Eye conditions and blindness in children: Priorities for research, programs, and policy with a focus on childhood cataract

Abstract

The major causes of blindness in children encompass intrauterine and acquired infectious diseases, teratogens and developmental and molecular genetics, nutritional factors, the consequences of preterm birth, and tumors. A multidisciplinary approach is therefore needed. In terms of the major avoidable causes (i.e., those that can be prevented or treated) the available evidence shows that these vary in importance from country to country, as well as over time. This is because the underlying causes closely reflect socioeconomic development and the social determinants of health, as well as the provision of preventive and therapeutic programs and services from the community through to tertiary levels of care. The control of blindness in children therefore requires not only strategies that reflect the local epidemiology and the needs and priorities of communities, but also a well functioning, accessible health system which operates within an enabling and conducive policy environment. In this article we use cataract in children as an example and make the case for health financing systems that do not lead to ‘catastrophic health expenditure’ for affected families, and the integration of eye health for children into those elements of the health system that work closely with mothers and their children.

Interventions to improve school-based eye-care services in low- and middle-income countries: a systematic review

“…Our review explored how school-based eye-care services function and connect with general health systems, how stakeholders interact with school-based eye-care services and programmes, and the possible paths to meeting population needs in a way that is equitable and responsive 70 , 71 . School-based eye-care interventions (including vision screenings) are key to reducing morbidity and developmental delays associated with vision impairment, while promoting early detection and prevention of eye diseases 67 , 72 . Increasing the availability of school-based eye-care interventions in low- and middle-income countries can help to address the burden on poorly resourced secondary and tertiary eye-care, 73 , 74 and enhance access for underserved rural children 21 , 30 …”

Causes of Childhood Blindness among Children Seen at the National Eye Centre, Kaduna, Nigeria

“…It could also be that males are at greater risk of blinding conditions than females or blind females have a higher mortality rate than blind males or the parents of blind males are more willing to seek eye care than the parents of blind females. Gilbert et al, [4] reported in their study that families less readily perceive a girl to be ill than a boy, and so health care is not sought. This may, in part, explain why virtually all studies in developing countries report higher prevalence of childhood blindness in males than females.…”

“…Variations in the findings reported could be due to rapid and marked socioeconomic changes in different countries. Moreover, studies have shown that as the economies of most countries continue to improve, the major causes of childhood blindness will also continue to change; retinal disorder will likely become a major cause of childhood blindness in developing countries while cataract will continue to overtake corneal scarring as the major avoidable cause in poor countries in Africa such as Nigeria [4]. Emphasis therefore needs to be placed on initiatives and programs for the control of blindness from retinal disorder and cataract in children.…”

“…However, in Sub-Saharan Africa, the number has increased by 31% from 129890 to 419000 [3]. Childhood blindness is responsible for a high number of "blind years" such that even though the actual number of blind children is much smaller than the number of blind adults, the total "blind years" lived are comparable to those due to age related cataract [4]. Furthermore, blindness in children is related to child mortality.…”

Childhood blindness: Is my world getting smaller?

“…The strategy for childhood blindness should comprise elements such as sustained political commitment (promoting eye health as part of the national health policy); active collaboration from all stakeholders, government/private, and civil society; adoption of appropriate technology (to ensure that greatest benefit accrues to largest number of people, within the limited resources available); strengthening of human resources/infrastructure; operational research to determine capacity of existing infrastructure/level of utilization and barriers to utilization; [6] institutional capacity building for enhancing training of ophthalmologists and allied health personnel for eye care including pediatric eye care; resource mobilization; advocacy of community-based rehabilitation services; epidemiologic assessments and priority setting on the basis of evidence-based public health approach; coordinating primary prevention of vitamin A deficiency/rubella cataract with nutrition and immunization programs; collaboration-cooperation and coordination at the regional/national and international levels with nongovernment organizations; and finally building proper mechanisms for monitoring…”