Changes in blindness prevalence over 16 years in Malawi: reduced prevalence but increased numbers of blind

Abstract

Background/aims: In the coming two decades significant increases in the burden of blindness are anticipated unless concerted efforts are made to improve eye care in developing countries. Evidence of changing prevalence rates or numbers of blind people are few. The change in blindness prevalence and the number of blind people in an adult population of Malawi was measured over a 16 year period. Methods: In 1999 a population based survey of blindness in adults (age 50+) was conducted in Chikwawa district of Malawi. Visual acuity and cause of vision loss were recorded for each eye independently. Blindness was defined as presenting better eye vision of <6/60. Findings from a 1983 survey of blindness in the same district (using similar methods) were re-analysed to be comparable with the survey conducted in 1999. Results: Among 1630 enumerated adults 89% were examined. The age adjusted prevalence of blindness in the adult population was 5.4% and more common in women than men. In each age group the prevalence of blindness was lower in 1999 than in 1983; the overall reduction in blindness was 31%. During this period the 50+ population in Malawi increased almost twofold. Extrapolating the Chikwawa district data to the Malawi population reveals that the number of blind people has increased by 24%; the increase is primarily because of the large increase in the size of the most elderly group, aged 70 and above. Conclusion: The majority of blind people in Chikwawa (1983 and1999) are in the age group 70 and over. This group has had the largest proportional increase in population size in this time. Services in this population have improved in the intervening 16 years and yet there was still an increase in the number of blind people. There was little change in excess blindness in women, suggesting that the same barriers that prevented utilisation of services in 1983 probably persist in 1999. Efforts to reach the most elderly and to reach women are needed to lead to a reduction in blind people in settings such as rural Malawi.

Follow-Up Survey of Cataract Surgical Coverage and Barriers to Cataract Surgery at Nkhoma, Malawi

“…They also compare favourably with studies in low and middleincome regions in Asia, including some regions of Nepal (59.5%) 10 and India (63%). 11 The difference in CSC between persons and eyes was 16%, indicating that the preference was given to operate first above second eyes, or that a number of patients elect not to have second eye surgery.…”

Self treatment of eye diseases in Malawi

“…Some of the identified problems in primary eye care in rural Africa reflect weakness in the overall structures: [1] inadequate health facilities, [2] too few trained health personnel; [3] lack of community outreach, [4] poor understanding and tolerance by staff of local health beliefs, [5] declining maintenance of facilities, equipment, and workers skill levels; [6] lack of good management, [7] lack of a clear definition within the front-line health facilities of staff roles, and [8] poor planning. (Lewallen and Courtright, 2001).…”

“…Nevertheless, while there has been a reduction in the prevalence of the blindness in all adult age groups, the increasing size of these age groups (particularly, the most elderly) has led to a 24% increase in the number of blind people. (Courtright et al,, 2003) Afr. J.…”

Revision of visual impairment definitions in the International Statistical Classification of Diseases

“…Because the ICD definition and WHO recommend use of a visual acuity level less than 3/60 to define blindness [ 1 ], many population-based surveys from less developed countries have reported blindness rates with this definition in the past [ 4 ]. There are exceptions such as India, where a visual acuity level less than 6/60 is used to define blindness [ 12 ], and recent reports from other less developed countries covering African and Chinese populations that have used visual acuity less than 6/60 to define blindness [ 13 - 16 ]. The more developed countries have often used visual acuity level less than 6/60 to define blindness [ 17 , 18 ]; the United States uses visual acuity less than or equal to 6/60 for this definition [ 19 ].…”