Sunday Magazine

Poor facilities, poverty, ignorance fueling blindness in children –Experts

Eye care professionals have said a comprehensive approach, including eye examination at birth, eye screening of pre-school and school children, as well as early vaccination for infectious diseases in children, is warranted to forestall the increasing rate of childhood blindness. They held that a multidisciplinary team of health care professionals – pediatricians and pediatric ophthalmologists – are needed for prevention and treatment of blindness in children. CHIJIOKE IREMEKA reports

 

Eye doctors, Ophthalmologists and Optometrists, among other relevant eye care professionals, say childhood blindness is a group of diseases and conditions which occur in childhood or early adolescence (16 years of age), which, if untreated, result in blindness.

 

According to them, childhood blindness is responsible for a high number of ‘blind years,’ though the actual number of blind children is smaller than the number of blind adults, but the total ‘blind years’ lived are comparable to those of adults due to age related cataract.

 

They held that blindness in children is related to child mortality and for these reasons, the control of blindness in children is considered a high priority in the World Health Organisation’s (WHO) Vision 2020 initiative: ‘The Right to Sight.’ Dr. Adedayo Omobolanle Adio of the Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, said childhood blindness is increasingly becoming a major challenge worldwide. According to him, it is estimated that a child goes blind somewhere in the world every minute, saying this is indeed disturbing in view of the attendant problems and hopelessness associated with blindness especially in children. He noted that most of the more serious disorders can be prevented but when they do occur and often in spite of attempts at treatment or if left untreated they can result in lifetime blindness.

 

“For a child who is born blind or who becomes blind, the total number of years of disability is greater than that of a person who becomes blind later in life,” he added. He noted that avoidable causes of blindness in children needs to be eliminated through the development of sustainable and equitably distributed high quality children eye care services as part of our national health care system.

 

Sunday Telegraph checks revealed that there are marked regional variations in the prevalence and causes of childhood blindness which reflect different socioeconomic development and under-5 mortality rates. It was learnt also that the prevalence figures ranges from 0.3 per 1000 children in highincome countries to 1.5 per 1000 children in low-income countries as the case may be.

 

The WHO estimation also showed that the number of blind children in the world has declined from 1.4 million in 1999 to the current number of 1.26 million, but in Sub-Saharan Africa (Nigeria inclusive); the number has increased by 31% from 129,890 to 419, 000.

 

WHO stressed that in the poorest countries, corneal scarring due to Vitamin A deficiency, measles, ophthalmia neonatorum and the use of traditional practices are said to be among the major causes of childhood blindness.

 

However, it was learnt, these conditions are declining in many countries due to economic development, extensive measles immunisation programmes and better control of vitamin A supplementation except in Nigeria where the case has been high yet preventable.

 

Eye care professionals are worried as most causes of childhood blindness are preventable, saying that a comprehensive and multidisciplinary approach comprising eye examination at birth, children eye screening and early vaccination for infectious diseases, is warranted.

 

A doctor of Optometry at the Department of Optometry, Madonna University, Elele, Chinyere Nnadi, said Nigeria is a country with a very low socioeconomic status, and children make up almost 45% of its over 140 million population, hence the mortality rate of children under 5 years is as high as 176 per 1000 live births.

 

She noted that there is inadequate and uneven distribution of eye care professionals between urban and rural areas of the country, saying that blindness is believed to be common in the northern part of Nigeria, though a national blindness survey has not been conducted to ascertain the claim.

 

Nnadi lamented that most causes of blindness in children are avoidable but children become blind or remain blind due to lack of adequate facilities, poverty and ignorance, and calls on the stakeholders in Nigeria to make eye care delivery a priority, especially among children.

She explained: “In the period 1980-2000, only a few population-based studies were carried out in different countries. Also, population- based surveys require large sample sizes and are costly to conduct; hence most prevalence data on the prevalence and causes of childhood blindness come from surveys in schools for the blind.

 

“Examination of children enrolled in schools for the blind offers the opportunity to examine a large number of children quickly in a standard manner by a few examiners.

Children enrolled in schools for the blind make up only a small proportion of the total blind in the community and children with multiple disabilities are likely to be under-represented.

 

“Most underdeveloped countries such as Nigeria have no registers for the blind. Baseline data on the prevalence and causes of childhood blindness are important for planning blindness prevention strategies.”

