National Diabetic Retinopathy Screening and Treatment Guidelines for Nigeria

At the end of January 2023, the Federal Ministry of Health hosted a two-day Stakeholders’ Workshop in Lagos to develop the National Diabetic Retinopathy Screening and Treatment Guideline for Nigeria.

The objectives of the Workshop were:

• To review and update the first draft of the Diabetic Retinopathy Screening and Treatment Guideline to ensure that the guideline recommendations are consistent with the national plan for blindness prevention, as outlined in the National Eye Health Policy 2019
• To design an implementation plan for piloting DR screening and treatment services once the Guideline was ratified.

Stakeholders participating in the Workshop

The stakeholders participating spanned government organisations, NGOs, professional associations, civil society and pharmaceutical companies. It included the Federal Ministry of Health (FMOH)’s National Eye Health Programme (NEHP) and Non-Communicable Diseases Division (NCDs), the National Health Insurance Agency (NHIA), National Primary Health Care Development Agency (NPHCDA), WHO, CBM International, Eye Foundation Hospital, IAPB, DR-NET – the global Diabetic Retinopathy Network established by the LINKS Programme at the International Centre for Eye Health (ICEH) UK – the Ophthalmological Society of Nigeria (OSN), Nigerian Optometric Association (NOA) and Nigerian Ophthalmic Nurses Association.

Issues affecting screening and treatment for DR in Nigeria

A number of fascinating presentations helped to set the scene for the Guideline discussions.

They included a talk by Professor Odorosa Uhumwangho of the University of Benin on the global and national burden of diabetes and DR. She noted that prevalence rates for diabetes in Nigeria range between 4.6-7.0% in urban areas. The Nigeria National Blindness and Visual Impairment Survey found that one-fifth of persons with diabetes have DR. She concluded that close collaboration amongst all stakeholders and a multidisciplinary team-based approach is required to tackle the heavy burden of DR in Nigeria.

Dr Chimezie Obi-Mgbam, Deputy Director of the NEHP, outlined the development of DR services in Nigeria. He highlighted the role of the VISION 2020 LINKS Programme and DR-NET (https://www.dr-network.org/) in strengthening capacity for DR service delivery in Lagos and Calabar over many years. He mentioned the welcome attention given to DR by professional associations such as the OSN and NOA. Growing interest in DR from all quarters had led to the NEHP convening the first DR Stakeholders’ Workshop in 2019 and while the pandemic had inevitably slowed down progress, it was now back on track.

Prof Dennis Nkanga of the University of Calabar Teaching Hospital outlined current issues in Nigeria, explaining that screening protocols and available treatment services vary across the country. DR screening activities were of variable quality, using different grading criteria and referral thresholds, hence the importance of this national Guideline.

From ICEH, LSHTM, UK, Dr Cova Bascaran, Technical Lead for DR-NET, outlined the patient’s journey towards prevention of blindness from DR and the need for key elements, such as effective treatment services, to be in place before screening PLWD. She emphasised the need for a nationally relevant Guideline specifically for Nigeria to ensure integrated, coordinated, high-quality services for PLWD.

Outcomes of stakeholders’ workshop

After two days of talks, discussions and focused work in break-out groups, the stakeholder group agreed the next steps and timeline towards finalising and disseminating the Guideline, followed by training health personnel and piloting the Guideline in selected states.

Welcoming the progress made in developing the Guideline, Dr Oteri Okolo, Head of the NEHP, FMOH, said “This guideline provides detailed instructions on how to screen for diabetic retinopathy, diagnose it, and what treatment options are available. It also highlights the need for different healthcare professionals to work together to provide effective screening and treatment services.”

In support of the development, Dr Olutomi Sodipo, WHO Country Representative, stated that “WHO is committed to supporting the FMOH and partners towards the implementation of priority activities in diabetes prevention and control, especially as it relates to eye health as well as the prevention and control of NCDs as a whole”.

Partners present – including WHO, Novartis, and Roche – gave their commitment to helping further the campaign against DR and other eye health issues in Nigeria.

For further information:

Dr Oteri Okolo, Head, NEHP, FMOH, Nigeria: [email protected]

Dr Cova Bascaran, DR-NET Technical Lead, VISION 2020 LINKS Programme, ICEH: [email protected]