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WORLD SIGHT DAY: THE STATE OF EYE CARE DELIVERY AND VISUAL MORBIDITY IN GHANA
World Sight Day (WSD) is a global event that focuses attention on blindness and vision impairment. Observed on the second Thursday of October each year, the primary goals of WSD are to raise public awareness of blindness and vision impairment as major public health challenges, to influence governments to participate in and commit funds to programs which target blindness prevention or sight restoration programs, and to educate the public on blindness prevention, and to generate support for VISION 2020-related programs. On this day, all major professional groups involved in eye care delivery; the Ghana Optometric Association, The Ophthalmological Society of Ghana, and the Ophthalmic Nurses Group organize programs to commemorate the occasion.


As WSD is observed, it is rational that the state of eye care and visual disability/impairment is made known to stake holders involved in eye care delivery and the public at large. This article thus seeks to discuss briefly, eye care delivery in Ghana with emphasis on human resource, epidemiology of visual impairment/blindness and some impacts of visual impairment.


Eye care delivery in Ghana
Eye care services in Ghana are rendered by government hospitals and clinics, facilities within the Christian Health Association of Ghana (CHAG), and private facilities (Drislane, Akpalu, & Wegdam, 2014). Approximately one-third of Ghana’s health facilities are operated under private ownership. In fact, a McKinsey study in 2008 found that over 50% of health service provision in Ghana is delivered by the private sector.


The eye care team in Ghana primarily comprises ophthalmologists, optometrists, and ophthalmic nurses. Currently, there are 91 ophthalmologists, 370 optometrists, and about 500 ophthalmic nurses in the country. These numbers are woefully inadequate for a country with a population of about 27 million people. Compounding the issue of inadequate eye care professionals is the inequity in the distribution of available care professionals. According to 2013 Ghana Health Service statistics, about 75% of eye care professionals are concentrated in the urban areas leaving rural dwellers with limited access to eye care.


The country’s eye care system is financed by four main sources: Government of Ghana, internally generated funds, development assistance for health, and out-of-pocket expenditures made by households. Overall, the health care delivery system in Ghana is seemingly underdeveloped with significant proportion of the population having limited access to basic health care services.


Epidemiology of blindness and visual impairment in Ghana
Ghana has a seemingly higher prevalence of visual disability. According to World Health Organization estimates, the prevalence of visual impairment in Ghana is 27 per 1,000 population (approximately 720,000 people) and prevalence of blindness of 9 per 1,000 population. Approximately 1% of the Ghanaian population suffers severe visual impairment (Ghana National Blindness and Visual Impairment Study, GNBVIS, 2017).


Overall, cataract is the leading cause of blindness in Ghana, accounting for 45 - 50% of the burden of blindness in 2013. The prevalence has marginally increased as a more recent survey conducted between February 2015 and November 2016 by the GNBVIS Group found a cataract prevalence rate of 54.8%, translating to approximately 112,000 cases of blindness resulting from cataract. According to a 2008 report of the National Eye Care Unit (NECU), approximately 48,000 new cases of cataract blindness are recorded each year in the country.


Glaucoma is the leading cause of irreversible blindness in Ghana. The country ranks high among the most affected countries in the world for glaucoma. A study by Ntim-Amponsah and colleagues found the prevalence of glaucoma among adult Ghanaian population is 8.4%, second only to St. Lucia’s 8.8%. The seemingly higher prevalence of glaucoma visual impairment could partly be attributed to late presentation of patients to eye care facilities. For instance, a survey at Bawku Presbyterian Hospital found that among patients seen for the first time and diagnosed of glaucoma, 34% were irreversibly blind (GHS, 2013).


Refractive errors (short-sightedness, long-sightedness, and astigmatism) remain the leading cause of visual impairment blindness in Ghana. In the recent study by the GNBVIS Group to profile blindness and visual impairment in Ghana, refractive error was found to be the leading cause of visual impairment in Ghana, accounting for 44.4% percent of visual impairment cases.


