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Background: The prevalence of functional low vision in southeast Nigeria is reportedly the highest in the country. Aim: This study evaluated the state of low vision services and perceptions of providers and users of the service in tertiary hospitals in the region, to facilitate advocacy and planning. Methods: This was a cross-sectional survey of available low vision services in the nine tertiary hospitals in Southeast Nigeria utilizing mixed methods. Data were collected on human resources, service delivery, and low vision equipment and devices. In-depth interviews were conducted to determine the perceptions of providers and users of the service. Results: Varying levels of low vision services were actively provided in three of the nine hospitals surveyed. Services, equipment, and devices were suboptimally available. The three functional centers had a combined output of 61 patients seen within 6 months preceding the study and had at most two-thirds of required equipment. Low vision devices (LVDs) were available in varying degrees in only four (44%) of the hospitals. Twenty-one (7.6%) of the 278 eye care personnel had some low vision training across seven hospitals. The challenges highlighted by providers were mainly inadequate funding (infrastructure, training, and equipment), communication gaps, and bureaucracy. Poor awareness, affordability, acceptability, and accessibility of LVDs were major constraints for users. Conclusion: Low vision services are available in some tertiary facilities in southeast Nigeria. Improved funding and better awareness of the availability of low vision services by eye care providers and the general public are needed to strengthen services.

Summary box An estimated 253 million people are blind or visually impaired worldwide, 90% of whom live in low-income and middle-income countries (LMICs).1 In Nigeria, a LMIC, approximately 4.25 million adults are blind or visually impaired with over 80% of the blindness from avoidable causes.2 Cataract is the most common cause of blindness in Nigeria and is readily treatable by surgery. Refractive errors, which can readily be treated by spectacles, are the most common cause of visual impairment. However, the Nigerian national blindness survey showed that almost half of all eyes that had a procedure for cataract had been couched (a traditional procedure for clearing the visual axis as a treatment for cataract3), with poor visual outcomes and

Objective To assess knowledge and practice of primary eye care among primary healthcare workers known as community health extension workers in Funtua district of Nigeria. Methods Cross-sectional mixed method study among health workers employed in government-owned primary healthcare facilities. Quantitative data were obtained using self-administered questionnaires and checklists, while qualitative data by modified Delphi technique, role plays and observation. A score of 1 was given for each correct answer, while a total score of ≥60% was considered ‘good’. Results Eighty three of 88 health workers participated (94%) in the questionnaire survey; while 16 of them were selected for the qualitative survey. Good scores regarding the knowledge of common eye diseases were obtained by 68.7%, but only 26.4% of them could identify their most important features. Participants could undertake 3 of 5 steps in visual acuity testing. Skills in recognising common eye diseases and their management were weak; while practice was often not according to the guidelines. Conclusion Community health extension workers displayed good knowledge of common eye diseases. Areas of weakness are recognition and interpretation of eye signs, and practice rarely follows the guidelines. Preventive medicine was neglected; community health extension workers require practical retraining and supervision to achieve integration of primary eye care into primary healthcare services. Objectif Evaluer les connaissances et les pratiques dans les soins oculaires primaires chez les agents des soins de sante primaires appeles agents de vulgarisation de la sante communautaire dans le district de Funtua, au Nigeria. Methodes Etude transversale a methode mixte chez les agents de sante exercant dans les centres de soins de sante primaire gouvernementaux. Les donnees quantitatives ont ete obtenues au moyen de questionnaires et des listes de controle auto-administrees, tandis que les donnees qualitatives ont ete obtenues par la technique Delphi modifiee, des jeux de role et par observation. Un score de 1 a ete attribue pour chaque reponse correcte et un score total de ≥ 60% a ete considere comme «bon». Resultats 83 des 88 agents de la sante ont participe (94%) a l'enquete par questionnaire; 16 d'entre eux ont ete selectionnes pour l'enquete qualitative. De bons scores concernant les connaissances sur les maladies oculaires courantes ont ete obtenus par 68,7%; mais seuls 26,4% d'entre eux pouvaient identifier les caracteristiques les plus importantes. Les participants pouvaient entreprendre trois des cinq etapes du test d'acuite visuelle. Les competences dans la reconnaissance des maladies oculaires courantes et leur prise en charge etaient faibles, les pratiques n’etaient pas souvent selon les directives. Conclusion Les agents de vulgarisation de la sante communautaires affichent une bonne connaissance des maladies oculaires courantes. Les points de faiblesse sont la reconnaissance et l'interpretation des signes oculaires, et les pratiques suivent rarement les recommandations. La medecine preventive etait negligee; les agents de vulgarisation de la sante communautaires necessitent une reformation pratique et la supervision afin de parvenir a l'integration des soins oculaires primaires dans les services de soins de sante primaires. Objetivo Evaluar los conocimientos y las practicas de la atencion primaria en oftalmologia de trabajadores del sector primario conocidos como trabajadores sanitarios de extension comunitaria en el distrito de Funtua en Nigeria. Metodos Estudio croseccional de metodos mixtos entre trabajadores sanitarios empleados en centros sanitarios gubernamentales de primer nivel. Los datos cuantitativos se obtuvieron utilizando cuestionarios auto-administrados y listas de verificacion; mientras que los datos cualitativos se obtuvieron mediante una modificacion de la tecnica Delphi, juegos de roles y observacion. Se daba un puntaje de 1 para cada respuesta correcta mientras que un puntaje total de ≥ 60% se consideraba ‘bueno’. Resultados 83 de 88 trabajadores sanitarios participaron (94%) en la encuesta mediante cuestionario; 16 de ellos fueron seleccionados para el estudio cualitativo. Un 68.7% obtuvo un buen puntaje en conocimientos sobre las enfermedades oftalmologicas comunes, pero solo un 26.4% de ellos pudo identificar sus principales caracteristicas. Los participantes podian realizar 3 de los 5 pasos de evaluacion de agudeza visual. Las habilidades para reconocer las enfermedades oftalmologicas comunes y su manejo eran escazas; la practica a menudo no estaba acorde con las guias. Conclusiones Los trabajadores sanitarios de extension comunitaria mostraban un buen nivel de conocimiento de las enfermedades oftalmologicas comunes. Las areas mas debiles eran el reconocer e interpretar los signos del ojo; y la practica raramente seguia a las guias. La medicina preventiva estaba olvidada; los trabajadores sanitarios comunitarios requerian de un reentrenamiento practico y de supervision con el fin de alcanzar la integracion de la atencion primaria en oftalmologia dentro de los servicios de atencion primaria.