CHAPTER ONE
INTRODUCTION
Background to the Study
Millions of people living in Nigeria are cut off from the mainstream of economic and social development due to heavy burden of diseases. Among these diseases is glaucoma which is the result of too much pressure in the eye. It is usually believed to begin after the age of 40 (forty) years and is a common cause of blindness (Mohammed, 2001).
Responsibility for health care in Nigeria is shared among the constitutional tiers of government: federal, state and local. The local governments are supposed to take care of the primary level (emphasizing preventive Medicare), while state governments are responsible for the secondary level (emphasizing curative Medicare), and the federal government is in charge of the tertiary level of care (emphasizing referral Medicare) to which teaching and specialist hospitals belong. This implies that there are basically three health care levels in Nigeria: primary, secondary and tertiary health care levels. (Anyanwu, Oyefusi, Oaikhegn, & Dimowo 1997: 608).
In Nigeria, glaucoma constitutes a medical, public health and socio- economic problem. This is because Nigeria is found to be one of the most endemic countries in the world, accounting for a sizeable proportion of the global cases, with about 6.7 million patients with glaucoma worldwide (WHO, 1992). The damaging and insidious nature of glaucoma make it spread gradually without being noticed but causes serious harm.
The Basic Health Service (BHS) scheme formed an important health programme of the Third Development Plan (1975-1980) and Fourth Development Plan (1981-1985) of the Federal Government. Under the BHS the government intended to significantly improve the modern health care system of the country within the framework of a three-tier national comprehensive health care delivery system mentioned earlier. Record achievement from the implementation of the BHS shows increases in personnel and institutions. For example, the number of registered medical practitioners in Nigeria rose from 10,399 in 1981 to 16,145 in 1987 (Mbanefo, Soyibo & Anyanwu) 1996.
However, the unsuccessful implementation of the BHS programme made the federal government to embark on a new direction health care delivery which makes Primary Health Care (PHC) the focus. There was need for close involvement of the local governments, local communities, and individuals in the implementation of the PHC in collaboration with the other two tiers of government. Activities that formed part of the PHC include: National Programme on Immunization (NPI), Campaign against River blindness, Oral Rehydration Therapy (ORT), among others (FMH, 1988).
The incidence of glaucoma among adult patients refers to the rate of occurrence of this disease. In epidemiology the interest is in the number of new cases arising in a given period of time in a specified group of people.
The American Academy of ophthalmology (1983) notes that an estimated 2 million people have been identified as having glaucoma. Of these 889,000 are visually impaired, 67,150 are legally blind and each year an additional 5,500 people become blind from glaucoma. Equally, in 1997 glaucoma caused 36,000 hospital admission in America, 25 million office visits and more than $440 million spent on direct health cost on glaucoma.