Nigeria has the highest population of people living with diabetes mellitus (DM) in sub-Saharan Africa. As at 2013 the population of people living with DM stood at 4.9 million, of whom an estimated 1.7 million had diabetic retinopathy (DR). There is currently no national DR screening and treatment programme.
The economic burden of the management of DM without blindness in a low and middle-income country (LMIC) is already huge. When associated with visual impairment or blindness, the effects are devastating. A systematic review of studies emanating from sub-Saharan Africa showed the prevalence of DR in the region ranged from 21-33% among persons living with DM. As this mostly affects the economically active age group (20-60), its contribution to the avoidable blindness burden and economic consequences justifies its place as a priority VISION 2020 disease.
The Ophthalmology Departments at the University of Calabar Teaching Hospital (UCTH) and Lagos University Teaching Hospital (LUTH) in Nigeria, with the help of their VISION 2020 LINK UK partners – the Royal Wolverhampton NHS Trust and Bolton / Sheffield – gave themselves the task of setting up a DR service and training of the necessary health professionals for DR services in Calabar and Lagos.
Through the Diabetic Retinopathy Network (DR-NET), multidisciplinary teams from the Royal Wolverhampton NHS Trust have made three training visits to Calabar and progress is slowly being made towards a national DR programme and screening service.
The absence of equipment, especially fundus cameras and OCT machines in both centres, has greatly hampered the programmes. Efforts are currently being made to improve public understanding and encourage uptake of routine screening for DR. With equipment in place, one would expect a fourfold increase in the number of people being screened and, for those who need it, referral for treatment. Screening could be done daily by screeners instead of the current once-weekly screening clinic by an ophthalmologist.
The centres being set up in Calabar and Lagos would serve as pilot screening and treatment centres to demonstrate what is possible and strengthen the case for a national programme.
The current COVID-19 pandemic makes the provision of this equipment by government extremely unlikely. Our appeal is for two good functioning fundus cameras and two OCTs to kickstart the Calabar and Lagos DR screening programmes. If you have one of these to spare, please contact nick.price1001@gmail.com or marcia.zondervan@lshtm.ac.uk. You will be helping enormously to develop DR services for the underserved population in and around Calabar and Lagos.
