Original Research

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

Wanjiku C. Mathenge, Tessa Hillgrove, Egide Gisagara, Parfait Uwaliraye, Olivia Hess, Emmanuel Byamukama, Alessandra Intili, Alex Nyemazi, John Nkurikiye
African Vision and Eye Health | Vol 80, No 1 | a576 | DOI: https://doi.org/10.4102/aveh.v80i1.576 | © 2021 Wanjiku C. Mathenge, Tessa Hillgrove, Egide Gisagara, Parfait Uwaliraye, Olivia Hess, Emmanuel Byamukama, Alessandra Intili, Alex Nyemazi, John Nkurikiye | This work is licensed under CC Attribution 4.0
Submitted: 07 May 2020 | Published: 15 July 2021

About the author(s)

Wanjiku C. Mathenge, Rwanda International Institute of Ophthalmology, Kigali, Rwanda
Tessa Hillgrove, Fred Hollows Foundation, Sydney, Australia
Egide Gisagara, Department of Ophthalmology, Central University Hospital, Kigali, Rwanda
Parfait Uwaliraye, Ministry of Health Rwanda, Kigali, Rwanda
Olivia Hess, Department of Ophthalmology, Stanford University School of Medicine, Stanford University, Stanford, United States of America
Emmanuel Byamukama, Department of Ophthalmology, Kirinda District Hospital, Rwanda
Alessandra Intili, Wills Eye Hospital, Philadelphia, United States of America
Alex Nyemazi, Rwanda Military Hospital, Kigali, Rwanda
John Nkurikiye, Rwanda International Institute of Ophthalmology, Kigali, Rwanda; and, Rwanda Military Hospital, Kigali, Rwanda; and, Dr Agarwal’s Eye Hospital Rwanda, Kigali, Rwanda


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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.


Keywords

RAAB; policy change; visual impairment; Rwanda; blindness; evidence

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