Will Bilkis see again?
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Transcript of Will Bilkis see again?
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Will Bilkis see again?
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Bilkis revisited
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Her suffering could have been avoided
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Childhood BlindnessRarer than blindness in adultsTotal number of blind-years suffered by blind
children is second only to that due to cataract in adults
Reliable data is not available from all geographic regions
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Childhood BlindnessPossible sources of dataAvailable data on childhood blindness in
India - prevalence & causesChange in the trend over time
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Prevalence - Sources of dataBlindness RegistrationBirth cohort studiesSurveillancePopulation based surveyCommunity Based Rehabilitation (CBR)
programme
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Community Based RehabilitationPrevention and treatment of preventable and
treatable visual impairmentRehabilitation of incurably blind individuals
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CBRBaseline door-to-door surveys of whole
populationVisual screening by qualified
ophthalmologists and optometristsIncludes all age groups
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Estimation of Prevalence of blindness using U5MRs
U5MR/1000
Estimatedprevalence
Example countries
0-19 0.3 UK, Sweden
20-39 0.4 Argentina, Thiland
40-59 0.5 Honduras, Vietnam
60-79 0.6 South Africa, Brazil
80-99 0.7 Zimbabwe, Papua New Guinea
100-119 0.8 Kenya, Nepal
120-139 0.9 Sudan, Laos
140-159 1.0 Tanzania, Albania
160-179 1.3 Nigeria, Central AfricanRepublic
180+ 1.5 Niger, Bhutan
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Prevalence of Childhood Blindness in India0.61/1000 children(95% CI0.51-0.82) in
Andhra Pradesh (CBR)0.51/1000 children(95% CI 0.37-0.65) in West
Bengal (CBR)1/1000 children(95% CI 0.094 - 0.106) in
Orissa (Survey)1/1000 children (East Delhi)1.06/1000 children (Karnataka)
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Prevalence of Childhood Blindness in some countries
Country Categoryof visualimpairment
Prevalence/1000
Agegroup inyears
Source ofdata
Year
Scandinavia
<3/60 0.15 –0.41 0-15 Registration
1992
Iceland variable 0.36 0-14 Survey 1980
UK <6/60 0.34 10 Cohortstudy
1988
India <3/60 0.51 -0.65 0-15 CBR 1998
Nepal <3/60 0.63 0-16 Survey 1980
Nigeria <3/60 1.00 5-14 Survey 1994
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Distribution of Severely Visually Impaired and Blind Children in the World
Region Population(0-15yrs.) inmillion
Estimate ofprevalenceper 1000
Estimated no.of SVI/Blindchildren
Africa 240 1.1 264000
Latin America 130 0.6 78000
NorthAmerica,Europe,Japan,Oceania,former USSR
240 0.3 72000
Asia 1200 (350 inIndia)
0.9 (0.8 inIndia)
1080000(270 000 inIndia)
Total 1810 1494000
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Incidence of Childhood BlindnessInsufficient informationIn industrialized countries 2/100,000
children/year due to acquired diseasesGlobally 500,000 children become blind every
year50 - 60% blind children die early in their
childhood
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Classification of Causes of Blindness in ChildrenAnatomical
Classification - Takes into account the part of the eye most affected
Aetiological Classification - Takes into account the time of onset of the condition leading to blindness
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Causes of Childhood Blindness - Sources of Data used in India
Blind School StudiesCBRPopulation based Survey
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Causes of SVI & Blindness in children from all the reported studies in India
Causes CBRN %
Blind SchoolsN %
TotalN %
WholeGlobe
36 29 530 25 566 25
CornealOpacity
14 11 607 28 621 27
Lens 17 14 239 11 256 11
Uvea 11 9 107 118 5
Retina 23 18 467 21 490 22
Optic Nv. 16 13 122 6 138 6
Glaucoma 3 2 64 3 67 3
Others 5 4 22 1 27 1
Total 125 100 158 100 2283 100
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Some recent findings from different parts of IndiaCongenital whole globe abnormality is as
high as 41% in MaharastraVAD is still a major cause of blindness in
North EastUncorrected Refractive error is major cause
of blindness among children in West Bengal in Sarva Siksha Abhiyan ( universal education drive), - unpublished . Results from surveys in Gujarat and west Bengal in 2005 also shows similar results.
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Aetiological CategoriesAetiologicalCategory
CBRN %
Blind SchoolsN %
TotalN %
Hereditaryfactors
13 24 552 26 565 26
Intra-uterinefactors
4 8 35 15 39 2
Perinatalevents
2 4 35 15 37 2
Childhoodfactors
8 5 622 29 630 28
Unknowncauses
26 49 914 42 940 42
Total 53 100 2158 100 2211 100
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Commonest Causes of Blindness in Children in IndiaCorneal scarring mainly due to VADCongenital anomalies of the whole globe,
usually of unknown cause, but where genetic factors may play a role
Retinal dystrophies mainly hereditaryCataract and amblyopia
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Regional Variation in the major causes of blindness in schools for the blind in India
State VAD Retinal dystrophies/ Albinism
Cataract/Aphakia/Amblyopia
Congenital anomalies
No. of Children % % % % Gujarat(97) 21.6 9.2 11.3 17.3 MP(101) 26.7 11.9 3.9 18.8 Haryana(141) 15.6 25.5 5.7 20.6 UP(134) 21.6 6.7 2.9 32.8 WB(89) 24.7 11.2 16.8 19.1 Maharastra(157) 20.4 13.8 12.7 17.2 Karnataka(122) 11.5 23.7 6.5 28.7 Kerala(93) 7.5 33.2 23.6 6.5 TN(384) 18.5 25.5 9.8 20.6
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Avoidable Childhood Blindness in IndiaUp to 30% Preventable20% causes treatable
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Corneal Blindness among students of Blind Schools in West Bengal
0
5
10
15
20
25
30
35
40
16-19 yrs. 11-15 yrs. 0-10 yrs.
Whole GlobeCornea
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Change of trend in the causes of childhood blindness in IndiaCorneal blindness is decreasingCongenital whole globe abnormalities are
becoming proportionately higherROP is likely increase in urban areasUncorrected refractive errors could be a
major cause if detected properly
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How to reach children- IssuesNeed vs. availability of serviceNeed vs. uptake of serviceAvailability of service vs. affordability
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Ways to reach childrenSchool health programmeThrough health workers working in MCHICDS – helps early detectionCBROutreach campsKey informantsPublic education in various formsNetworking with physiciansUtilising Immunisation daysSensitising all levels of workers even
priests
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Motivating ICDS workers
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Training ICDS Workers
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Childhood blindness survey
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Why Early Rehabilitation?When a mother brings a visually impaired
child to a doctor she doesn’t know whether the disease is curable or incurable. She needs help.
All our efforts to restore vision may fail, but we should not fail to give proper guidance to parents about the child’s overall development.
Outcome is always better if the process is started early
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Low vision devices have greater role to playExhaust maximum medical management and
continue follow-upFind out suitable LVD (optical and non
optical) at the earliest opportunityGive overall training
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Low Vision Assessment in camps
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Practical approachAwareness generationActive Case finding utilising all sourcesEarly interventionIndividualised approachMaking devices affordable
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Computer Braille training centre (2002), VMA School for the Blind
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Integrated Education for a Blind child
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Sakera at Victory Stand
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Thank you