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Prevalence and causes of blindness and Low Vision in Ethiopia
Y Berhane, A Worku, A Bejiga, L Adamu, W Alemayehu, A Bedri, Z Haile, A Ayalew, Y Adamu, T Gebre, T D Kebede, E West, S West
Ethiopian Journal of Health Development , 2007,
Abstract: Background: Ethiopia lacked accurate recent national estimates of blindness and low vision. Therefore, prevention and control programs face serious problem of lack of recognition of the problem and challenges in tracking achievements towards program goals. Objective: To determine the prevalence of blindness and low vision at the national and regional levels in Ethiopia. Method: A national survey was conducted on a representative population in all nine regional states and two city administrations of the country. The LogMar chart was used to determine the presenting visual acuity and ophthalmologists determined the primary cause of low vision and blindness. Results: Based on the assessment of the presenting visual acuity, the national prevalence of blindness is 1.6% (1.1% for urban and 1.6% for rural populations) and that of low vision is 3.7% (2.6% for urban and 3.8% for rural populations). Blindness and Low vision are more prevalent among females. The major causes of blindness are cataract and trachomatous corneal opacity. The major causes of low vision are cataract and refractive error. Prevalence of childhood blindness is 0.1% and accounts for over 6% of the total blindness burden in Ethiopia. The national prevalence of Bitot\'s spots is 0.7%. Conclusion: Blindness and low vision are major public health problems in Ethiopia. The large proportion of low vision (91.2%) and blindness (87.4%) are due to avoidable (either preventable or treatable) causes. Females and rural residents carry greater risk for eye problems. Adequate emphasis needs to be given to prevent blindness among children and avert millions of years of unnecessary blindness. Recognizing the severity of the magnitude of eye problems (blindness and low vision) and enhancing the government commitment to improve the situation is critical. Ethiopian Journal of Health Development Vol. 21 (3) 2007: pp. 204-210
Prevalence of Cataract Blindness in Rural Ethiopia
A Woldeyes, Y Adamu
Ethiopian Journal of Health Development , 2011,
Abstract: Background: Over three-quarter of all blindness worldwide are preventable and usually caused by cataract and trachoma. Objective: To assess the prevalence of cataract blindness in rural Ethiopia in order to facilitate further health care planning. Methods: A Cross-sectional, community-based study of inhabitants over 40 years of age from villages in the Abeshge and Kebena Districts, south of Addis Ababa. A total of 1100 eligible participants were identified in the study. Visual acuity (VA) was measured using a Snellen’s E chart at 6 metres and eye examinations were performed using torch light, 2.5 X magnifying glasses and an ophthalmoscope. Cataract was defined as lens opacity identified as the cause of blindness and low vision after ruling out other causes. Unfortunately, there was no access to a refraction set and slit lamp to conduct thorough examinations. Results: The adjusted prevalence of bilateral cataract blindness (VA<3/60) was 2.4%, 95% confidence interval [CI], 1.8%–3.0%. Cataract is the major cause of bilateral blindness (66.7%) among the participants. The cataract surgical coverage was 28.9% for men and 18.1% for women. The adjusted prevalence of bilateral cataract and VA<6/60 was 3.6% (95% CI, 1.4%–5.8%). In this last group, the surgical coverage was 41.2% (persons) and 38.5% (eyes). Of all operated eyes, 30% could not see at 6/60. Inability to afford the procedure (64.5%) and poor knowledge of cataract (29.8%) were the reasons why surgery had not been performed. Conclusions: Cataract blindness is a major health problem in the study area with low surgical uptake. There is backlog of cataract blindness in the study area that will increase with ageing. This backlog was also reflected in other developing countries. Awareness campaigns, reducing cost, and expansion of surgical services may help to increase the cataract surgical rate, and women should be offered more cataract surgery. These results will enable health managers to plan effective interventions in line with Vision 2020. [Ethiop. J. Health Dev. 2011;25(2):156-160]
Rapid trachoma assessment in Kersa District, Southwest Ethiopia
M Ejigu, MM Kariuki, DR Ilako, Y Gelaw
Ethiopian Journal of Health Sciences , 2013,
