Ocular disease and ophthalmic services in Malawi

About 1% of the population of Malawi is blind. The major contributors are cataract (40%), trachoma and other infections (15%) and measles/Vitamin A deficiency (15%). There are 3 ophthalmologists in government service. However, one serves as the director of medical services, and is therefore frequently burdened with administrative duties. In addition, one missionary ophthalmologist and 25 ophthalmic auxiliaries are available. Two of the ophthalmic auxiliaries are being trained to perform cataract surgery to aid the ophthalmologists in attacking the current backlog of approx. 24,000 blind cataract patients in the country. Trachoma and onchocerciasis are present regionally, although the latter by itself does not appear to be a major cause of vision loss. In children under age five, the major causes of blindness are measles and protein-energy-malnutrition (PEM) and its associated hypovitaminosis A. Previous surveys in Malawi have been either clinic/hospital-based or have been local population-based studies. In order to establish a realistic plan of preventive and therapeutic action, a comprehensive series of country-wide population-based ocular disease prevalence surveys is planned over the next five years. The information will enable the Ministry of Health to more equitably disperse trained ophthalmic personnel and to obtain appropriate supplies and drugs in a rational manner.