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Background: Maternal and child health workers (MCHWs) are often the first point of contact with pregnant women, children, and caregivers. Therefore, they can play a significant role in early detection of causes of childhood blindness, facilitate prompt referral to specialized centers and provide health education to caregivers for preventive eye care. Methods: This is a pre-test, post-test, single group, quasi-experimental study to evaluate the outcome of training MCHWs on common blinding childhood diseases. All MCHWs in Ifo Local Government Area were selected to participate in the study. Pre-training, qualitative data was obtained from two focus group discussions while quantitative data was obtained using a self-administered questionnaire. Three months post-training, quantitative data was obtained using the same self-administered questionnaire as was used pre-training. Total and percentage scores on the pre- and post-tests were calculated for each participant. A score of ≥70% was regarded as sufficient while < 70% score was regarded as insufficient. McNemar's test was used to determine differences in proportions between pre- and post-training quantitative measurements. Results: Of the 65 MCHWs in the Local Government Area, 61 participated in the study giving a response rate of 93.8%. The age range of study participants was from 28 to 57 years with a mean age of 41 ± 8.3 years. The male: female ratio was 1:7.7. During the focus group discussions, measles was the most commonly mentioned cause of childhood blindness however, participants showed more knowledge of the signs and symptoms of new-born conjunctivitis. Based on a sufficient knowledge score of ≥70%, only one participant (1.6%) demonstrated sufficient knowledge on quantitative survey pre-training. Post-training, there was a statistically significant increase (20, 32.8%) in the proportion of participants with sufficient knowledge (McNemar's test p =.000). Conclusions: This study demonstrated that the training of MCHWs on common childhood blinding diseases (such as congenital cataract and congenital glaucoma) had the potential to improve knowledge regarding prevention, prompt recognition and early referral of common treatable potentially blinding diseases.
This was a pre-test, post-test, single group quasi-experimental study. The study took place over a 3-month period (August–November 2016) in Ifo Local Government Area of Ogun State, Nigeria. The study population included primary healthcare workers who give direct health care to pregnant women and children in PHC facilities in Ifo Local Government Area. These are healthcare workers within the following cadres: Nurses/Midwives, Community Health Officers (CHOs) and Community Health Extension workers (CHEWs). Ethical approval was obtained from the Health Research Ethics Committee of the Lagos University Teaching Hospital (Protocol number: ADM/DCST/HREC/APP/1061; approval dates 08-07-2016 to 08-07-2017.) The study adhered strictly to the Helsinki declaration. Approval was obtained from Ifo Local Government Area Medical Administrator and written informed consent was obtained from all study participants. Purposive sampling was used to select two Maternal and Child Health Workers (MCHWs) [One nurse and one CHEW/CHO] per ward to participate in the focus group discussions. Nurses and CHEWs/CHOs from 10 wards balloted separately for one slot each. The 11th ward had primary health facilities manned by CHEWs only; one CHEW was selected from that ward by balloting. For the questionnaire survey, to achieve sufficient knowledge of common blinding eye conditions in children in 80% of MCHWs after training, a minimum sample size of 294 was calculated using the formula for comparison between two groups when endpoint is a qualitative variable [12]. The standard normal deviate was set at 1.96; the proportion of PHC workers with good knowledge of common eye diseases in a previous study was taken as 68.7% [13] while the desired level of precision was set at 5%. Considering this study assesses a finite population [14], the sample size was adjusted for the Finite Population Correction [15]. This yielded a minimum sample size of 53 which was further increased to 59 after allowance for 10% attrition. To further increase the power of the study, all willing and consenting MCHWs in Ifo Local Government Area that met the inclusion criteria were enrolled in the study. Pre-survey activities commenced with visits by the lead investigator to selected PHC facilities in Ifo Local Government Area. Following this, the study instrument (Pre-test and post-test questionnaires) and training curriculum were developed. Team members were then trained after which a pilot study to validate the study instrument was conducted at a PHC in a Local Government Area in the neighboring state (Lagos State). The pre-test, focus group discussions and training on childhood blindness were made to coincide with the monthly meeting at the Local Government Headquarters between the Medical Administrator and PHC workers. This provided the opportunity to access the entire MCHWs in the LGA at the same time. A pre-test was conducted on the 4th of August 2016. The pre-test was in the form of a self-administered questionnaire. The pre-test took place in the conference room at the Local Government headquarters. It was undertaken at the same time by all the study participants in the presence of the lead researcher and two research assistants. In the first section of the pre-test, study participants were asked to identify congenital cataract, congenital glaucoma and newborn conjunctivitis from colored pictures. The same eye conditions were presented in the pre-test and post-test however the pictures were different. The second section had 11 multiple choice questions which were the same in the pre- as well as the post-test. These assessed participants’ knowledge of the leading causes of childhood blindness (Measles, Vitamin A deficiency, eye injury, congenital cataract congenital glaucoma, and newborn conjunctivitis) as well as their signs and symptoms, treatment and prevention. In the third section participants were asked to choose between immediate referral and treatment for eye conditions assessed in the second part of the test. The last section of the questionnaire assessed barriers to child eye care. This was followed by two focus group discussions. The first focus group discussion comprised nurses only; the second focus group discussion took place immediately after the first and was comprised of CHEWs only. The segregation was done to ensure that discussants freely express themselves. The focus group discussions were conducted in English and they explored knowledge of the leading causes of childhood blindness, how these are identified, managed and prevented. A research assistant recorded the proceedings with a smartphone camera and a tape recorder. The lead investigator also took notes during the discussions. A training session was then provided (the curriculum for the training was developed by the authors using a modified version of the Prevention of childhood blindness teaching set [16] and also based on the Nigerian standing orders for CHOs and CHEWs [17]. The training consisted of a power point presentation followed by a practical session. After the training, the MCHWs were advised to keep a record of children with eye diseases that they see during the study period and referrals were to be made to a designated eye center within the local government. The lead investigator was to be informed of all referrals and her contact information was to be given to the referred children’s caregivers. These referrals were included in the data analyzed by the principal researcher. Educational materials in the form of booklets with pictures depicting common blinding childhood eye diseases to educate caregivers were given to the MCHWs. A post-test using the same self-administered questionnaire from the pre-test was administered 3 months after the pre-training on November 10th, 2016. Data was entered into IBM-SPSS version 23 (© Copyright IBM Corporation 2014 Armonk NY). Total and percentage scores on the pre- and post-tests were calculated for each participant. A score of ≥70% was regarded as sufficient while < 70% score was regarded as insufficient. The authors chose 70% as the threshold for “sufficient (Good)” and “insufficient (Poor”) scores because it is expected that the study participants should have average knowledge having undergone basic healthcare training whose curriculum is expected to have covered the common causes of childhood blindness. Further training should therefore aspire to impart above average knowledge with expectations of excellent scores ≥70%. McNemar’s test for two paired proportions was used to specifically examine changes pre- and post-training. Level of statistical significance was set at 5%. Data from the focus group discussions was transcribed from the audiovisual devices and comments entered into Microsoft Excel Version 3, 2016. Comments were arranged for each interview question such that answers from the two focus group discussions were together. Major themes were identified and illustrative quotes were noted.
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