Abstract: Background: Trachoma is the leading cause of infectious blindness worldwide. Though trachoma can be treated with antibiotics (active trachoma) or surgery (trachomatous trichiasis), it is still endemic in most parts of Ethiopia. Despite the prevalence of this infectious disease in different parts of the country, district level data is lacking. This study was thus conducted to assess the prevalence estimate of trachoma and its risk factors in Kersa District, Southwest Ethiopia. Methods: A community based cross sectional Rapid Assessment of Trachoma was conducted using a WHO guideline. Six sub-districts were selected from Kersa District based on primary high risk assessment and from each sub-district; 21-27 households were randomly selected. Active trachoma for children aged 1-9 years, trachomatous trichiasis for people above 15 years old and environmental risk factors for trachoma were assessed. Data were analyzed using SPSS version 16. Results: The overall prevalence estimate of active trachoma was 25.2% (95% CI: 20.7-30.4%). Forty three percent of children had unclean faces, 11.5% of households had water source at more than half hour walking distance, 18.2% did not have functional latrine, and 95.3% of the households had solid waste disposal within a distance of 20 meters. Households with environmental risk factors were at an increased risk to active trachoma, but the association was not statistically significant (p>0.05). The prevalence estimate of trachomatous trichiasis inclusive of “trachoma suspects” was 4.5%. Conclusion: Trachoma is endemic in Kersa District with active trachoma being a public health problem in the studied sub-districts. Hence, SAFE strategy should be implemented.
Screening for ocular abnormalities and subnormal vision in school children of Butajira Town, southern Ethiopia
Yoseph Worku, Samson Bayu
Ethiopian Journal of Health Development , 2002,
Abstract: Background: As in most African countries there is no national preschool or school eye screening service in Ethiopia. The purpose of this study was to conduct school eye screening in Butajira town to identify the causes of ocular morbidity and subnormal vision in school children and suggest possible intervention strategies. Methods: A cross-sectional study of 1846 students from Mekicho (1397) and Dobo-tuto (449) junior and elementary schools of Butajira Town selected by systematic random sampling of the sections of each grade was performed from Sep.13 to Nov.11, 1999. Visual acuity and detailed ophthalmologic examinations were done. Results: One or more ocular abnormalities were found in 62.6% of the students. Trachoma was the leading cause (54%) of ocular morbidity, followed by refractive error (11.8%), strabismus (4.4%), non-trachomatous acute conjunctivitis (2.3%), corneal opacity (1.3%), Xerophthalmia (1.1%)and Vernal keratoconjunctivitis (0.7%). Refractive error was the leading cause of low vision. Conclusion: Trachoma is a public health problem in the community, hence mass mobilization and the WHO comprehensive SAFE strategy has to be implemented. Concerned government bodies as well as NGOs should take the initiative of providing those children with refractive error with low cost eyeglasses. Health education and yearly school eye screening by local health personnel will prevent common causes of blindness and visual impairment. [Ethiop.J.Health Dev. 2002;16(2):165-171]
Prevalence and Causes of Blindness and Low Vision in Southern Sudan  [PDF]
Jeremiah Ngondi ,Francis Ole-Sempele,Alice Onsarigo,Ibrahim Matende,Samson Baba,Mark Reacher,Fiona Matthews,Carol Brayne,Paul M Emerson
PLOS Medicine , 2006, DOI: 10.1371/journal.pmed.0030477
Abstract: Background Blindness and low vision are thought to be common in southern Sudan. However, the magnitude and geographical distribution are largely unknown. We aimed to estimate the prevalence of blindness and low vision, identify the main causes of blindness and low vision, and estimate targets for blindness prevention programs in Mankien payam (district), southern Sudan. Methods and Findings A cross-sectional survey of the population aged 5 y and above was conducted in May 2005 using a two-stage cluster random sampling with probability proportional to size. The Snellen E chart was used to test visual acuity, and participants also underwent basic eye examination. Vision status was defined using World Health Organization categories of visual impairment based on presenting visual acuity (VA). A total of 2,954 persons were enumerated and 2,499 (84.6%) examined. Prevalence of blindness (presenting VA of less than 3/60 in the better eye) was 4.1% (95% confidence interval [CI], 3.4–4.8); prevalence of low vision (presenting VA of at least 3/60 but less than 18/60 in the better eye) was 7.7% (95% CI, 6.7–8.7); whereas prevalence of monocular visual impairment (presenting VA of at least 18/60 in better eye and VA of less than 18/60 in other eye) was 4.4% (95% CI, 3.6–5.3). The main causes of blindness were considered to be cataract (41.2%) and trachoma (35.3%), whereas low vision was mainly caused by trachoma (58.1%) and cataract (29.3%). It is estimated that in Mankien payam 1,154 persons aged 5 y and above (lower and upper bounds = 782–1,799) are blind, and 2,291 persons (lower and upper bounds = 1,820–2,898) have low vision. Conclusions Blindness is a serious public health problem in Mankien, and there is urgent need to implement comprehensive blindness prevention programs. Further surveys are essential to confirm these tragic findings and estimate prevalence of blindness and low vision in the entire region of southern Sudan in order to facilitate planning of VISION 2020 objectives.
