Africa, Zimbabwe: Childhood blindness
Marcia Zondervan on behalf of London School of Hygiene & Tropical Medicine, UK

Aim

Saving children's sight in Zimbabwe through retinoblastoma training.

The project

Every year, thousands of babies and children in Africa lose their sight and their lives to the childhood eye cancer retinoblastoma (Rb). In Africa, children present late and most die, while in the western world nearly all children survive due to early diagnosis and treatment. The successful treatment of Rb requires working in the community to raise awareness of the signs; in tertiary centres with multidisciplinary teams (ophthalmologist, pathologist, oncologist, counsellor) and through sharing skills and protocols in north-south and south-south collaborations. In Zimbabwe there are two paediatric-trained ophthalmologists who have established a paediatric eye service and have successfully treated children with Rb. The need is to further build their skills and share learning with four local countries - Kenya, Uganda, Tanzania and Malawi – within a training network (Rb-NET), established in 2017. Participants in Rb-NET are London and Birmingham, UK; Hyderabad and Chennai, India; together with the centres treating Rb in Tanzania, Uganda, Kenya and Malawi.

The objectives of this project are to standardise and improve management of Rb across eastern Africa through agreeing and following standard protocols for treatment and pathology. This is a 'holistic' approach to improving diagnosis and treatment of children with Rb in Zimbabwe. A multidisciplinary team from Harare, Zimbabwe, will join Rb-NET and access specialist training from their counterparts in specialist Rb centres. As part of this, a pilot project will train 20 community nurses to detect abnormal red reflex in babies (picking up congenital cataract as well as Rb), and refer them to the nearest tertiary centre.

The improvements in Rb management will be sustained after the grant ends, as anonymized, standardised information will continue to be collected and shared between the Rb-NET participants, and ongoing support will be provided. As the numbers of children affected each year are small (approximately 3,000/year in the Rb-NET participating countries), combining data across countries enhances the likelihood of strong research publications resulting.

Children being seen with adults in the general clinic before the children's eye clinic was set up. The paediatric ophthalmology clinic was set up. Children now also have their own ward. The option of enucleation is easier to accept when good cosmetic outcome is offered.