Speaking on the state of paediatric eye care in Nigeria, Dr. Rhoda Komolafe (an Ophthalmologist) said the fight against childhood blindness is being given top priority by the WHO, especially in regions of the world, like Nigeria where the gross income per capita is relatively low with up to 60.9% of them living in absolute poverty. Dr. Komolafe said: “Paediatric ophthalmology is the subspecialty that deals with ocular disorders in the pediatric age group.

 

Most common ophthalmologic problems in children are different from the most common ones in adults. As a result, the skills and competence required for pediatric ophthalmology care are peculiar and should not be generalised as children are not merely small adults.

“Childhood eye care not only requires discipline and dedication as more effort is taken to elicit any response from them but also requires the complete trust of not just the parent but the child himself.

“Trained pediatric ophthalmologists are therefore, needed in addition to adopting a programmatic approach in the care of children.

 

Reducing visual impairment and blindness in children in resource poor countries is one of the key components of the major global prevention of blindness initiative, VISION 2020: the Right to Sight.

 

“Nigeria with a total population of around 200million, however, has its childhood population of 75 million largely under served in terms of eye care for various reasons.

 

Many needy children are not identified to have eye problems and these children tend to die early and further worsen the infant mortality rate.”

 

Komolafe noted that there are extremely few numbers of paediatric trained ophthalmologists with over two thirds of the states of the federation without any form of training, saying that out of these 400 plus general  ophthalmologists, there are only four with full in paediatric ophthalmology and eight others with three to six month (short term) fellowships and one about to go for training in South South (full fellowship).

 

Speaking further, an Optometrist, Ngozika Ezinne said childhood factors constituted the major etiology of blindness, which comprised measles (10%), trauma (12.4%); 2.3% of which was open globe injury, intrauterine e.g., maternal rubella (23.2%) and harmful traditional eye medication (3.2%). Citing a retrospective study to determine the causes of childhood blindness among children who attended the National Eye Centre Kaduna, from January 2011 to December 2015, she said, the findings will be useful for paediatric ophthalmic care, development of appropriate measures for interventions and management of avoidable causes of blindness in children in this region. According to her, case files of 2,145 children aged 0-18 years with a mean age of 5.53 ± 4.39 years were reviewed.

 

A total of 789 (36.8%) children including 334 females (42.3%) and 455 males (57.7%) were blind in one or both eyes. She noted that the survey also reveals that out of 789 children with childhood blindness, 468 (59.3%) had unilateral blindness and 321 (40.7%) had bilateral blindness, saying that the causes of childhood blindness were cataract (52.6%), corneal opacity (14.1%), trauma (11.7%), glaucoma (10.3%), retinal disorders (5.7%) and refractive errors (5.6%).

 

The study, she said, further revealed that most of the childhood blindness was found among children between 5-12 years (34.5%) and 0 to 1 year (17.8%). While 459 (58.2%) of the causes of the childhood blindness were preventable, 126 (16%) were treatable.

 

But as a solution to the problem, she noted that the preventable causes of blindness can be addressed by increasing public awareness for measles immunisation, promotion of breast feeding, health and nutrition education as well as continued programs for the control  of VAD through child survival programs.

 

She said: “Availability and accessibility of first aid and antibiotic eye drops would decrease the incidence of blinding corneal ulcers due to trauma, whereas treatable causes (e.g., cataract, glaucoma, refractive errors) require more specialised, pediatric ophthalmology units, systems for early identifications and referrals.

 

“A comprehensive approach including eye examination at birth, eye screening of preschool and school children and early vaccination for infectious diseases in children is warranted. In addition, a multi – disciplinary team of health care professionals including pediatricians and pediatric ophthalmologists are needed for prevention and treatment of blindness in children.”

Speaking on the solutions to blindness and virtual impairment at the School for the Blind Owo, Ondo State, Dr. Omolase Oluwole of Department of Ophthalmology, Federal Medical Centre, Owo, said the challenge of childhood cataract should be addressed by training community health workers to identify them and promptly refer such cases to the ophthalmologists.