According to data at NECU, the topmost 5 eye conditions seen in Ghana, based on number of patients seen in outpatient departments: are acute red eye, refractive error, cataract, glaucoma, and uveitis. In fact, acute eye conditions rank among the top 10 causes of outpatient morbidity in the country.


Prevalence of visual disability is higher in rural regions than urban regions. The lower accessibility of eye care professionals and facilities (GHS, 2013) could account for the uneven distribution of the prevalence of visual disability in Ghana. The fact that poverty has a significant association with visual disability, and most of the 24.2% of the population who live under the poverty line inhabit deprived, rural areas (Central Intelligence Agency, 2016) also explains this pattern of distribution of visual impairment.


Several factors account for this seemingly high prevalence of visual impairment in Ghana. The overall limited number of eye care professionals in Ghana is a major contributing factor to visual disability in Ghana. Most eye diseases and conditions such as refractive errors, trachoma, cataract, and to an extent, glaucoma results in disability only when the affected is unable to access eye care services. With the limited eye care workforce in a country with a positive annual population growth, the prevalence of visual impairment is not expected to reduce significantly anytime soon. Self-medication and reliance of unorthodox eye care practices by some people also contributes to the higher prevalence of visual impairment resulting from infection. There are several anecdotal reports people resorting to the use of breast milk, sea water, urine, and herbs as forms of medication to treat certain eye infections. These practices perhaps delay case resolution, worsen the conditions and subsequently results in impairment.


Impacts of Visual impairment
Visual impairment has negative impacts on the affected individuals and the nation at large. Visual impairment causes a considerable economic burden (direct and indirect) for affected persons, their caregivers and society at large. Direct economic loss to the affected persons and their care givers derives from the considerable costs incurred in the provision of surgical and non-surgical interventions. Indirect economic loss results from considerable absenteeism at work due an affected person’s inability to work or a caregiver’s unavailability to work, resulting in diminished economic productivity (Köberlein, et al., 2013). More often than not, persons with blindness are unable to partake in economic discourse with the end result being extreme poverty. In fact, a positive association has been found between productivity loss among caregivers and the magnitude of visual impairment since time spent by caregivers increases with the extent of vision loss.


In addition to the aforementioned, also affected by visual impairment are one’s mental health and cognitive abilities. In fact, persons with visual impairment have higher risk for depression, anxiety, and other psychological problems (Kempen et al., 2012). Visual impairment also impacts negatively academic attainment. It is worthy of note that children with visual impairment are more likely to have poor academic performance (Kulp et al., 2016). Uncorrected refractive errors are largely implicated in visual impairments’ association with poor academic performance. Children with uncorrected refractive errors may experience blurred vision, headache during reading, sore eyes, itchy eyes and tearing. School children with these symptoms have a propensity to be less engaged in academic-related activities, hence the diminished academic attainment.


Last but not least, visual impairment significantly affects the activities of daily living (reading, socializing, pursuing hobbies, etc.) of persons with visual impairment. It results in loss of social independence and reduction in mobility which leads to reduction in one’s quality of life (QOL). It must be stressed that QOL diminishes with the onset of visual impairment (Rein et al., 2007).


Conclusion
Visual impairment is a bane of Ghana’s socioeconomic development. The government of Ghana and all stakeholders in the eye care delivery system should be more proactive in efforts to make eye care more accessible to underserved areas and to reduce the spate of visual disability. Equally important is the need for all the eye care professional sub-groups to forge greater collaborations to maximize their output in the quest to reduce the overall prevalence rates of blindness and visual impairment in Ghana.


Contributing Authors:
Dr. Kwaku A. Osei, O.D.
Dr. Justice A. Akpabla, O.D.
Dr. Yvonne Adu-Agyeiwaah, O.D.

CHINA is "colonising" smaller countries by lending them massive amounts of money they can never repay, it's been claimed. The country is accused of leveraging massive loans it holds over small states worldwide to snatch assets and increase its military footprint. Developing countries from Pakistan to Djibouti, the Maldives to Fiji, all owe huge amounts to China. 

