The National Screening Program for Refractive Errors in Kindergarten Children in The State of Kuwait

Dr. Khalid Al AneziMRCGP (int.)Head of Jahra School Health Division State of Kuwait

Introduction

• The National Screening Program for Refractive Errors in Kindergarten Children in The State of Kuwait is initiated by both school health administration and the Ophthalmology departments Counsel , Kuwait MOH.• This program aims for the Early Detection of RE

in KG children & Prevention of visual disability.

Introduction

• These conditions could hinder the child ‘s academic performance , social interaction , and cognitive functioning.

• Prevalence in school age children : 12%• Joint Responsibility. (SH – School – Family)• Cost-Effective.• EBM.

Refractive errors

• Refractive errors are abnormalities in the way light from a distant object is focused - via convergence of rays at the convex cornea and lens - onto the retina.

• Common at any stage of childhood.

• Treatment of refractive errors is with spectacles , to improve visual acuity and prevent blindness.

• Commonest cause of blindness in childhood & Adolescence.

Goals

• Early Detection of Refractive errors.• Prevention of complications & Visual Disability.• Estimation of possible Risk factors for RE &

Visual Health.

Methodology

• An estimation of the Total Population of KG1 Children with RE in all schools (Governmental & Private) in the State of Kuwait.

• Our target Age group is : 4-5 years old.

Methodology

Timeline : Preparation : March 2013 – August 2013EBM Joint meetings with ophthalmology Dept.,Development of Clinical practice protocols Staff training Population estimationMass Media (Audiovisual , Printed , social M.)

Methodology

Starting Date : Sept 2013

Finishing Date : Jan 2014

MethodologyGovernorate No. of KG

School (Gov.)

No. of KGSchool(Private)

No. of KG 1Students

No. of Nursing Staff

No. of School Health Physicians

Ahmadi 39 18 8462 39 6

Jahra 31 5 3991 31 5

Hawalli 27 52 6241 27 7

Capital 28 4 3000 28 4

Farwania 39 27 10630 39 5

Mubarak K. 34 - 2000 34 4

Total 198 106 34324 198 31

Methodology

School Health Nurse

School Health Doctor

Optician & Ophthalmologist

Methodology

Examination Technique :Snellen chart was used in a distance of 6 m. and 1.5-2 m. height ,

pointers were used.Room with adequate natural and artificial lightening with no

reflective surfaces.Quiet Environment.Adequate explanation for school staff , toys .Disposable Eye pad. (right then left).Standing sign.Repetition of the exam by the school nurse in case of uncooperative

child or positive result.Children with glasses were included.

Methodology

Examination Technique :Recording of result was done in the Student Health File & The

Screening Program Registry.Follow up examination after 1 month for positive cases , and after 6

months for negative cases.

Tools

1- Guardian Consent Form and Risk factors Questionnaire:A medico legal consent form is distributed to the

guardians of the child to allow the visual assessment by the nurse , if the guardian agrees , a questionnaire contains the following :

possible Risk factors to visual acuity.Whether the Child weirs spectacles or notWhether previous ophthalmological procedure was

done for the child or not.The Academic Qualifications for both parents /Guardians

:(University/College , High school , below High School)

Toolspossible Risk factors to visual acuity include :

No. of Hours per day of :ReadingWritingDrawingUsing Devices with Screens (Computers , Tablets , Smart phones , Video Games).

Tools2- The School Clinic Registry :

StudentName

Civil IDNumber

ContactTel.

The Result Referral FeedbackReport

Recommendations

With Glasses

W/OGlasses

Rt. Lt. Rt. Lt.

Tools3- Referral Letter From School Health Physician :

Tools4- Feedback Letter from the ophthalmologist :

Results

Province

Total NO. of Children

NO. of Children examined

No. of Children referred

Absentees &Refusal

% of Examined

Ahmadi 8462 4997 88 3465 59%

Jahra 3991 3281 67 710 82%

Hawalli 6241 5492 113 749 88%

Capital 3000 2480 136 520 83%

Farwania

10630 5422 106 5208 51%

Mubarak K.

2000 1440 102 560 72%

Total 34324 23112 612 11212 67%

Barriers

• Shortage of staff• Constant absence of children• Refusal (Children / Parents)• Lack of feedback.• Overcrowded 2ry point of care.

The End