Cataract in Children Attending Schools for the Blind and Resource Centers in Eastern Africa

doi:10.1016/j.ophtha.2008.12.020

Ophthalmology

Volume 116, Issue 5, May 2009, Pages 1009-1012

https://doi.org/10.1016/j.ophtha.2008.12.020 Get rights and content

Objective

The aim of this study was to describe results of a representative sample of children who have undergone cataract surgery in schools for the blind in 4 African countries.

Design

Cross-sectional study.

Participants

Children enrolled at schools for the blind in Kenya, Malawi, Tanzania, and Uganda.

Methods

We used a population-proportional-to-size methodology to select a representative sample of schools for the blind and annexes and included all the children attending the selected schools. Trained teams using standardized examination methods and a modified World Health Organization form examined the children. The form was modified specifically to collect information on outcomes of cataract surgery.

Main Outcome Measures

Operative status and postoperative visual acuity.

Results

Of 1062 children examined, 196 (18%) had undergone cataract surgery or had cataract as the major cause of visual impairment; 140 (71%) had bilateral surgery, 24 (12%) had unilateral surgery, and 32 (16%) had not had surgery. Of operated eyes, 118 (41%) had visual acuity ≥20/200. Intraocular lenses were implanted in 65% of the operated eyes. Eyes with intraocular lens were more likely to have better vision than those without (P for trend = 0.04). Amblyopia was the most common cause of poor visual acuity in children who had undergone cataract surgery.

Conclusions

The number of children in the schools who receive cataract surgery has increased greatly since 1995. The high rate of amblyopia highlights the critical need for programs to find children earlier and to ensure adequate follow-up after surgery. Without such programs, the value of training pediatric surgeons will not be fully realized.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Methods

For the purpose of this study, schools for the blind were defined as dedicated schools for children who are blind or have severe visual impairment. Annexes were defined as units for blind and severe visual impairment children, which are attached to regular schools; there are an increasing number of children in annexes in a number of countries as a step toward integration. Both types of schools are generally run by ministries of education. There are limited policies or guidelines regarding

Results

We examined 1062 children in 44 schools and annexes. Of these, 196 had been operated in one or both eyes for cataract or had cataract as the major cause of visual impairment. Of the 196, 32 (16%) had not had cataract surgery, 140 (71%) had undergone bilateral cataract surgery, and 24 (12%) had 1 eye operated. Among the 24, the fellow eye in one child was normal and the other fellow eyes were all blind or severely visually impaired.

Demographic information on the children is shown in Table 1.

Discussion

Childhood cataract is becoming increasingly important as an avoidable cause of blindness in eastern Africa. Two community surveys suggest that cataract was the single most important cause of blindness in children.6, 7 The VISION 2020 initiative emphasizes the need to address childhood blindness¹² and there have been increasing efforts to train pediatric ophthalmologists in eastern Africa. The World Health Organization suggests that pediatric cataract patients should undergo surgery at

