Abstract
Objective: To estimate the prevalence and causes of blindness and severe visual impairment among children in Ntungamo district South-western, Uganda.Methods: This was a cross sectional community survey using the key informant method; approximately 200 village health team members were carefully selected and trained to screen for severe visual impairment using a torch, 6 meter string and a 6/60 E chart. They did house to house screening for severe visual impairment and blindness among children below 16 years in the whole district. Identified children were referred to a rendezvous point within the community to be examined further by the ophthalmologist. Data was collected using the standardized WHO childhood blindness data collection form. Proportions and causes of severe visual impairment and blindness were determined. Clinical and social characteristics were described.Results: A total of 59 children were identified, 15 with severe visual impairment and 44 with blindness. Mean age was 6.5 years (95% CI 5.3-7.4) and 59% of the children were male. The prevalence of blindness and severe visual impairment was 0.02% (95% CI 0.01-0.03). Causes were analysed by anatomical site, aetiology and specific diagnosis. Majority of the anatomical causes were due to cornea (18%) and lens (17%) abnormalities. With respect to specific diagnosis, 30% was cataract and cataract surgery complications and corneal scar. Overall, 72% of the blindness and severe visual impairment was due to avoidable causes.Conclusion: Prevalence of severe visual impairment and blindness was relatively low in this population. Lens and corneal abnormalities were the leading cause of blindness. Most of the cases of visual impairment and blindness were avoidable.
References
WHO, editor. Preventing blindness in children:
Report of a WHO/IAPB Scientific Meeting.
Preventing blindness in children: report of a WHO/
IAPB scientific meeting; Preventing blindness in
children: report of a WHO/IAPB scientific meeting;
: WHO.
Gilbert C, Foster A. Childhood blindness in the
context of VISION 2020: the right to sight. Bull
World Health Organ. 2001;79(3):227-232.
Resnikoff S, Pascolini D, Etya’ale D, Kocur I,
Pararajasegaram R, et al. Global data on visual
impairment in the year 2002. Bull World Health
Organ. 2004; 82(11):844-851.
Titiyal J, Pal N, Murthy G, Gupta S, Tandon R, et al.
Causes and temporal trends of blindness and severe
visual impairment in children in schools for the blind
in North India. Br J Ophthalmol. 2003; 87(8): 941-
J Ophthalmol East Cent & S Afr. July 2016; 20(1): 26-325. Dandona L, Dandona R. Revision of visual impairment definitions in the International Statistical Classification of Diseases. BMC Med. 2006; 4(1):7.6. Muhit MA, Shah SP, Gilbert CE, Hartley SD, Foster A. The key informant method: a novel means of ascertaining blind children in Bangladesh. Br J Ophthalmol. 2007; 91(8):995-999.7. Kalua K. Use of key informants in determining the magnitude and causes of childhood blindness in Chikwawa district, southern Malawi. Comm Eye Health. 2007; 20(61):8.8. Gogate P, Kalua K, Courtright P. Blindness in childhood in developing countries: time for a reassessment? PLoS Med. 2009; 6(12):e1000177.9. Dan B. Childhood blindness and its impact: key informant method in Bulambuli District, Eastern Uganda [Community key informant]. London: London School Trop Med Hygiene; 2011;10. UBOS. Census preliminary report. In: Affairs I, editor. Kampala: UBOS; 2014.11. Rosser D, Laidlaw D, Murdoch I. The development of a “reduced logMAR” visual acuity chart for use in routine clinical practice. Br J Ophthalmol. 2001; 85(4):432-436.12. Adoh TO, Woodhouse JM. The Cardiff acuity test used for measuring visual acuity development in toddlers. Vision Res. 1994; 34(4):555-560.13. Maida JM, Mathers K, Alley CL. Pediatric ophthalmology in the developing world. Curr Opin Ophthalmol. 2008; 19(5):403-408. 14. Knappe S, Schittkowski M, Schroder W, Hopkins A, Fichter N, Guthoff R. The currently most common causes of childhood blindness in Kinshasa (D. R. Congo). Klin Monbl Augenheilkd. 2007; 224(7):597-602. Epub 2007/07/28. Die gegenwartig haufigsten Ursachen der Kinderblindheit in Kinshasa (D. C. Kongo).15. UBOS. Uganda Population and Housing Census. In: affairs MoI, editor. Kampala: Government of Uganda; 2002.16. Mganga H, Lewallen S, Courtright P. Overcoming gender inequity in prevention of blindness and visual impairment in Africa. Middle East Afr J Ophthalmol. 2011;18(2):98-101. 17. Johnson JD. The epidemiology of eye diseases. CE QGG, JS R, editors. London2003.18. Gilbert CE, Wood M, Waddel K, Foster A. Causes of childhood blindness in East Africa: results in 491 pupils attending 17 schools for the blind in Malawi, Kenya and Uganda. Ophthalmic Epidemiol. 1995; 2(2):77-84. 19. Njuguna M, Msukwa G, Shilio B, Tumwesigye C, Courtright P, Lewallen S. Causes of severe visual impairment and blindness in children in schools for the blind in eastern Africa: changes in the last 14 years. Ophthalmic Epidemiol. 2009; 16(3):151-155. 20. Nallasamy S, Anninger WV, Quinn GE, Kroener B, Zetola NM, Nkomazana O. Survey of childhood blindness and visual impairment in Botswana. Br J Ophthalmol. 95(10):1365-1370. 21. Waddell KM. Childhood blindness and low vision in Uganda. Eye (Lond). 1998; 12 (Pt 2):184-192. 22. Duke R, Otong E, Iso M, Okorie U, Ekwe A, Courtright P, et al. Using key informants to estimate prevalence of severe visual impairment and blindness in children in Cross River State, Nigeria. J AAPOS. 2013; 17(4):381-384. 23. Randrianotahina HC, Nkumbe HE. Pediatric cataract surgery in Madagascar. Niger J Clin Pract. 2014; 17(1):14-17. 24. Ezegwui IR, Aghaji AE, Uche NJ, Onwasigwe EN. Challenges in the management of paediatric cataract in a developing country. Int J Ophthalmol. 2011; 4(1):66-68. 25. Courtright P, Lewallen S, Kanjaloti S, Divala DJ. Traditional eye medicine use among patients with corneal disease in rural Malawi. Br J Ophthalmol. 1994; 78(11):810-812. 26. Yorston D, Foster A. Herpetic keratitis in Tanzania: association with malaria. Br J Ophthalmol. 1992; 76(10):582-585. 27. Courtright P. Childhood cataract in sub-Saharan Africa. Saudi J Ophthalmol. 2012; 26(1):3-6. 28. Kong L, Fry M, Al-Samarraie M, Gilbert C, Steinkuller PG. An update on progress and the changing epidemiology of causes of childhood blindness worldwide. J AAPOS. 2012; 16(6): 501-507. 29. Demissie BS, Solomon AW. Magnitude and causes of childhood blindness and severe visual impairment in Sekoru District, Southwest Ethiopia: a survey using the key informant method. Trans R Soc Trop Med Hyg. 2011; 105(9):507-511.