Already there are examples of defaulters being pressured into surrendering control of assets or allowing military bases on their land. Some are calling it "debt-trap diplomacy" or "debt colonialism" - offering enticing loans to countries unable to repay, and then demanding concessions when they default.

Sri Lanka provided a prime example last year. Owing more than $1billion (£786million) in debts to China, Sri Lanka handed over a port to companies owned by the Chinese government on a 99-year lease.

And Djibouti, home to the US military’s main base in Africa, also looks likely to cede control of a port terminal to a Beijing-linked firm. America is eager to stop the Doraleh Container Terminal falling into Chinese hands, particularly because it sits next to China's only overseas military base.

Last March ex-Secretary of State Rex Tillerson said Beijing encouraged "dependency using opaque contracts, predatory loan practices, and corrupt deals that mire nations in debt and undercut their sovereignty". A report from The Center for Global Development offers some insight into the spreading China debt.

It shows how infrastructure project loans to the likes of Mongolia, Montenegro and Laos have resulted in millions or even billions in debts, which often account for huge percentages of the countries' GDPs. Many of these projects are linked to the "Belt and Road" initiative - a bold project to create trade routes through huge swathes of Eurasia, with China at the centre.

Participating countries often undertake work on roads and ports with part-funding from China. More recently, China's debt empire has been rearing its head in the Pacific, prompting fears the country intends to leverage the debt to expand its military footprint into the South Pacific.

Beijing's creation of man-made islands in the disputed South China Sea for use as military bases suggests the concern may be warranted. In April China made these intentions more obvious - approaching Vanuatu about setting up a military base.

Australia expressed alarm at this move, which would effectively increase Chinese military presence on a key gateway to Australia’s east coast, The Times reports. Vanuatu owes £191million to China, according to one think tank. Among the projects this money funded was the largest wharf in the South Pacific - considered capable of accommodating aircraft carriers.

Tonga also carries some big debts and has already admitted to struggling with repayments. Tongan PM Akilisi Pohiva said on Wednesday that he was concerned Beijing was preparing to seize assets from his country. He urged other Pacific islands to join voices in calling for loan write-offs.

Two loans from China's Export Import Bank totalling more than £91million equal a quarter of the country's GDP. He told Australia's ABC: “It has become a serious issue. We have debt distress.”

Pohiva said with China debt becoming so prolific, it was no longer a problem to be dealt with individually. He added: “I think these small countries will eventually come together to find a way out.”

China defended its lending practices, saying they were "sincere and unselfish", and insisting it only lent to countries that could repay. Tonga is one among a list of South Pacific countries that have taken on debt in recent years.

Sydney’s Lowy Institute think tank, which has closely monitored China’s activities in the Pacific, estimates Beijing has poured nearly £1.4billion into Pacific countries since 2006. Other big debtors include Papua New Guinea, which owes roughly £498million in development and aid debt, Fiji, which owes £496million, and Samoa, with debt of £181million.
By Gerard du Cann -The Sun

President Buhari has assured Nigerians of his administration’s commitment to return the country to the path of peace and prosperity. He also said it was wrong to blame leaders alone for the present state of affairs in the country.

The President, who spoke at the graduation ceremony of Senior Course 40 of the Armed Forces Command and Staff College, Jaji, Kaduna State, assured of his administration’s efforts to take Nigeria to higher. “May I assure you of this administration’s effort to return our country on the path of peace and prosperity,” he said.

Buhari, who recalled his campaign promises during the last general elections, assured of his administration’s commitment to return the country to the path of peace and prosperity. He said: “I made three key promises to Nigerians. First is to address the various security challenges facing our country; second, to reposition our economy and third to fight the serious challenge of corruption, which had eaten so deep into the very fabric that sustain our nation.

“On the issue of security, we recognize that security challenges abound in all countries of the world, including Nigeria. I am certain, with the consistent efforts of our security agencies; these challenges shall be considerably mitigated and minimized.”

