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Review Article the Status of Childhood Blindness And [Downloaded free from http://www.meajo.org on Wednesday, January 07, 2015, IP: 41.235.88.16] || Click here to download free Android application for this journal Review Article The Status of Childhood Blindness and Functional Low Vision in the Eastern Mediterranean Region in 2012 Rajiv Khandekar, H. Kishore1, Rabiu M. Mansu2, Haroon Awan3 ABSTRACT Access this article online Website: Childhood blindness and visual impairment (CBVI) are major disabilities that compromise www.meajo.org the normal development of children. Health resources and practices to prevent CBVI are DOI: suboptimal in most countries in the Eastern Mediterranean Region (EMR). We reviewed the 10.4103/0974-9233.142273 magnitude and the etiologies of childhood visual disabilities based on the estimates using Quick Response Code: socioeconomic proxy indicators such as gross domestic product (GDP) per capita and <5‑year mortality rates. The result of these findings will facilitate novel concepts in addressing and developing services to effectively reduce CBVI in this region. The current study determined the rates of bilateral blindness (defined as Best corrected visual acuity(BCVA)) less than 3/60 in the better eye or a visual field of 10° surrounding central fixation) and functional low vision (FLV) (visual impairment for which no treatment or refractive correction can improve the vision up to >6/18 in a better eye) in children <15 years old. We used the 2011 population projections, <5‑year mortality rates and GDP per capita of 23 countries (collectively grouped as EMR). Based on the GDP, we divided the countries into three groups; high, middle‑ and low‑income nations. By applying the bilateral blindness and FLV rates to high, middle‑ and low‑income countries from the global literature to the population of children <15 years, we estimated that there could be 238,500 children with bilateral blindness (rate 1.2/1,000) in the region. In addition, there could be approximately 417,725 children with FLV (rate of 2.1/1,000) in the region. The causes of visual disability in the three groups are also discussed based on the available data. As our estimates are based on hospital and blind school studies in the past, they could have serious limitations for projecting the present magnitude and causes of visual disabilities in children of EMR. An effective approach to eye health care and screening for children within primary health care and with the available resources are discussed. The objectives, strategies, and operating procedures for child eye‑care are presented. Variables impacting proper screening are discussed. To reach the targets, we recommend urgent implementation of new approaches to low vision and rehabilitation of children. Key words: Childhood Blindness, Eastern Mediterranean Region, Functional Low Vision, Visual Disability INTRODUCTION illness and subsequent rehabilitation. It also includes the right of children with any kind of disability to special care and n 1989, the United Nations adopted a convention on the support.1 In 2009, a 20‑year review of the CRC identified Irights of the child (CRC). A major article of this convention various challenges facing member states in the implementation is the right of children to have access to the highest attainable of this article. It determined that the limited allocation of standard of health and to the facilities for the treatment of resources to be a significant factor in hampering optimal Department of Research, King Khalid Eye Specialist Hospital, 2Middle East Africa and IMPACT NGO, Riyadh, Saudi Arabia, 1Department of Pediatric Ophthalmology, Al Nahdhah Hospital, Ministry of Health, Oman, 3Avicenna Consulting Pvt Ltd., Islamabad, Pakistan Corresponding Author: Dr. Rajiv Khandekar, Department of Research, King Khaled Eye Specialist Hospital, POB: 7191, Riyadh 11462, Saudi Arabia. E‑mail: [email protected] 336 Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014 [Downloaded free from http://www.meajo.org on Wednesday, January 07, 2015, IP: 41.235.88.16] || Click here to download free Android application for this journal Khandekar, et al.: Childhood Blindness in EMR Region physical and mental development of children in many parts As an example, gross domestic product (GDP) per capita and of world.2 mortality rates of children < 5‑year of age have been shown to be reliable proxy indicators to determine the magnitude of Childhood blindness and visual impairment (CBVI) has a childhood blindness. 