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Survey on prevalence of cataract in selected communities in Limpopo Province of South Africa
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Citation Excerpt :
Population based surveys conducted in some African countries suggest that cataract is the major cause of blindness. In their study on cataract in children attending schools for the blind and resource centres Msukwa et al. in (2009) in a study conducted in Eastern Africa, found that over 18% of children had undergone cataract surgery or had cataract as a major cause of visual impairment [26]. Similar findings were also reported in Nigeria, whereby a survey was conducted on the risk of cataract among Nigerian metal arc welders and found that although there was an elevated risk of cataract among the welders compared to those who do not weld, but the association was not statistically significant [23].
Over three-quarters of all blindness worldwide are preventable and usually caused by cataract. However data on the prevalence and risk factors about cataract are not always available in South Africa. This study sought to determine prevalence and factors associated with cataracts in selected communities in Limpopo Province of South Africa.
A population-based cross-sectional survey was conducted on respondents aged 18 years and above in selected villages of Vhembe District. Visual Acuity (VA) was evaluated at 6 m using Snellen's E chart whilst eye examinations were conducted using torch light, 2.5 X magnifying lenses and an ophthalmoscope. Chi Squared tests (χ²) and Multiple Logistic Regressions (MLRs) were conducted to determine associations of different variables using STATA V 13 SE.
About 387 out 467 targeted respondents participated in the study. Household heads were the majority of the respondents (246; 63.6%). Cataract prevalence amongst respondents was estimated at 44% of which 261 (67.4%) were females with 3.1% of the respondents having permanent blindness. Cataract knowledge still remains low as 228 (58.9%) and Age of respondent, gender specific, marital status, occupation, and primary care giver were significantly associated with prevalence of cataracts.
There is an urgent need to improve eye care services so as to improve access to cataract surgery as soon as one is diagnosed. There is also need to conduct community awareness campaigns that are gender specific so as to improve community members’ knowledge on cataracts and ensure they develop proactive eye services seeking behavior. This would minimize chances of the community members suffering permanent blindness due to cataracts.
Is the existing knowledge and skills of health workers regarding eye care in children sufficient to meet needs?
2012, International Health
Citation Excerpt :
The level of knowledge and skills of health workers in this setting appears to be too limited to ensure that children receive appropriate and timely interventions. Delay in referral and intervention is a critical problem in Africa and contributes to childhood blindness.5,9 The lack of appropriate recognition and management (urgent referral) by primary health workers has been noted in other settings.3,4,10
Although uncommon, childhood blindness is a major contributor to blind-person years in Africa. Children with vision-related problems need urgent referral, but existing evidence suggests that there is delay in presentation. A pilot study in a random selection of government dispensaries in two districts of Kilimanjaro Region, Tanzania, was conducted to assess the knowledge and skills of primary healthcare workers regarding eye care needs of children. Questionnaires were administered to 16 healthcare workers, and in-depth interviews were conducted with 9 health workers and 2 key informants. Overall, 88% of workers recognised cataract in a picture, 63% knew that it required surgery but only 50% realised surgery was urgent. Only 38% recognised squint as needing referral and none considered this urgent. Moreover, 38% could correctly suggest a cause of a large corneal scar and 44% of workers believed that children with albinism need to attend schools for the blind. Poor knowledge of referral and treatment guidelines are likely due to a number of factors, including inadequate training and the rarity of childhood blindness. Primary eye care manuals should be reviewed to ensure that information regarding childhood blindness is adequate and appropriate. Referral pathways should also be revised.
Childhood cataract in sub-Saharan Africa
2012, Saudi Journal of Ophthalmology
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Interestingly, a recent survey of schools for the blind in Malawi, Kenya, Uganda, and Tanzania showed that among the 196 children with cataract enrolled at these schools only 32 (16%) had not had surgery23; a previous survey (1994) at schools for the blind showed that only almost no child with cataract had surgery.24 Not only has access to surgery expanded in these countries but the quality of surgery has also been good, judging by the fact that only 17 (10.4%) of the 164 operated children had vision loss due to surgical complications.23 Similarly, surgery for traumatic cataract in children has also been shown to have good results; in Kenya 1 month after surgery 65% of eyes had a vision of 6/18 or better.25
Investment by organizations and agencies has led to a growing body of evidence and information to assist ophthalmologists and others to meet the needs of children with cataract in Africa. The geographic distribution of research, training, and programme development across Africa has been uneven; investment has been greatest in eastern and southern Africa. Population based surveys (using key informants) suggest that 15–35% of childhood blindness is due to congenital or developmental cataract. There may be up to 82,000 children with non-traumatic cataract in Africa, with approximately 19,000 new cases each year.
Effective strategies to find and refer children are those that engage the community in case detection. Identification and referral does not automatically mean surgical intervention with distance to the surgical facility being the most common reason for failure to seek care. Surgical management has become more specialized and a team based approach has been adopted by many paediatric ophthalmologists and their programmes. Although many children still present late for surgery, outcomes of surgery are much improved from previous experiences. Research suggests that post-operative follow up, still a challenge, can be improved through adoption of specific strategies. There has been limited success in ensuring that children are placed in appropriate educational settings. While eye care professionals may feel their responsibility ends with clinical care, it is important for the paediatric eye care team to be engaged with educational and rehabilitation services.
Cataract in children in sub-Saharan Africa: an overview
2018, Expert Review of Ophthalmology
Unmet needs of cataract blind children in special schools in Southeast Nigeria
2018, Eye (Basingstoke)
The Use of Key Informant Method for Identifying Children with Blindness and Severe Visual Impairment in Developing Countries
2017, Ophthalmic Epidemiology

View all citing articles on Scopus

: Manuscript no. 2008-1131.

: Supported by SightSavers International, Nairobi, Kenya.

: Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

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Original articleCataract in Children Attending Schools for the Blind and Resource Centers in Eastern Africa

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Methods

Results

Discussion

J Cataract Refract Surg

Ophthalmology

Causes of childhood blindness: results from west Africa, south India and Chile

Eye

Causes of childhood blindness in east Africa: results in 491 pupils attending 17 schools for the blind in Malawi, Kenya and Uganda

Ophthalmic Epidemiol

Causes of severe visual impairment and blindness in children in schools for the blind in Ethiopia

Br J Ophthalmol

Causes of childhood blindness: results from schools for the blind in south eastern Nigeria

Br J Ophthalmol

Childhood blindness and low vision in Uganda

Eye

Original article
Cataract in Children Attending Schools for the Blind and Resource Centers in Eastern Africa