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RAPID ASSESSMENT OF AVOIDABLE BLINDNESS (RAAB)

RAPID ASSESSMENT OF AVOIDABLE BLINDNESS (RAAB) SURVEY IN NEPAL 2018/019

First National Blindness Survey, 1981 in Nepal had shown prevalence of bilateral blindness as 0.84%, prevalence of unilateral blindness as 1.7 % in the country in 1981. The survey also revealed that cataract is leading cause of blindness accounting for almost 71 %. Similarly Eleven RAAB surveys were conducted from 2006-2010 in different zones of Nepal showed further reduction of blindness in the country as extrapolated prevalence of blindness was 0.35% in all ages. Diabetic retinopathy is ranked as the fifth most common cause of preventable blindness and fifth most common cause of moderate to severe visual impairment since, out of 37 million blind people, 4.8% is due to diabetic retinopathy blindness.

After the promulgation of new constitution, Nepal has gone into the federal system with 3 tier governance system. All the health implementation is being done by the provincial government. Hence it was necessary to conduct the RAAB Survey on provincial basis as it will be an advocacy document for the provincial government to increase the financial commitment and political will towards prevention of blindness. The information reveled from this survey will also be useful to develop strategic plan on eye health at provincial level. So that, accordingly the RAAB survey was planned to carry out in all the province within 2019 using WHO approved RAAB Survey protocol.

The RAAB survey methodology is one of the preferred method of blindness survey in WHO, GAP 2014-2019, already implemented in more than 70 countries.The entire survey can be completed with local ophthalmologists, ophthalmic assistants and support staff,e.g.ophthalmic nurses,optometrists,etc.,using basic ophthalmic equipment. In the survey eligible participants undergoes for visual acuity and basic eye examination by ophthalmologist using torchlight, slitlamp, ophthalmoscope and retinoscopy. Their findings are being recorded in the data entry program provided in smart phone which ultimately feed to the RAAB6 software server computer by email. RAAB6 software is in built report generating system which is freely available software that enables us to save costly and lengthy process of data analysis and report preparation in this study for prevalence of blindness, prevalence of diabetic retinopathy among the known diabetic cases, major causes of blindness and service coverage with existing eye care services of the survey area. It is been assumed that the survey finding will be useful and helpful to upgrade the services by evidence based strategic planning of eye care services in the respective province and throughout the nation.

The study will also reveal the existing prevalence of blindness and visual impairment with its causes, the service coverage and quality of existing services as visual outcome of cataract surgery.  The information gathered in this study will reflect the impact of ongoing eye care program in the province and country and the findings directly aligns to promote high quality, sustainable programs that deliver eye care services and develop infrastructure. Evidence of surgical outcomes will inform the need for surgical training skills of eye health professionals.

To evaluate overall magnitude of blindness, visual impairments and main causes of blindness and impairments among the Nepalese people aged 50 and above is general objective of the RAAB survey.

 

Specific objective of RAAB Survey;

  • To identify prevalence of blindness, severe visual impairment and visual impairment;
  • To identify prevalence of blindness, severe visual impairment and visual impairment from avoidable causes;
  • To find out prevalence of blindness, severe visual impairment and visual impairment from cataract
  • To outline the main causes of blindness, severe visual impairment and visual impairment;
  • To find out the prevalence of DR among known DM cases.
  • To find out prevalence of aphakia and/or pseudophakia;
  • To assess the cataract surgical coverage;
  • To find out the visual outcome of cataract surgery;
  • To find out the barriers to cataract surgery;
  • To identify the prevalence of uncorrected refractive errors and uncorrected presbyopia;
  • To outline the cataract surgery service indicators (age at time of surgery, place, costs and type of surgery, cause of visual impairment after cataract surgery).

All indicators are subdivided by sex and in many cases also by age group. The indicators thus obtained can be used as baseline information for the formulation of eye care programs and for regular monitoring of ongoing cataract intervention programs.

 

Current Status of the RAAB survey in Nepal:

Province

Status

Involved hospitals

Supported by

Remarks

Province-01    

Ongoing

SCEH, BEH and MEH

ECF and CBM

Commenced in 2019

Province-02

Pipeline

 

 

 

Province-04

Ongoing

HEH

ECF

Commenced in 2019

Province-05

Analysis and Report generation

LEI, REH, FBEH and PLLEH

SEVA and NABP

Field work completed in 2018

Province-06

Pipeline

 

 

 

Province-07

Pipeline

 

 

 

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