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Friday, May 24, 2013
- Every minute, somewhere in the world, a child goes blind according to the World Health Organization. Three in five poor children who go blind are likely to die within two years of losing their sight – yet half of cases of childhood blindness are avoidable. Sub-Saharan Africa is the region with the highest prevalence of blindness in the world – 1.24 per 1,000 children, compared to 0.8 in India and 0.3 in Europe.
“In the East African countries of Kenya and Uganda, as well as Zambia for example, the commonest cause of childhood blindness is cataracts,” says Dr Daniel Etya’ale, executive director for Africa for the International Agency for the Prevention of Blindness’s (IAPB) and a member of the Africa Initiative Steering Committee of ORBIS, a non-profit organisation committed to saving sight worldwide.
It has worked in 88 countries since its inception in 1982, including establishing 28 paediatric eye care clinics in India since 2007.
Blind children in sub-Saharan Africa face three major challenges: “Firstly, many are not being reached early enough for successful intervention; secondly these children are extremely vulnerable – about half are likely to die within two to three years of becoming blind; thirdly there is very little infrastructure and specialised medical help available to them.”
Etya’ale says the high mortality rate of blind children may be linked to the medical conditions that cause their blindness. Xerophtalmia, for example, is caused by a vitamin A deficiency which is also associated with diminished ability to fight infections.
Professor Colin Cook, Head of Opthamology at the University of Cape Town and the Red Cross Hospital, says prevention measures for childhood blindness vary in different regions, sometimes requiring surgery, sometimes children need glasses, or even community and primary health interventions such as immunisation and improved nutrition.
Congenital cataracts have been linked to the childhood disease rubella in a significant percentage of cases of cataracts in children in South Africa, Zambia and Kenya; in response, immunisation programmes have been stepped up to ensure girls are vaccinated against the disease before reaching childbearing age. Vaccinations serve both to avoid loss of eyesight and to minimise other risks rubella poses to developing fetuses, like deafness and cardiac malformation.
Early detection and correction of problems with children’s vision calls for a more inclusive and holistic system to check eye health at community, district, provincial levels; for example training community health groups to do simple eye tests.
“Whenever they see evidence of a cataract, they can immediately send the child for a proper assessment which can be the difference between a life of misery, or even premature death, and a full life,” says Etya’ale.
ORBIS uses flagship tools such as its Flying Eye Hospital, a mobile ophthalmic training hospital aboard a DC-10 airplane, and Cyber-Sight, an online telemedicine mentoring and teaching resource. It relies on 450 expert medical volunteers to bring eye care and training to partners in developing countries – more than 12 million people have received care and 260,000 health care professionals have benefited from training.
Dr Hunter Cherwek is the Medical Director of the Flying Eye Hospital and agrees that early screening is essential, with children examined annually as part of a routine paediatric checkup. “School screenings are important, but a lot of places we go to, there is no mechanism to screen vision, even for glasses. Nothing is in place.”
Orbis is hosting 58 delegates from 15 countries at a two-day conference in Cape Town on May 4 and 5. Lene Øverland, Director of Programmes for ORBIS in Europe, the Middle East and Africa said, “All these people have an interest to provide eyecare services on a very high level to children on a primary and tertiary level. We want to define a plan of how to work together in the next five years on a comprehensive model to address childhood avoidable blindness in line with Global Vision Goals by 2020.”
“Blindness and poverty create a very vicious cycle,” said Cherwek. “It’s like a double hit, and it’s almost impossible for someone to overcome both as a child. Vision restoration and visual rehabilitation help break that cycle for quality of life, and for financial repercussions.”