Symposium – The World Report on Disability: Implications for Asia and the Pacific
University of Sydney, 5-6 December, 2011
Establishing an evidence-base
for disability inclusion in eye
health programmes
Presenter
Gail M Ormsby
Noela Prasad
Manfred Mörchen
Te Serey Bonn
Ngeth Sarun
Evangeline Dunton
Myrna Porto
Natalie Maggay
Nguyen Hong Nga
Nguyen Ngoc Anh
Jill Keeffe
– CBM Australia; Centre for Eye Research Australia
– Centre for Eye Research Australia
– Takeo Eye Hospital, Cambodia
– Takeo Eye Hospital
– Takeo Eye Hospital
– Takeo Eye Hospital
– Takeo Eye Hospital
– CBM Viet Nam
– CBM Viet Nam
– CBM Viet Nam
– Centre for Eye Research Australia
Cambodia and Vietnam
“Disability” inclusive approach to
community eye health
• Our experience
– Gender
– Education
– Disability
• As related to eye health knowledge, attitude and
practice
• How this informed project implementation
Context: Disability Inclusion
AusAID strategy for disability inclusion - Development for All:
Towards a disability inclusive Australian aid program 2009-2014,
– all AusAID funded activities will need to show consideration of
disability mainstreaming,
– so disability inclusion training and guidelines were included under
AusAID Avoidable Blindness Initiative.
Field research included Rapid Assessment of Avoidable Blindness
(RAAB) and surveys of Knowledge, Attitude and Practice (KAP) to
– Provide baseline data on blindness and vision impairment
– Provide a picture of the community’s perception of eye health
so that the project responds to needs of the community being served.
Baseline information
Results of RAAB survey
Prevalence of vision impairment in people over 50 years of age
• Cambodia (conducted in 2007)
• Vietnam (conducted in 2010)
Region
Prevalence of
blindness <3/60
Prevalence of
severe visual
impairment
<6/60 – 3/60
Prevalence of
moderate visual
impairment
<6 / 18 – 6/60
Cambodia
2.8 %
Viet Nam
3.1 %
Son La 2010
1.7 %
1.3 %
7.1 %
Thanh Hoa 2011
5.44 %
3.48 %
12.24 %
17.61 %
Baseline information
Areas of focus for KAP survey
 Knowledge and attitude of the community regarding their eye
health.
 Current practices and attitudes regarding uptake of eye care
services.
 Perception and practices on the inclusion of women, children
and persons with disability in community eye care
programmes.
Survey Locations
Thanh Hoa and Nghe An
Provinces
Bati
Takeo
Kiri Vong
Sampling
Cambodia
• 600 people surveyed from across 3
districts 200 people per district
• 30 randomly selected villages from
across districts 10 villages per district
• 20 people surveyed from each village
– 6 or 7 people from each age
group surveyed from each
village (At least 1 or 2 people
with a disability)
• Random walk to find people
– Random lank mark chosen, called
in at consecutive houses until
number of participants reached
–
If people with disability not in this sample,
convenient sampling used where village
leader was asked where person with
disability lives (was not found necessary)
Vietnam
• 4 cities & districts in each province
selected according to the following
criteria:
2 districts that will be sites of project
implementation,
1 urban area where available eye services are
linked to the project,
1 district adjacent to site of project
implementation.
•
Quota: people from each district
75% of the total number of respondents
in a province from each project district
(94 people per district),
15% from urban areas (37 people from
each area),
10% from adjacent sites (25 per site).
Ensure at least 1 or 2 people with a disability
are included at each site.
Results
Potential service users surveyed
1130 people over 25 years of age
• 599 from one province in Cambodia
• 531 from two adjacent provinces in Vietnam
Men
Women
Cambodia
214
385
Vietnam
254
277
Education
Cambodia
Disability
Type
Seeing
Hearing
Walking
Understanding
Other
Cambodia
Vietnam
Total
110
21
33
4
8
174
19
100
39
15
284
40
133
43
23
176
347
523
Vision disability reported in
18% (Cambodia) & 33% (Vietnam)
TOTAL
39% (443/1130) of the surveyed population reported SOME disability.
Multiple disability
Cambodia
Vietnam
Total
Males
Females
Males
Females
61
70
122
133
386
Two
‘disabilities’
8
5
20
11
44
Three or more
‘disabilities’
3
2
4
4
13
Single disability
12% (18/149) in Cambodia, and 13% (39/294) in
Vietnam reported having more than one ‘disability’.
Knowledge: heard about eye conditions
Knowledge: know treatment for cataracts
Attitude
Can a child with Vision Impairment or Seeing Difficulty attend school?
Practice: getting eyes examined
CAMBODIA
38% of all respondents (142 of the 370 that responded) and
40% of people who reported having a disability (46 of the
116 that responded)
VIETNAM
85% of all respondents (354 of the 419 that responded) and
84% of people who reported having a disability (210 of the
249 that responded)
said that they ‘went for examination of an eye problem’
Conclusions
• Self-reported ‘Disability’ is common among the sampled
population.
• Inclusive planning can be achieved even without positive
discrimination towards persons with disability.
– through integration into existing eye programmes
– at minimal additional cost
• Some people with disability report accessing access eye care
services if available.
• But people with disability have less access to eye health
information.
• Evaluation at end of the project period will assess outcomes
of a disability inclusive approach to community eye heath
programme.