1. Gender and Blindness: The conditions do matter: differences in use of services for cataract and trichiasis after implementation of a community based eye health programme Ahmed Mousa Abdel Rahim, M. Sc., Ph. D. Lecturer, Ocular Epidemiology, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

2. Major Goal: To increase eye care service utilization by women in rural Upper Egypt. Major Goal: To increase eye care service utilization by women in rural Upper Egypt. Achievable through Increase the awareness of avoidable blindness. Increase surgical uptake of cataract and trachomatous trichiasis. Build the capacity of local eye care providers. Decrease the impact of barriers Increase the awareness of avoidable blindness. Increase surgical uptake of cataract and trachomatous trichiasis. Build the capacity of local eye care providers. Decrease the impact of barriers

3. Methods: Intervention Control 40 KM Capital and Hospital

4. Major Model Components: Conduct of Community Health Education Screening and Referral of Eligible Cases Capacity Building of Local Eye Care Providers Breaking Down Barriers to Service Utilization Helping People to Seek Service Decrease the Blindness Burden

5. Seven Health Education Messages Magnitude and causes of avoidable blindness (with a special referral to the area). Identification of the two main targeted diseases; Cataract Trichiasis. Hygiene issues and maintaining good eye health. Detailed message about cataract including; different types, causes, manifestations and availability of treatment (surgical procedures). Detailed message about trachoma in children; infection, causes, prevention, complications, and treatment. Detailed message about Trichiasis and its causes, treatment and complications. Specific message about gender issues, why we focus on females and the impact of reducing gender gap.

6. Results: The KAP Gap

7. Results: Comparing Pre to Post Intervention Prevalence of Low Vision and Blindness.

8. Results: Comparing Pre to Post Intervention Gender Specific Prevalence of Low Vision and Blindness (Intervention Villages). Pre InterventionPost Intervention

9. Results: Comparing Pre to Post Intervention Prevalence of Cataract Pre InterventionPost Intervention Intervention Control

10. Results: Comparing Pre to Post Intervention Prevalence of TT Pre InterventionPost Intervention Intervention Control

11. Results: Comparing Pre to Post Intervention Prevalence of Barriers to Eye Care Service Utilization S.Barrier No (%). reported Yes Difference 95% CI p PrePost 1I didn't feel a problem77 (87.5)104 (70.7)16.80%(6.71 - 26.89)0.0051 2Fear of Surgery78 (90.7)97 (66.4)24.30%(14.48 - 34.12)0.0001 3Fear of Surgical Outcome78 (90.7)83 (63.8)26.90%(16.61 - 37.19)< 0.0001 4I am too Old75 (87.2)59 (51.8)35.40%(23.82 - 46.98)< 0.0001 5Fear of Bad treatment at hospital59 (68.6)44 (41.1)27.50%(13.97 - 41.03)0.0003 6Distance to hospital is too long62 (72.9)52 (48.1)24.80%(11.46 - 38.14)0.0009 7Expenses of surgery are too much76 (89.4)66 (54.5)34.90%(23.87 - 45.93)< 0.0001 8No one to accompany me to hospital47 (56)42 (40)16.00%(1.8 - 30.2)0.041 9I couldn't quit work to go36 (42.4)44 (42.3)0.10%(-14.06 - 14.26)0.8933 10No one to take care of family and children32 (37.6)25 (30.1)7.50%(-6.76 to 21.76)0.3877

12. Results: Comparing Pre to Post Intervention Prevalence of Female Specific Barriers to Eye Care Service Utilization S.Barrier Reported Yes, No (%). Difference 95% CI p PrePost 1I didn't feel a problem58 (86.6)69 (68.3)17.60%5.44 to 29.760.015 2Fear of Surgery60 (90.9)65 (64.4)26.50%14.87 to 38.130.0002 3Fear of Surgical Outcome62 (93.9)57 (60.6)33.30%21.86 to 44.74< 0.0001 4I am too Old56 (84.8)39 (47.6)37.20%23.35 to 51.05< 0.0001 5Fear of Bad treatment at hospital39 (70.9)32 (39)31.90%15.91 to 47.890.0005 6Distance to hospital is too long48 (73.8)38 (46.9)26.90%11.66 to 42.140.0018 7Expenses of surgery is too much60 (90.9)43 (49.4)41.50%28.91 to 54.09< 0.0001 8No one to accompany me to hospital35 (53.8)29 (35.4)18.40%2.46 to 34.340.0387 9I couldn't quit work to go29 (43.9)29 (38.2)5.70%-10.51 to 21.910.6044 10No one to take care of family and children25 (37.9)16 (26.2)11.70%-4.39 to 27.790.2228

13. Results: Comparing Pre to Post Intervention Surgery Uptake

14. Important Limitations Lack of well trained local cadres. Considerable percentage of errors in screening. Difficulty to change perceptions, behaves and norms. Lack of equipment at local hospital. Community mistrust of local providers. Difficulty to dissolve persistent barriers. Inflexibility of some MoH bylaws. Inability to calculate exact figures for comparisons. Percentage of error in relating the improvement in service uptake to the intervention. Degree of precision in calculating accurate win rates. Community expectations exceeded the program capacity.

15. Important Conclusions and Recommendations: Interventions to control blindness should be integrated to cover different aspects. Major avoidable causes should be prioritized then Targeted. A pre intervention community assessment should include: – Current situation analysis. – Understanding community in terms of perceptions and barriers. Community health education is a quite successful tool. Community volunteers and area residents are the best candidate to deliver such messages. Using program logic models adds a lot of value in planning and evaluation processes.

16. Important Conclusions and Recommendations contin’d: Conduct of pre and post intervention assessments helps in evaluation of the model and its components. Capacity building of local providers enables absorption of the increase in demand and re-build confidence. Participatory development approach that engages the community would guarantee sustainability. Gender sensitive approach accelerates the prevention and control processes. Sustainability of results should be incorporated in the plan a priori.

17. So, what’s next Encourage developing countries to adopt and implement gender sensitive interventions. Widening the range of national and international collaborators (ex. Including other ministries; education, scientific research, water and sanitation, etc. Research to develop and document more action oriented research for prevention of blindness. Incorporation of prevention of blindness activities into primary health care activities. Paying special attention to training and capacity building research.

18. Funders and Collaborates Funders & Supporters: Funders & Supporters: – The Canadian Institute for Health Research (CIHR-IGH). Canada. – British Columbia Centre for Epidemiologic and International Ophthalmology (BC-EIO). Canada. – Al Noor Magrabi Foundation. Egypt. – Magrabi Eye Care Group. Egypt.