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Background: Control of blindness in children is one of the priorities of VISION 2020. Early detection of children needing eye services is essential to achieve maximum visual recovery. Even though training primary (community) Health care workers (PHC) should play an important role in early identification of children, it is not known how many of these workers leave after being trained, and whether those who remain continuing identifying children in the long term. The objectives of the study were to determine the attrition of primary health workers over a 3-year period after training, and to assess their knowledge and skills on cataract in children in southern Malawi. Methods: This was a cohort study that followed primary health care workers (health surveillance assistants) over a 3-year period from 2008 to 2011 and reassessed their attrition rates, knowledge and skills on cataract in children. Results: Among the 59 HSAs that were originally trained in 2008, 54 (92%) were interviewed and were found to be still working in the health sector. Knowledge regarding cataract blindness in children remained constant over the 3-year period, however, only two HSAs had reported identifying and referring children. Conclusion: Despite attrition among primary health care workers being low, only a few actually identify cataract children in the communities after being trained. Other innovative ways are needed to identify prevalent and incident cases in Malawi, as the use of HSAs is unlikely to be successful in addressing blindness in children.

Three-year follow up of primary health care workers trained in identification of blind and visual impaired children in Malawi