In 2014 CBM, in collaboration the Ministry of Health and the National Eye Care Programme, Red Cross and other partners, began work towards the prevention of avoidable blindness in Côte d’Ivoire, primarily through increasing the number of cataract surgeries performed. To assess the achievements and sustainability of this Scaling up Prevention of Blindness in Ivory Coast project, and in particular work done in communities to raise awareness and understanding of eye problems, two Knowledge, Attitudes and Practice (KAP) studies were carried out by Red Cross Côte d’Ivoire in five project areas.
A baseline KAP study was conducted in March 2016, allowing data to be used in the planning and refining of project interventions. A follow-up endline KAP study was completed in June 2018, providing data to measure results and evaluate the success of the project against its objectives.
Both studies were conducted in two phases incorporating a mixed methods approach: a literature review of existing documentation alongside semistructured qualitative interviews, and a quantitative household survey within the five target areas using the RAMP Toolkit – a quick survey completed using a mobile phone or tablet. During each study, approximately 600 men and women over the age of fifteen were interviewed in mostly urban areas. Questions focussed on knowledge of cataracts, causes, consequences, treatment, prevention, and attitudes and practices in the event of cataracts. Finally, interviews with local Red Cross committees on the sustainability of the project were completed.
Comparison of cataract knowledge pre and post KAP data (%)
- March 2016
- June 2018
- March 2016
- June 2018
The results of both studies were analysed and compared following completion of the final KAP study, and positive results emerged. The percentage of respondents who had heard of cataracts had risen from 73.1% to 88.6%, whilst almost twice the number of people from the initial survey results were able to define what cataracts is. There was also a significant increase in the number of people who could list at least three causes of cataracts, from 1.2% at in 2016, to 12.3% during the final study. These included exposure to the sun, poor diet and ageing, with 72.4% of participants aware that cataracts are preventable, compared with an initial 54.9%.
The knowledge of three signs of cataracts had also significantly increased, from 8.3% to 22.3%. The most commonly mentioned signs included blurred vision, whitish pupils and redness of the eye. Furthermore, a greater percentage of the population are now aware that cataracts can be cured, with 82% of respondents citing surgery as the preferred method for curing cataracts, compared with 61.4% reported in the baseline study. This is an important achievement in the fight against avoidable blindness. Unfortunately, some misconceptions surrounding cataracts remain amongst the population, including the belief that cataracts is a cancer or contagious infection, however their prevalence has been reduced.
The effectiveness of radio as a method for disseminating information on cataracts was also explored during this study. Local radio was used, with consideration given to popular listening times in order to maximise effectiveness of broadcasts. The results of the final study revealed a high level of effectiveness, with a significant increase in the percentage of people who had listened to a cataract broadcast on the local radio from 4.9% to 39.6%. In one area, some radio show listeners visited the radio stations for additional information on cataracts and were immediately referred to the local committee of the Red Cross.
The attitudes and practices observed amongst research participants were also fairly positive, with the majority of the respondents claiming that in the event of experiencing cataracts within their family, they would visit a hospital to seek assistance. In conjunction with the increased understanding of cataracts, this appears to be reflected in a significant increase in the number of consultations and diagnosis of cataracts reported in one of the four regional hospitals participating in the project. However the use of traditional medicine and practices also continues, and there are also some individuals who do not have the means to access surgery and are consequently living with avoidable blindness; this is being addressed with a subsidy system for surgeries in the final year of the project.
In addition to this quantitative information, the KAP study also collected qualitative information which showed that those reached by sensitization activities were generally satisfied with the way the volunteers conducted their work, supported by local authorities, and there was good collaboration between volunteers and ophthalmology services.
Awareness raising activities appear to have been an important part of fighting blindness and should be systematically combined with supply side efforts to improve access to medical care for sustainable results.
Author: Lachan Read,
Programme Development Intern, CBM UK