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M. Muhit, S.P. Shah, C.E. Gilbert, A. Foster; Causes of Blindness in Children in Bangladesh: Results From a National Study of 1,935 Children . Invest. Ophthalmol. Vis. Sci. 2006;47(13):710.
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© ARVO (1962-2015); The Authors (2016-present)
Data on the causes of blindness in children are required for rational planning, but are not available for Bangladesh, the world’s 8th most populous country. The objectives of this national cross sectional study were to identify the main anatomical site & underlying aetiology of blindness in children, & the main preventable and treatable causes.
Blind children (i.e. visual acuity <6/60 in the better eye; age <16 years) were recruited from all 64 districts over 1 year from August 2001, from the following sources: a) all special and integrated schools for blind children b) all community based rehabilitation (CBR) programs, and c) by Key Informants (trained community volunteers–KIs). Eye examinations were performed by one ophthalmologist (MM) and causes categorized using the World Health Organization’s classification system for children.
1,935 children were recruited with a median age 132 months and 63.1% boys. 1,847 (96%) children were from rural areas, and 1,839 (95%) had no other disability. Ascertainment was as follows: 394 (20.4%) from schools; 296 (15.3%) from CBR; 1,245 (64.3%) by KIs. 83.6% of children were blind by 5 years of age, 22.1% had a positive family history and 18% had consanguineous parents. 68.1% children had near acuity of <N30 in the better eye, while 6.3% had ≥N10. Disorders of the lens (mainly unoperated cataract) was the single commonest cause (31.4%), followed by corneal opacities (26.6%), whole globe anomalies (13.2%), retinal diseases (12.7%) and optic nerve disorders (8%). The underlying cause was unknown in >50%; childhood factors were responsible in 31.1%, and hereditary factors in 15%.
Overall 1,326 (68.5%) children were blind from avoidable conditions. Preventable causes were identified in 23.7% children: vitamin A deficiency 17.6%; measles 6.1%; meningitis 1.6%; harmful traditional practices 0.4%. Treatable conditions (36.9%) included bilateral unoperated cataracts 27.3%; poor outcome following cataract surgery 5.3%; glaucoma 4.2%.
There are estimated to be 40,000 blind children in Bangladesh, and the results of this study suggest that 69% of them are blind from avoidable causes. Primary health care and primary eye care need to be strengthened; more tertiary paediatric eye care centers need to be developed, and a public health education strategy put in place. Restoring sight to the 10,000 cataract blind children in the country, and preventing other causes of blindness in the 50 million children at risk, remains a major challenge.
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