11 These are reliable indicators due to the significant effect on the physical, mental, and social development intimate relationship between some causes of blindness (measles, of a child. Therefore, childhood blindness remains a priority Vitamin A deficiency, ophthalmia neonatorum, rubella, disease of the global initiative for the elimination of avoidable etc.) and diseases with high morbidity and mortality in blindness by the year 2020: “VISION 2020 ‑ The Right to developing countries. Developing countries have a low level of the Sight”.3 All 23 countries of the Eastern Mediterranean socioeconomic development and suboptimal health resources Region (EMR) were signatories to the CRC and World Health to prevent or treat these conditions. To estimate the number Organization (WHO) resolutions on the VISION 2020 and of children with bilateral blindness in each EMR country on Millennium Developmental Goals. 4 Measures to address the basis of socioeconomic indices such as GDP and under 5‑year rights of children unfortunately have not been adequately or of age mortality rate, we grouped the 23 EMR countries into uniformly implemented. In order to identify effective methods 3 categories using the data from the 2011 annual report of the to provide optimal child eye heath care within a comprehensive Regional Director of WHO EMR.12 Countries with GDP over health delivery system, we assessed the magnitude and causes of US$15,000 were classified as Group 1, countries with GDP of CBVI in children in the EMR. CBVI mainly includes bilateral US$1,500‑US$15,000 were classified in Group 2 and countries blindness and functional low vision (FLV). Bilateral blindness with GDP < US$1,500 were classified in Group 3. We also is defined as the best‑corrected visual acuity (BCVA) of less grouped the countries into three sets based on the childhood than 3/60 in the better eye or field of vision restricted to 10° mortality rates of under 5‑year of age: Set 1 included children around central fixation. FLV is defined as visual impairment for with a mortality rate of < 20/1,000 live births; Set 2 with a which no treatment or refractive correction can improve the mortality rate between 20 and 50/1,000 live births and; Set 3 vision up to >6/18 in a better eye. Our previous publication countries with a mortality rate > 50/1,000 live births [Figure 1]. covered important aspects of visual disabilities in children in We determined that this classification coincided well with the EMR.5 However, civil conflicts have affected the economy of GDP grouping of countries. many middle eastern countries in the previous 5‑year.6 Children, as the highest at‑risk population, are often the most affected For each group, we applied a blindness prevalence rate obtained in these conflicts. Due to new conflicts arising in the area, it is from countries with similar GDP. Thus, for Group 1 countries, likely that factors affecting visual disabilities in children might the rate was tabulated to be 0.3/1,000, for Group 2, it was 11 have changed, thus warranting a re‑examination of this issue 0.9/1,000, and for Group 3, it was 1.5/1,000. These data were and a new analysis for the regional countries. used to calculate the number of children with bilateral blindness MAGNITUDE OF THE PROBLEM Somalia 180 Afghanistan 655 Evidence‑based information on the magnitude of certain health Pakistan 840 issues is vital for an appropriately enhanced approach in the Yemen 926 Djibouti 1031 7 public health sector. Elimination of preventable childhood Sudan 1353 blindness is one of the priorities of the “VISION 2020 ‑ The Palastine 1804 Right to the Sight” initiative in the subcontinent. Estimates show Syria 1804 that there are 1.4 million blind children living in the middle‑ and Egypt 1949 low‑income countries. Of these blind children, 200,000 were Morocco 2707 8 Jordan 3257 projected to be blind in member countries of the WHO EMR. Iraq 3524 The report further states that every year, an additional 50,000 Tunisia 3796 9 children go blind in worldwide. Iran 5070 Labanon 7659 Community‑based prevalence surveys for childhood blindness Libya 14846 are essential in creating roadmaps to manage this health issue. Saudi Arabia 18603 Oman 19102 However, they require a large sample and are costly. Therefore, Bahrain 27943 conducting these surveys is a major challenge in developing Kuwait 40485 countries where there are competing demands for financial United Arab Emirates 64009 resources.10 In such circumstances, creation of alternative Qatar 88990 methods to estimate the magnitude and identify causes of Figure 1: Gross domestic product in US$ and <5 mortality per 1000 live births in childhood blindness must be considered. member countries of Eastern Mediterranean Region of the World Health Organization Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014 337 [Downloaded free from http://www.meajo.org on Wednesday, January 07, 2015, IP: 41.235.88.16] || Click here to download free Android application for this journal Khandekar, et al.: Childhood Blindness in EMR Region in an individual EMR country [Table 1]. We determined that Table 1: Estimated bilateral blindness and FLV in children aged the bilateral blindness rate in the EMR region was 1.2/1,000 15-year or younger in member countries of EMR of the WHO children < 15‑year of age.
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