Pediatric Case Finding in Madagascar: A Controlled, Prospective Population-based Assessment of Key Informant
Jeannot Richard Rasoloniaina1, Richard Raberosoa1, Philippe Rakotondrajoa2
1FLM SALFA Fitsaboana Maso Antsirabe, Antsirabe, Madagascar.
Insights
Adding Key Informants (KI) to eye care outreach significantly increased the number of children screened for visual impairment and blindness. This strategy proved cost-effective, identifying more children needing services with only a modest rise in expenses.
Area of Science:
- Ophthalmology
- Public Health
- Global Health
Background:
- Key Informant (KI) case finding trains community members to identify children with eye problems.
- This method is common for referring children with visual impairment and blindness to services.
- Previous studies have not evaluated the benefit and cost of integrating KIs into routine outreach.
Purpose of the Study:
- To determine the benefit and cost-effectiveness of adding Key Informants (KIs) to routine eye care outreach activities.
- To assess the impact of KIs on the number of children identified with eye conditions, including visual impairment and blindness.
Main Methods:
- Four eye programs in Madagascar integrated KIs into a portion of their established outreach camps over one year.
- KIs recorded screened children and their attendance, while outreach personnel collected demographic, visual acuity, diagnosis, and treatment data.
- Costs associated with the KI program and outreach camps were systematically collected.
Main Results:
- Outreach camps with KIs identified significantly more children (average 61 vs. 24) and children with eye problems (average 50 vs. 19) compared to regular camps.
- KI camps identified more children with moderate to severe visual impairment or blindness (21 vs. 8 per 10 camps).
- KI camps incurred a modest additional cost of $463 per camp and $3 per child seen.
Conclusions:
- The Key Informant method substantially increased child participation in outreach camps across all visual impairment levels.
- This strategy effectively identifies more children with visual impairment and blindness.
- The KI approach offers a cost-effective enhancement to existing eye care outreach services.
Abstract:
Purpose: The Key Informant (KI) case finding method, which trains community members to screen children for eye problems and refer them to eye services, is a common strategy to identify and refer children with blindness and visual impairment. However, studies to date have not determined the benefit and cost of adding KIs to routine outreach activities.Methods: Four eye programs in Madagascar with established outreach camps added KIs to a portion of their camps distributed equally throughout their service region over a one year period. KIs recorded children screened and their attendance at an outreach camp. Outreach personnel used standardized registration forms to gather age, sex, visual acuity, diagnosis and treatment data. Costs were gathered for the KI program and outreach camps.Results: In one year, the 4 eye programs held 138 outreach camps, 43 with KIs. The KI camps were more productive than regular camps seeing an average of 61 and 24 children and 50 and 19 children with an eye problem, for KI and regular camps, respectively. The KI camps also saw more children with moderate or severe visual impairment or blindness with 21 and 8 children (per 10 camps) for KI and regular camps, respectively. A KI camp cost $463 ($642 vs. $179) more than a regular camp and $3 ($8 vs. $11) more per child seen.Conclusion: The KI method significantly increased the number of children attending outreach camps, at all levels of visual impairment and blindness, at a modest increase in costs.
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