The President said the citizenry cannot be absolved of the blame as well in the nation’s woes. His words: “The change we desire in Nigeria actually starts with us as individuals. In Nigeria, there is the tendency to lay the blame for the state of affairs in the country on the doorsteps of leaders alone.

“Yes, leaders have a major role to play in providing direction and the enabling environment. However, the citizens’ role also is vital in attaining meaningful transformation of any society.” The President hailed the military for their sacrifice, saying:

“Over the years, the Nigerian Armed Forces have provided the appropriate response to the numerous security challenges facing our country. “Their response to Boko Haram insurgency, militancy, kidnapping, activities of separatists and armed militias, amongst others, have been very commendable.

“The military has also committed huge resources towards stability of the West African sub-region and world peace in general. “Our efforts in Liberia and Sierra Leone, which stabilized the West African sub-region readily come to mind.

“More recently, our armed forces have also contributed to the peace in The Gambia, Mali and South Sudan. “It, therefore, goes without saying that a force that is extensively committed to the maintenance of local, national, regional and world peace needs to be adequately prepared to confront security challenges as they emerge.”

Buhari said his administration will give attention to training in the military. His words: “It is pretty obvious that our dear nation is having its fair share of security challenges. “However, it is important to reiterate that capacity building remains the bedrock of combat ready, effective and efficient military.

“Incidentally, our tri-service training institutions, especially the Armed Forces Command and Staff College Jaji, have been playing critical roles in this regard.b“These institutions, as well as the single-service training institutions, must continue to be provided with the requisite support to enable them to discharge their obligations.

“To this end, the Federal Government will continue to give priority to the training and welfare of officers and men of our armed forces. “This is not only because we salute their courage and sacrifice for the safety and stability of our country, but because the armed forces of Nigeria have continued to be the bastion of our unity.”

The President also said he was delighted to observe that amongst the graduating students are 11 international officers from various African countries. He, therefore, called for partnership among African countries to tackle security challenges facing the continent.

Grainy video circulating on social media this week shows two women — one with a baby on her back and another holding hands with a young child — walking across a dirt patch. Armed men walk behind them, and one yells in French “You are B.H., you are going to die.”

The men blindfold them and force them to kneel. Then they raise their rifles and shoot them.

Since the video began to be shared widely this week, questions have arisen over who the perpetrators and victims are, and where and when it was recorded. The Washington Post was unable to verify where the video was filmed or who appears in it.

But Amnesty International released a statement this week saying that its experts have “gathered credible evidence that it was Cameroonian soldiers depicted in a video carrying out the horrific extrajudicial executions of two women and two young children.” The human rights group says the video was probably shot in Cameroon's far north region, where Cameroonian forces have been fighting to push back Boko Haram extremists over the past several years.

The Post was unable to reach the Cameroon Embassy in Washington for comment, but Issa Tchiroma Bakary, a spokesman for the Cameroonian government, told reporters this week, that “the video … is nothing but an unfortunate attempt to distort actual facts and intoxicate the public."

“Its sincerity can be easily questioned,” he said of the video, calling it “fake news.” Reuters reported that Bakary also said the weapons and uniforms did not line up with those worn by soldiers in Cameroon's far north region.

The Cameroonian government said it would carry out an investigation, but Amnesty International has expressed fears it will not be impartial as the government has already not dismissed the video as not depicting their soldiers. In its statement this week, Amnesty also said that “both the weapons and uniforms of the soldiers in the video are indicative of the Cameroon army.”

In a phone call with The Post, Ilaria Allegrozzi, Amnesty International's Lake Chad researcher who covers Cameroon, said there are a number of key details that make the human rights group think the video was recorded in Cameroon and features Cameroonian soldiers as the perpetrators. She said in addition to their analysis of the uniforms and weapons, “the landscape really meshes” with scrubland in northern Cameroon, and the armed men are heard speaking Cameroonian-accented French. She said they accuse the women in the video of belonging to B.H., a common nickname in the region for Boko Haram.

