ArticleBMJ paediatrics open2025
Evaluation of primary healthcare worker training to screen children under 5 years of age with a low-cost alternative to the direct ophthalmoscope, the 'Arclight', as part of the Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania.
Article in BMJ paediatrics open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate the integration of childhood eye screening with the Arclight direct ophthalmoscope into an already existing WHO/UNICEF Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania.
designProspective interventional study.
settingPrimary healthcare facilities in a semirural district, central Tanzania.
participantsTwo IMNCI (Integrated Management of Newborn and Childhood Illness) facilitators received training enhanced with four newly developed videos on using the Arclight. These facilitators then trained 378 primary healthcare workers (PHCWs) who were already familiar with the IMNCI 'Eye Module'. The training covered how to perform red reflex testing with the Arclight device, interpret the results and appropriately refer children who failed the screening.
intervention'Arclight' direct ophthalmoscope and training of primary healthcare workers.
main outcome measuresNumber of children screened and diagnosed with eye conditions.
resultsOver 4 months, 2 trained IMNCI facilitators trained 378 PHCWs on how to use the Arclight direct ophthalmoscope to screen children's eyes. Over a 6-month period, 36 000 children were screened in primary care settings with 136 seen at district level facilities and 105 referred to regional and tertiary facilities. The most common diagnoses of children referred were allergic conjunctivitis (37.4%), bacterial conjunctivitis (31.2%) and cataract (7.1%). There were six cases of ophthalmia neonatorum (3.9%) and two cases of retinoblastoma (1.3%). The incidence rate per 10 000 children of cataract was 3.05, ophthalmia neonatorum 1.67 and retinoblastoma 0.55.
conclusionPrimary healthcare workers in Tanzania can be trained to screen for eye disease in babies and children using the Arclight direct ophthalmoscope as part of an ongoing child health programme leading to the detection of treatable and serious eye diseases. Training all PHCWs would allow every child under 5 years old to be screened for eye disease, detecting serious eye conditions such as cataract and retinoblastoma earlier preventing avoidable childhood blindness and mortality.
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