Know-how of primary eye care among Health Extension Workers (HEWs) in Southern Ethiopia
Y Hailu, A Tekilegiorgis, A Aga
Ethiopian Journal of Health Development , 2009,
Abstract: Background/ Aim: Frontline health personnel can play key role in preventing and controlling blindness if they have good understanding of primary eye care (PEC). This study determined knowledge, attitude and practice of PEC among health extension workers (HEWs) in southern Ethiopia. Methods: A cross sectional community based study was conducted between June and July 2007 in five randomly selected woredas of Gurage Zone. Quantitative data were collected using a questionnaire completed in a face-faceinterview with 111 HEWs. And this was supported with qualitative information from two focus group discussions. Result: HEWs (87%) had poor understanding of the functional definition of blindness. They identified cataract (85%), trachoma (96%) and trauma (64%) as causes of blindness. Although most (89%) correctly mentioned signs and symptoms of trachoma, but only 10% could describe its control strategy. Refractive error was wrongly perceived by most (77%) as only a near vision problem. Glaucoma was barely known but causes of childhood blindness were well identified.. Their main source of information for eye health care was pre-service training (50%) and refresher trainings by international organizations (46%). HEWs practiced mainly preventive aspects of PEC. Group discussions revealed that HEWs have good will to participate in PEC but barriers such as inadequate knowledge and lack of basic supplies are limiting their contribution. Conclusion: Know-how of blinding eye disease among HEWs is too low to enable them contribute meaningfully towards prevention of blindness. It is recommended that PEC be incorporated in their training curriculum.
The epidemiology of low vision and blindness associated with trichiasis in southern Sudan
Jeremiah Ngondi, Mark Reacher, Fiona Matthews, Francis Ole-Sempele, Alice Onsarigo, Ibrahim Matende, Samson Baba, Carol Brayne, Paul Emerson
BMC Ophthalmology , 2007, DOI: 10.1186/1471-2415-7-12
Abstract: A population based survey was undertaken and eligible persons underwent eye examination. Visual acuity (VA) was tested using Snellen E chart and persons with TT identified. Vision status was defined using the WHO categories of visual impairment based on presenting VA: normal vision (VA ≥ 6/18 in better eye); low vision (VA < 6/18 but ≥ 3/60 in better eye); and blindness (VA < 3/60 in better eye). An ordinal logistic regression model was fitted and age/sex specific distribution of vision status predicted.Overall 341/3,567 persons examined had any TT. Analysis was based on 319 persons, 22 persons were excluded: 20 had both TT and cataract; and 2 had missing VA data. Of the 319 persons: 158(49.5%) had trichiasis-related corneal opacity (CO); bilateral TT and bilateral CO were found in 251(78.7%) and 110 (34.5%), respectively; 146 (45.8%) had low vision or blindness; the ratio of low vision to blindness was 3.2:1; and no sex differences were observed. In our model the predicted distribution of vision status was: normal vision, 53.9% (95% CI 50.9–56.9); low vision, 35.3% (95% CI 33.3–37.2); and blindness, 10.9% (95% CI 9.7–12.0).We have reported severe trichiasis and high prevalence of vision loss among persons with trichiasis. Our survey showed that almost 1 in 20 of the entire population suffered low vision or blindness associated with trachoma. The need for trichiasis surgery, trachoma prevention services, and rehabilitation of the blind is acute.The World Health Organization (WHO) estimates that 1.3 million people world wide are blind due to trachoma [1] and 7.6 million have trichiasis, the potentially blinding stage of the disease, in 55 countries [2]. In southern Sudan, the magnitude and prevalence of active trachoma and trachomatous trichiasis (TT) are among the highest in the world. In areas surveyed so far, mean prevalence of active trachoma in children aged 1–9 years was 64% while trichiasis prevalence in persons aged 15 years and above was 9.2%, thus making bl
Current state of active trachoma among elementary school students in the context of ambitious national growth plan: The case of Ethiopia  [PDF]
Molla Gedefaw, Ali Shiferaw, Zelalem Alamrew, Amsalu Feleke, Tsegaw Fentie, Kiros Atnafu
Health (Health) , 2013, DOI: 10.4236/health.2013.511238