“It's one of the worst videos I've ever watched, and I've watched many videos coming from perpetrators in the Boko Haram conflict, but this is really shocking,” she said. “Two kids are killed — one baby boy and one girl maybe 6 or 7 years old maximum.”

A presidential election is scheduled in Cameroon for October, and this week, longtime President Paul Biya announced he will run for a seventh term. Biya, 85, has been in office since 1982. Lately, the military has been struggling against extremists in the country's far north and against separatists in Cameroon's Anglophone regions.

Amnesty International has on other occasions accused authorities in Cameroon of abusing civilians in its fight against Boko Haram extremists. Last year, the group released a report documenting the arbitrary arrests and torture of civilians by authorities in northern Cameroon.

Allegrozzi said in relation to the execution video, “this dismissal by the Cameroonian authorities is pretty concerning.

“They said they'd open an investigation and already dismissed it as fake news without proving anything,” she said. “What we have seen in Cameroon is a climate of total impunity where any crime can be committed and no one will be held accountable.”

To be a parent in the Lake Chad region today is to live with two permanent fears. The first is that you’re unable to provide your family with the most basic elements to ensure their survival – food, water, shelter and healthcare.

The second is that your family may be taken away from you in the blink of an eye, either kidnapped, killed or lost in the chaos. This is what happened to Saratu. When the sound of gunfire reverberated through the town of Baga, north-east Nigeria, everyone fled for their lives. They had no time to pack possessions.

Saratu’s mother searched for her children. She found Saratu alone and crying. She took her to the lakeside and put her on a boat with others escaping the fighting. She ran back to look for her other children. By the time she found them, the boat had already left with Saratu.

Governments and humanitarians are meeting in Berlin this week to galvanise the response to the humanitarian emergency in Africa’s Lake Chad region. The high-level conference comes one week after UK Prime Minister Theresa May visited Nigeria. While May’s visit highlighted the ongoing ties between the UK and Nigeria, very few people are aware of the humanitarian emergency in the north-east of the country.

Since 2009, conflict has crippled parts of Nigeria, Niger, Cameroon and Chad. Around 2.4 million people have been forced from their homes, some multiple times. It is one of the most complex, devastating and far-reaching emergencies in 21st century in sub-Saharan Africa. Yet it receives scant attention.

Decimated healthcare
In order to understand the situation, you need to look at the underlying issues. The lack of basic infrastructure, even prior to the conflict, meant that access to health care was limited.

When fighting erupted in north-east Nigeria, healthcare workers fled and what few health facilities existed were abandoned. Many have subsequently been attacked – it’s estimated that more than half of healthcare facilities have been damaged. So you have a situation where an already weak healthcare system has been further decimated by violence. The result is an overwhelming demand for healthcare in areas that are difficult to access due to insecurity.

Climate change

If you want to see how climate change can wreak havoc on lives, take a look at Lake Chad itself. The lake, which straddles the four countries, has shrunk by 90 per cent since the 1960s, in part due to climate change. The entire region is getting drier. Rains are irregular and farmers can no longer depend on them. This has given rise to cyclical malnutrition. 

The insecurity in the region has compounded the food shortages. Fishermen can seldom access the lake, pastoral land has become unsafe, while farms have become inaccessible.

The upshot is that people can no longer provide for themselves and economic activity has ground to a halt. Lactating mothers and children under five are the most vulnerable. Emergency relief can help in the short term, but the damage has already been done. On one of my last trips to Nigeria, we visited villages where there were barely any children aged under five.

This is no natural phenomenon, no freak of nature. The truth is much sadder: most children under the age of five had simply perished due to a lack of food. Our focus, together with the Nigerian Red Cross, is to help communities provide for themselves: tools and seeds; cattle vaccinations, nets for fishermen; cash as capital for new businesses. With independence comes dignity. 

African solidarity

Conflict, in short, has exacerbated an already dire situation. Yet the Lake Chad region is also a place of great humanity. More than 90 per cent of those who have fled their homes have been welcomed into local communities, communities that are among the poorest in the world. It’s African solidarity at its best and an example for the rest of the world to heed. It’s our job to support these communities as well as those who have been displaced.

