (7.1%). There were six cases of ophthalmia neonatorum (3.9%) and two cases of retinoblastoma (1.3%). The incidence rate per 10 000 children of cataract was 3.05, ophthalmia neonatorum 1.67 and retinoblastoma 0.55.</p><p><strong>Conclusion: </strong>Primary healthcare workers in Tanzania can be trained to screen for eye disease in babies and children using the Arclight direct ophthalmoscope as part of an ongoing child health programme leading to the detection of treatable and serious eye diseases. Training all PHCWs would allow every child under 5 years old to be screened for eye disease, detecting serious eye conditions such as cataract and retinoblastoma earlier preventing avoidable childhood blindness and mortality.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182163/pdf/","citationCount":"0","resultStr":"{\"title\":\"Evaluation of primary healthcare worker training to screen children under 5 years of age with a low-cost alternative to the direct ophthalmoscope, the 'Arclight', as part of the Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania.\",\"authors\":\"A N J Malik, Godfrey Furhini Mnedeme, Nemes Iriya, Philip Bahati, Henry Marealle, Andrew Blaikie, Mlika Mafwiri\",\"doi\":\"10.1136/bmjpo-2025-003520\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the integration of childhood eye screening with the Arclight direct ophthalmoscope into an already existing WHO/UNICEF Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania.</p><p><strong>Design: </strong>Prospective interventional study.</p><p><strong>Setting: </strong>Primary healthcare facilities in a semirural district, central Tanzania.</p><p><strong>Participants: </strong>Two IMNCI (Integrated Management of Newborn and Childhood Illness) facilitators received training enhanced with four newly developed videos on using the Arclight. These facilitators then trained 378 primary healthcare workers (PHCWs) who were already familiar with the IMNCI 'Eye Module'. The training covered how to perform red reflex testing with the Arclight device, interpret the results and appropriately refer children who failed the screening.</p><p><strong>Intervention: </strong>'Arclight' direct ophthalmoscope and training of primary healthcare workers.</p><p><strong>Main outcome measures: </strong>Number of children screened and diagnosed with eye conditions.</p><p><strong>Results: </strong>Over 4 months, 2 trained IMNCI facilitators trained 378 PHCWs on how to use the Arclight direct ophthalmoscope to screen children's eyes. Over a 6-month period, 36 000 children were screened in primary care settings with 136 seen at district level facilities and 105 referred to regional and tertiary facilities. The most common diagnoses of children referred were allergic conjunctivitis (37.4%), bacterial conjunctivitis (31.2%) and cataract (7.1%). There were six cases of ophthalmia neonatorum (3.9%) and two cases of retinoblastoma (1.3%). The incidence rate per 10 000 children of cataract was 3.05, ophthalmia neonatorum 1.67 and retinoblastoma 0.55.</p><p><strong>Conclusion: </strong>Primary healthcare workers in Tanzania can be trained to screen for eye disease in babies and children using the Arclight direct ophthalmoscope as part of an ongoing child health programme leading to the detection of treatable and serious eye diseases. Training all PHCWs would allow every child under 5 years old to be screened for eye disease, detecting serious eye conditions such as cataract and retinoblastoma earlier preventing avoidable childhood blindness and mortality.</p>\",\"PeriodicalId\":9069,\"journal\":{\"name\":\"BMJ Paediatrics Open\",\"volume\":\"9 1\",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-06-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182163/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Paediatrics Open\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjpo-2025-003520\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Paediatrics Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjpo-2025-003520","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
Evaluation of primary healthcare worker training to screen children under 5 years of age with a low-cost alternative to the direct ophthalmoscope, the 'Arclight', as part of the Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania.
Objective: To evaluate the integration of childhood eye screening with the Arclight direct ophthalmoscope into an already existing WHO/UNICEF Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania.
Design: Prospective interventional study.
Setting: Primary healthcare facilities in a semirural district, central Tanzania.
Participants: Two IMNCI (Integrated Management of Newborn and Childhood Illness) facilitators received training enhanced with four newly developed videos on using the Arclight. These facilitators then trained 378 primary healthcare workers (PHCWs) who were already familiar with the IMNCI 'Eye Module'. The training covered how to perform red reflex testing with the Arclight device, interpret the results and appropriately refer children who failed the screening.
Intervention: 'Arclight' direct ophthalmoscope and training of primary healthcare workers.
Main outcome measures: Number of children screened and diagnosed with eye conditions.
Results: Over 4 months, 2 trained IMNCI facilitators trained 378 PHCWs on how to use the Arclight direct ophthalmoscope to screen children's eyes. Over a 6-month period, 36 000 children were screened in primary care settings with 136 seen at district level facilities and 105 referred to regional and tertiary facilities. The most common diagnoses of children referred were allergic conjunctivitis (37.4%), bacterial conjunctivitis (31.2%) and cataract (7.1%). There were six cases of ophthalmia neonatorum (3.9%) and two cases of retinoblastoma (1.3%). The incidence rate per 10 000 children of cataract was 3.05, ophthalmia neonatorum 1.67 and retinoblastoma 0.55.
Conclusion: Primary healthcare workers in Tanzania can be trained to screen for eye disease in babies and children using the Arclight direct ophthalmoscope as part of an ongoing child health programme leading to the detection of treatable and serious eye diseases. Training all PHCWs would allow every child under 5 years old to be screened for eye disease, detecting serious eye conditions such as cataract and retinoblastoma earlier preventing avoidable childhood blindness and mortality.