Three-year follow up of primary health care workers trained in identification of blind and visual impaired children in Malawi


Background: Control of blindness in children is one of the priorities of VISION 2020. Early detection of children needing eye services is essential to achieve maximum visual recovery. Even though training primary (community) Health care workers (PHC) should play an important role in early identification of children, it is not known how many of these workers leave after being trained, and whether those who remain continuing identifying children in the long term. The objectives of the study were to determine the attrition of primary health workers over a 3-year period after training, and to assess their knowledge and skills on cataract in children in southern Malawi. Methods: This was a cohort study that followed primary health care workers (health surveillance assistants) over a 3-year period from 2008 to 2011 and reassessed their attrition rates, knowledge and skills on cataract in children. Results: Among the 59 HSAs that were originally trained in 2008, 54 (92%) were interviewed and were found to be still working in the health sector. Knowledge regarding cataract blindness in children remained constant over the 3-year period, however, only two HSAs had reported identifying and referring children. Conclusion: Despite attrition among primary health care workers being low, only a few actually identify cataract children in the communities after being trained. Other innovative ways are needed to identify prevalent and incident cases in Malawi, as the use of HSAs is unlikely to be successful in addressing blindness in children.

Share and Cite:

Kalua, K. , Nyirenda, M. , Lewallen, S. and Courtright, P. (2013) Three-year follow up of primary health care workers trained in identification of blind and visual impaired children in Malawi. Health, 5, 1791-1795. doi: 10.4236/health.2013.511241.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Courtright, P., Hutchinson, A.K. and Lewallen, S. (2011) Visual impairment in children in middleand lowerincome countries. Archives of Disease in Childhood, 96, 1129-1134.
[2] Foster, A., Gilbert, C. and Johnson, G. (2008) Changing patterns in global blindness: 1988-2008. Community Eye Health, 21, 37-39.
[3] Gilbert, C. and Foster, A. (2001) Childhood blindness in the context of VISION 2020—The right to sight. Bulletin of the World Health Organization, 79, 227-232.
[4] Gilbert, C. and Muhit, M. (2008) Twenty years of childhood blindness: What have we learnt? Community Eye Health, 21, 46-47.
[5] Gogate, P., Kalua, K. and Courtright, P. (2009) Blindness in childhood in developing countries: Time for a reassessment? PLoS Medicine, 6, e1000177.
[6] Gilbert, C. and Rahi, J. (2010) Visual impairment and blindness in children. In: Johnson, G., Foster, A. and Gilbert, C. Eds., Epidemiology of Eye Diseaase, Imperical College Press, London.
[7] Mwende, J., et al. (2005) Delay in presentation to hospital for surgery for congenital and developmental cataract in Tanzania. British Journal of Ophthalmology, 89, 1478-1482.
[8] Shirima, S., et al. (2009) Estimating numbers of blind children for planning services: Findings in Kilimanjaro, Tanzania. British Journal of Ophthalmology, 93, 1560-1562.
[9] Shija, F., et al. (2010) Using key informnats to identify and refer children who need eye care services. A manual for Africa. Kilimanjaro Centre for Community Ophthalomology, Tumaini University, Moshi Tanzania, 1-20.
[10] Muhit, M.A., et al. (2007) The key informant method: A novel means of ascertaining blind children in Bangladesh. British Journal of Ophthalmology, 91, 995-999.
[11] Kalua, K., et al. (2009) Productivity of key informants for identifying blind children: Evidence from a pilot study in Malawi. Eye (Lond), 23, 7-9.
[12] Gona, J.K., et al. (2010) Identification of people with disabilities using participatory rural appraisal and key informants: A pragmatic approach with action potential promoting validity and low cost. Disability and Rehabilitation, 32, 79-85.
[13] Boye, J. (2005) Validating key informant method in detecting blind children in Ghana. Community Eye Health Journal, 18, 131.
[14] Demissie, B.S. and Solomon, A.W. (2011) Magnitude and causes of childhood blindness and severe visual impairment in Sekoru District, Southwest Ethiopia: A survey using the key informant method. Transactions of the Royal Society of Tropical Medicine and Hygiene, 105, 507-511.
[15] Xiao, B., et al. (2011) Using key informant method to assess the prevalence and causes of childhood blindness in Xiu’shui County, Jiangxi Province, Southeast China. Ophthalmic Epidemiology, 18, 30-35.
[16] Muhammad, N., et al. (2010) Tracing children with blindness and visual impairment using the key informant survey in a district of North-Western Nigeria. Middle East African Journal of Ophthalmology, 17, 330-334.
[17] Kalua, K., et al. (2012) Using primary health care (PHC) workers and key informants for community based detection of blindness in children in Southern Malawi. Human Resources for Health, 10, 37.
[18] Shija, F., et al. (2011) Comparing key informants to health workers in identifying children in need of surgical eye care services. International Health, 4, 1-3.
[19] Kishiki, E., et al. (2012) Is the existing knowledge and skills of health workers regarding eye care in children sufficient to meet needs? International Health, 4, 303-306.
[20] Callaghan-Koru, J.A., et al. (2012) Health workers’ and managers’ perceptions of the integrated community case management program for childhood illness in Malawi: The importance of expanding access to child health services. The American Journal of Tropical Medicine and Hygiene, 87, 61-68.
[21] Nsona, H., et al. (2012) Scaling up integrated community case management of childhood illness: Update from Malawi. The American Journal of Tropical Medicine and Hygiene, 87, 54-60.
[22] Gilroy, K.E., et al. (2012) Quality of sick child care delivered by health surveillance assistants in Malawi. Health Policy Plan.
[23] Masangwi, S.J., et al. (2012) Pattern of maternal knowledge and its implications for diarrhoea control in Southern Malawi: Multilevel thresholds of change analysis. International Journal of Environmental Research and Public Health, 9, 955-969.
[24] Kadzandira, J. and Chilowa, W. (2001) The role of Health Surveillance Assistants (HSAs) in the delivery of health services and immunization in Malawi. UNICEF Evaluation Report.
[25] Kalua, K., et al. (2008) Causes of blindness among children identified through village key informants in Malawi. Canadian Journal of Ophthalmology, 43, 425-427.
[26] Dovlo, D. (2005) Wastage in the health workforce: Some perspectives from African countries. Human Resources for Health, 3, 6.
[27] Chandna, A. and Gilbert, C. (2010) When your eye patient is a child. Community Eye Health, 23, 1-3.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.