And what of Saratu?
Her story is intertwined with that of a lady called Hawa, who also fled Baga. As a refugee in Chad, Hawa took care of six children. Two were hers and four were children separated from parents. One day she found Saratu alone on a boat, crying. Saratu spent one year living in a makeshift camp under the loving care of Hawa. Eventually, the ICRC was able to reunite her with her step sister, using only names and photos.

This is far from an isolated example. The Red Cross is currently looking for around 17,000 missing people in Nigeria alone, including 7,100 children. In Saratu’s story you have a microcosm of the crisis: indiscriminate violence; the flight to safety; families torn apart; resilience and survival; the best of humanity.

The pledging conference in Berlin is right to highlight the need to address the root causes of the crisis and a more joined-up approach to humanitarian and development programming.

Ultimately, however, what people need more than anything is peace. They want to stand on their own feet. We owe it to the likes of Saratu and Hawa to at least afford them the opportunity to do so.

Mamadou Sow is the ICRC’s operations coordinator for Africa. He tweets @MamadouSowICRC​ 
INDEPENDENT

Cameroon’s President, Paul Biya, is clearly not ready to leave office as he has confirmed his candidacy for presidential polls slated for October 7th this year.

This will be his seventh consecutive mandate which will also extend his reign till 2025. It will, however, be the fifth universal suffrage with multiple candidates.

The octogenarian who is considered one of Africa’s longest-serving leaders made the announcement via his social media handles on early Friday morning.

“Dear Compatriots in Cameroon & the Diaspora, Aware of the challenges we must take up together to ensure a more united, stable & prosperous Cameroon, I am willing to respond positively to your overwhelming calls. I will stand as Your Candidate in the upcoming presidential election,” his post read.

Paul Biya of Cameroon, became President in November 1982, having served as Prime Minister since June 1975

Predecessor: Ahmadou Ahidjo
Presidential reign: 36 years. 43 years (PM and presidential era)

Our neighboring country Tanzania has started to build its own helicopters in a project that will see the first batch of such choppers taking into the sky sometimes in 2018.
The prototype model, a two-seater aircraft is already in its final stages of completion at the Mechanical and Engineering Department of the Arusha Technical College (ATC), a school which runs a fully-fledged factory producing various forms of machinery.

“We are complementing President Magufuli’s industrialization policy in pioneering the first locally made helicopters that will be available to ordinary residents at affordable prices,” wrote Tanzania Daily News quoting Engineer Abdi Mjema, who is behind the ATC chopper project.

“We had initially intended the two-seater helicopter to be used for surveillance, rescue and agricultural purposes. However, as the project takes shape, we may increase the airframes to carry more people for serious transportation,” said the engineer. The helicopter is currently 50 per cent complete and features the popular gasoline-powered VW flat engine on board. The motors, manufactured by Volkswagen in Germany, are the same used to make the ‘Robinson’ helicopters in the United States.
tanzania helcopter
“Once we get the aviation authority approval, we shall complete the most sensitive part of the helicopter — mounting the main rotor.This should be ready in three week’s time,” said Eng Mjema, adding that Arusha will set history as the first region to fly the first-ever Tanzanian manufactured helicopter in July 2016.

With a non-pressurised cabin, the Prototype ATC helicopter has a flying ceiling of 400 feet for starters, taking into consideration that Arusha is already at a higher altitude.
The engineer also added that the technical college can manufacture up to 20 helicopters per year. ATC will see an upgrade from being an ordinary technical college to being a fully-fledged factory, dealing in vehicle and heavy machinery repair and manufacturing.

The Tanzanian government is committed to helping the school achieve this dream and others.

On Saturday, a modern hydraulics laboratory worth $400,000 was launched at the college. The facility will be used for practical training in civil and irrigation engineering courses.
The laboratory will also be equipped with the latest technology that would ensure we train competent engineers.

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