Abstract: Trachoma is a classical disease of poverty. It is still the second leading cause of blindness in Ethiopia. Cognizant of the poor living condition of its people, every effort of the current government of Ethiopia is geared towards eradication of extreme poverty. The main aim of this study was to assess the current status and correlates of active trachoma among elementary school students. A cross sectional school-based study was conducted in Dangla town administration in the month of March 2012. Multistage sampling technique was employed. Pre-tested structured questionnaire and eye examination were data collection tools. The data were collected by health professionals especially trained for eye care. The data were analyzed using SPSS version 16 for windows. Possible associations, and statistical significance between, and among variables were measured using odds ratio at 95% confidence interval. The study indicated that overall prevalence of active trachoma was 12%. The multi-variate analysis revealed that those children with unclean face were seven times more likely to develop active trachoma than those with clean face (AOR = 7.07, 95% CI: 3.36-14.96). Moreover, children who didn’t use soap to wash their face were two times more likely to develop active trachoma than those who claimed to use soap to wash their face (AOR = 2.03, 95% CI 1.72-3.01). In short, the prevalence of trachoma is lower than the figures in previous survey reports in the region and at national levels; however, the risk factors remain the same. The struggle to eradicate extreme poverty should continue in a sustainable manner so that diseases of poverty including trachoma could be eliminated altogether.
Trachoma and women: latrines in Ethiopia and surgery in Southern Sudan
Paul M Emerson,Lisa Rotondo
Community Eye Health Journal , 2009,
Abstract: Although there may be an underlying biological reason that more women are affected by trachoma and trichiasis, the role of women as childcare providers is a likely cause. In most countries where trachoma is endemic, girls grow up in environments where one of their primary activities is taking care of their younger family members and siblings. This continues into adulthood, with women carrying the main responsibility of caring for children. During their lifetime, women therefore spend more time in direct contact with children who may be infected. Ethiopia and Southern Sudan are two locations with an exceedingly high burden of trachoma. Projects focusing on environmental improvement (in Ethiopia) and increasing access to surgery (in Southern Sudan) have made significant progress towards reducing the impact of the disease on women. These examples show how trachoma programmes can address the particular needs of women while designing interventions aimed at eliminating blinding trachoma in the community as a whole.
The Burden of Trachoma in South Sudan: Assessing the Health Losses from a Condition of Graded Severity  [PDF]
Hebe Gouda ,John Powles,Jan Barendregt,Paul Emerson,Jeremiah Ngondi
PLOS Neglected Tropical Diseases , 2012, DOI: 10.1371/journal.pntd.0001538
Abstract: Introduction Trachoma is a disease that can lead to visual impairment and ultimately blindness. Previous estimates of health losses from trachoma using the Global Burden of Disease methodology have not, however, included the stage prior to visual impairment. We estimated the burden of all stages of trachoma in South Sudan and assessed the uncertainty associated with the severity and duration of stages of trachoma prior to full blindness. Methods The prevalence of trachoma with normal vision, low vision and blindness in the Republic of South Sudan has been estimated previously. These estimates were used to model the incidence and duration of the different stages employing DISMOD II. Different assumptions about disability weights and duration were used to estimate the Years Lived with Disability (YLD). Results We have estimated the total burden of trachoma in South Sudan to be between 136,562 and 163,695 YLD and trichiasis with normal vision contributes between 5% and 21% of the total depending on the disability weight applied. Women experience more of this burden than men. The sensitivity of the results to different assumptions about the disability weights is partly dependent upon the assumed duration of the different disease states. Interpretation A better understanding of the natural history of trachoma is critical for a more accurate burden estimate.
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