The peculiar challenges of blindness prevention in Nigeria: a review article.

AIM: To describe the challenges peculiar to Nigeria in the implementation of vision 2020: the right to sight and to proffer solutions as to the way forward

METHOD: A review of the recently completed national blindness survey, current literature, and the advocacy experience of the Ophthalmological Society of Nigeria.

FINDINGS: The prevalence of blindness in Nigeria is 0.78%. Over 43% of these are blind from cataracts and a further 9% from uncorrected aphakia or complications of couching. 50% of all cataract interventions are carried out by itinerant couchers. Other major causes of blindness are glaucoma (16%) corneal opacities (12%), trachoma (4%), optic atrophy (3%) onchocerciasis (1%) and macular disease (1%). 70% of these are either preventable or reversible. Nigeria has a relatively favourable ophthalmologist/population ratio of about 2.8 per million, but has a low Cataract surgical rate of 300 per million per year. The reasons for this include a lack of ownership of blindness prevention programs, a lack of political will and parlous state of funding for vision 2020. There is an abdication of responsibility for both training and services on the part of government to the International NonGovernmental organisations. Teaching hospitals no longer generate enough patient surgical load to support training. We estimate it would cost N8.5 billion ($56.8 million) to sustain the WHO recommended Cataract Surgical Rate of 3000 per million per year in Nigeria.

CONCLUSIONS: Nigeria is not headed in the direction of meeting Vision 2020 targets. Advocacy involving funding through the MDGs, needs to be intensified.