 

He said: “There is also an urgent need to train more paediatrics ophthalmologists. Possible treatment for all children with severe visual impairment or blindness should be explored prior to enrollment in School for the blind. “Effective preventive strategies should be explored through VISION 2020 to eliminate all the avoidable and preventable causes of blindness in children. Population based studies should be conducted to determine the causes of blindness and severe visual impairment in children.”

He added that the lens was the leading anatomical site of blindness and impairment of vision, noting that intrauterine and hereditary factors were the leading aetiological agents for blindness and visual impairment. “Cataract was the single commonest diagnosis in Owo School of the Blind, followed by glaucoma and opticatrophy. Less than half of the study population had treatable causes of blindness,” he quipped.

 

Anthony Village Diamond Lions Club to sponsor 50 eye surgeries Anthony Village Diamond Lions Club, District 4041 Nigeria, has joined the Federal Government and Lagos State Government in the war against blindness, especially the childhood blindness in the country.

 

The Club said its Board of Directors has approved the sponsoring of free cataract eye surgeries for 50 people as its own interventionist programme towards ending blindness in the state, especially among the less privileged.

 

The newly installed President of the Club, Lion Oyefunke Orimolade, NLCF, made this known recently during her presentation and investiture as the 3rd President of the Club for 2020-2021 Lions Year, held at Sheralton Hotels, Ikeja, Lagos. Lion Oyefunke, who rolled out the projects she intends to accomplish before the end of her tenure, said the current Lions year has been wonderful and challenging, but quickly added that God has been the strength of the Club despite the pandemic and unstable economy.

According to her, the Lions year started July 2020 and the Club has engaged in many activities despite the challenges during pandemic. This ranged from distribution of thousands of free facemasks to hand sanitisers and relief materials in our communities and environs among others. She said: “We have done 10 free cataract surgeries including pediatric cataract surgeries and all were successful. They were done at the Eye Foundation Clinic, Ikeja.

 

We did free eye screening and gave out hundreds of free glasses to the people with one eye defect or the other. “We have done a number of pediatric surgeries including that of Master Michael Olonlokun. During one of our Club’s eye screening exercises, we discovered and adopted him as a project to be sponsored. “We took him to Eye Foundation Hospital, Ikeja, where the doctors said there was more to his condition and opted for more screenings to determine what should be done since Michael is a minor and wouldn’t undergo the operation twice.

 

“We brought him to the Eye Foundation Hospital because this is a foundation. And because we are a Club, the Foundation subsidised the cost. The surgery ordinarily would have cost us N1million. That’s N500, 000 for each eye and both of them N1, 000, 000. At the end of the day, we got a bargain way below half a million naira.

 

 

“When we brought in the child, the doctor said his both eyes were dancing and were not connecting well to the brain. He said he will be in close medical surveillance after the surgery, which we did and are still doing.” Speaking of Michael’s sight after the surgery, she said: “Lions is going to follow up on him. We did the same for adults. This is not the first time we are doing this, but this one is a minor case. “Michael couldn’t go to school until the surgery. His eye defect was from birth. I am happy; I feel great for helping someone to see. I was equally happy when another beneficiary we sponsored said his eyes were as clear as glass after the surgery.” She continued: “We did so many feed the hungry programmes to relief the hunger. We donated cash, gifts materials to some pediatric cancer patients in LUTH, creating awareness to the communities about the diabetes diseases and donated sanitary products to some of the students in a popular school in Anthony village.” Among the interventionist programmes lined up for the Club, according to the president, include continuation of the Lions Core Project such as the Youth Empowerment where young people are trained in make-up, cake baking, beads making which we have carried out in this year.

 

“We donated a public address system and one 50KVA power generating set to one of our adopted schools in Anthony Community, bought a bus for my club to enable our members to attend training and activities in and out of Lagos. “Cleaning environment and planting trees around Anthony Village and its environs as well as pediatric cancer enlightenment and diabetes awareness across the state,” she added.

 

However, the Club’s Chairperson, Sight Project, Lion Chinenye Nwaka NLCF, whose Committee organised, adopted and recommended Michael for further investigation which led to his eye surgery said the club was happy in its entirety to give hope to the little boy and happiness to the family in this ‘Night of the Blind’ project. She said: “In our quest to end blindness, we are determined to give hope to this little boy. It was a great day for us, seeing the happiness on the faces of the boy’s parents.”

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