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BADAS-ORBIS Eye Care Project

The project, “Strengthening eye care capacity in the peripheral hospitals of Diabetic Association of Bangladesh with emphasis on diabetic retinopathy services”, is being implemented by the Diabetic Association of Bangladesh (BADAS) and ORBIS International since July 2008. The goal of the project is “to contribute to the prevention of blindness due to diabetic eye diseases, especially diabetic retinopathy, by establishing treatment services (including surgery) for the rural people of Bangladesh” and, at the same time, organizing primary and secondary preventive measures through community awareness, focused intervention and generation of appropriate tools for health promotion.

The project started functioning in two districts i.e., in two sub-regional hospitals, namely Thakurgaon Swasthoseba Hospital (TSH) and Bogra Swasthoseba Hospital (BSH), and in two peripheral health care centers in Ranishonkail and Talara upazilas. There is a plan to extend its services Pabna gradually.During the period of the project designed, it was estimated that 3.8 million people, or 4.8% of the country’s population, suffered from diabetes.  It was also estimated that a quarter of the diabetic patients, or almost a million people, suffered from diabetic retinopathy (DR).  DR services were scarce and no screening program for DR existed in the country.

Our partner, Diabetic Association of Bangladesh (DAB) is the major provider in diabetes care, however, only about 15-20% of the estimated diabetic patients in the country have been brought under the regular health care services. All available services were concentrated in Dhaka and there was no DR Service for the population of 33 million living in the northern region of Bangladesh.  It was estimated that there were 1.5 million diabetic patients in that region, of whom about 500,000 were at any stage of DR. All these people needed to be examined for DR and had to be brought under counseling and treatment so as to prevent them from going blind.

Background

Now a day’s non communicable diseases (NCDs) poses considerable medical as well as socioeconomic burden all over the world and this is specially true for resource constrained countries like Bangladesh. Accordingly, early management and more particularly, prevention should be the cornerstone for NCDs-health care movement in such countries.

'Nutrition' plays a central role in the prevention and management of NCDs and other disorder associated with metabolic syndrome. The health care providers in developing countries, however, do not seriously acknowledge this fact in most cases and this leads to the unfortunate consequence of looking "health" as a purely “medical” issue. Blames are easily given to the policy makers and health care agencies, but the professionals and scientists cannot avoid their failure. Although limited in scope, efforts have often been taken in Bangladesh in improving nutrition of population within the major goal of health care reform, but most of these programs utterly failed in attaining their objectives.

One of the major reasons for such failure is that such programs were divorced with the chemical-biological, socioeconomic and cultural realities of the population that they addressed. Without primary data generated on the food items consumed, on the biological effects they produce on the specific population and on the knowledge, attitude and practices of the community concerned, any attempt for a nutritional reform program is bound to fail in producing optimum result.

Realizing the above facts, the Bio-Medical Research Group (BMRG) of BIRDEM (The central Institute of the Diabetic Association of Bangladesh) started, back in 1997, a comprehensive program on nutritional evaluation of local food materials with particular focus on chemical analysis and on glycemic index (GI) which has direct implication for prevention and management of DM and metabolic syndrome in general. The program also contained projects in studying issues related to Body Mass Index & Knowledge-Attitude-Practice in various groups of diabetic subjects.

The main goal of this project was to find out more basic research works from other reliable sources and translate the findings to promotional tools and strategies for improving the nutritional knowledge, attitude and practice (KAP) of the population in general and of the diabetic population in particular. As a whole this project targeted to reduce the prevalence of diabetic patients and other vulnerable groups through nutrition education, life style change, effective tools and strategies. BMRG which is now more popular in the name Bangladesh institute of health sciences (BIHS) is trying to involve mass people with the outcome of this project and implement all the research results among them as well sharing and improving more. Projects design

To achieve the goal mentioned above this project had some specific objective. These are:

  1. To accumulate existing information and knowledge on nutrition and diabetes (chemical, biological, cultural and socioeconomic) generated within the ENRECA supported BMRG program as well as from other sources.
  2. To translate those cumulated information and knowledge into culturally sensitive educational tools and strategies to promote better nutrition among general population, and
  3. To generate further data with a practical goal for enriching the tools and strategies.

To achieve the objectives of this project the whole working group was divided into 3 sub-teams with clarified type of works and the total program was coordinated centrally.

The responsibilities of the teams are:

Biological team
  • Compilation and standardization of the existing chemical and biological data related to nutrition in Bangladesh, already generated by BMRG or by other reliable institutes/groups, and continued generation of further data.
  • Identified the discrepancy of laboratory technology and using unit in practice.
  • Develop some user friendly tools for mass people.
Sociocultural team
  • Compilation of existing socioeconomic, cultural and behavioral data on dietary practices in Bangladeshi communities, and continued generation of data.
  • Identified the gaps between knowledge, attitude & practice (KAP) among subjects suffering from metabolic syndrome.
  • Prioritize important communication tools for upgrade participants KAP status.
Promotional Team
  • Transformation of all relevant information generated by the other two teams into popular formats for effective communications among various segments of the population.
    The team mainly gave the intellectual input and guidance and the actual technical works (e.g. design and development of audiovisual or multimedia programs or interactive software’s) were given to subcontracted appropriate partners.
  • Give emphasis on creating awareness among the different level of stakeholder/policy makers/scientists and researchers.

Summary Report of Last quarter (April 2012-June 2012)

Last quarter (April 2012-June 2012) a total of 12758 patients were examined in where 11721 people were medically treated. 1037 surgeries were performed and among these total no of 97 were LASER.
As a part of Human Resource Development Two Nurses were trained up on 3 (three) months long training on OT Management from Islamia Eye Hospital & MA Ispahani Institute of Ophthalmology, one Jr Technical Asst received 2 (two) months long exposure training on Vision, Refraction and OT Management and one Jr Technical Asst was trained 10 (Ten) days Training on Optical Dispensing from Fashion Optics Ltd during last quarter.

Major Targets

Under the coordination of the Project Leader the activities were implemented by the respective teams, linkage with DAB projects was the key for ensuring long-term sustainability/continuity. A large number (at least 40% of the 150 million people in Bangladesh) of lay people and professionals was expected to be benefited from the project. It was assumed somewhat like following:
1. Patients and relatives - 3 million targeted campaign and group programs 2. Doctors - 1200 (group program) 3. Paramedics - 600 (group program) 4. Nurses - 800 (group program) 5. Dieticians/ Educators - 100 (group program) 6. Mass people – 60 million (covered by satellite TV channel)

The assessment was planned to be done with the following tools

  1. KAP studies or different target groups to assess the impact of the promotional activities on lay people, patients, professionals and policy makers.
  2. Development, publication and dissemination of promotional materials (both printed and digital) – both qualitative and quantitative.
  3. Adaptation into the policy of Diabetic Association of Bangladesh
  4. Generation of new research data (to be translated into promotional campaign) as assessed by publications, presentations and postgraduate students.
  5. Attraction of alternate sources of support, particularly from the private sector for ethical promotion of nutritional knowledge in community through commercially sustainable activities.

  6. A large number of diabetic subjects and their family members are directly benefited from the project through educational program. A large number of health professionals improved their knowledge and method of patient handling after attending different programs taken under this project. Near 60 million of mass people are expected to be benefited from the TV promotional broadcasted by all the national and private satellite channels