Ocular needs in Africa: Increasing priorities and shrinking resources

Current demands for ophthalmic treatment services in Africa far outstrip available resources, especially in terms of ophthalmic surgeons. With a few exceptions, the gross national product per capita in African countries is less than US$500. Even in those petroleum economies where the figure is considerably higher, the wealth is grossly inequitably distributed. In a continent whose population is expected to double within 20 years, this means that the ratio of trained health worker to population is expected to become much greater rapidly. The money needed to expand the corps of specially trained health workers at a rate matching the expected population growth rate is non-existent. About 1% of the African population is blind. The three major causes are cataract, trachoma and glaucoma. These involve specific age groups of the population. Cataract, which causes roughly 40% of all blindness, mostly affects the over-60s. This group comprises 5% of the population. Glaucoma occurs mostly over the age of 40, i.e. in about 20% of the population. The trachoma 'reservoir', from which chronic re-infections arise, is the under-15 group, an alarming 42% of the population. The prevalence of trachoma is inversely related to access to safe water, a commodity generally available to less than half of the people in Africa, and especially limited in rural areas. Finally, nutritional blindness and its associated high-mortality protein energy malnutrition (PEM) affects the under-five segment, about 18% of the population. Given the inequities in expected population growth and possible health services growth, preventive activities in ophthalmology in Africa take on added and urgent meaning.