Inter‐regional trends in causes of childhood blindness and low vision in Ghana

Abstract

Background Inter‐regional trends of visual loss in most developing countries remain largely unknown. We compared the causes of childhood blindness among children attending blind schools in the northern (one school) and southern (two schools) regions of Ghana and assessed their need for spectacles and low‐vision devices. Methods Using a standardised methodology, children were examined by an ophthalmologist and optometrists in each location. Causes of visual loss were classified anatomically and by time of onset, and avoidable causes identified. Children identified with functional low vision were assessed and provided with low‐vision devices. Results A total of 252 children under 16 years of age were examined in the schools. The overall prevalence of total blindness was 73 (29.0 per cent), with similar proportions (p = 0.87) in the north (29 [28.4 per cent]) and south (44 [29.3 per cent]); 92 (36.5 per cent) had functional low vision. Two children improved with spectacles and 35 benefited from low‐vision devices. Corneal scarring was significantly (p = 0.045) more prevalent in southern Ghana (n = 150) than in the north (n = 102), responsible for visual loss in 36 (24.0 per cent, 95% CI 17.2–30.8 per cent) and 14 (13.7 per cent, 95% CI 7.0–20.4 per cent) cases, respectively. No significant difference (p = 0.321) was observed in the prevalence of cataract between northern (28: 27.5 per cent, 95% CI 18.3–36.2 per cent) and southern Ghana (33: 22.0 per cent, 95% CI 15.4–28.6 per cent). Over 87 per cent of children had ‘avoidable’ causes of visual loss, with a higher proportion being treatable (124: 49.2 per cent) than preventable (96: 38 per cent). Conclusion Cataract was the major cause of visual loss in the overall population. The south had a higher proportion of corneal scarring and late‐onset blindness compared with the north. More than one‐third of blindness in blind schools in Ghana could have been prevented by primary care interventions and nearly half could have been treated surgically to prevent visual loss. Two in five children in blind schools in Ghana could benefit from optical intervention.

Clinical characteristics and causes of vision impairment in a paediatric population in a university-based low vision clinic

“…In the present study, the retina ( n = 74, 47.4%) was the most common anatomical site causing vision impairment which is consistent with the trend noted in previous studies involving children in South Africa (Esra & Mayet, 2020; O’Sullivan et al, 1997). This finding differs from other studies where it was noted that the most common site was the lens mostly as a result of cataracts and aphakia in Eritrea ( n = 55, 22.1%) (Gyawali et al, 2017) and Ghana ( n = 75, 29.8%) (Ilechie et al, 2020). A study conducted in India noted that the most common site was the whole globe category mostly as a result of phthisis bulbi and microphthalmos ( n = 83, 32%) (Panda et al, 2020).…”

“…In an earlier study involving children enrolled in blind schools across South Africa, O’Sullivan et al (1997) reported that corneal scarring attributed to vitamin A deficiency and/or measles infection accounted for avoidable vision impairment in 27 children (5%). The percentage of cases due to corneal opacity/scarring in the present study and previous studies in South Africa are lower than the percentages reported in studies in other developing countries (Gyawali et al, 2017; Gyawali & Moodley, 2017; Ilechie et al, 2020; Panda et al, 2020) (12%–24%) and may reflect the better levels of perinatal care and success of primary health care interventions aimed at measles/rubella immunisation and vitamin A supplementation in South Africa (Baker, 2010; du Plessis et al, 2007).…”

Childhood vision impairment and blindness in West Africa: public health measures and implications for systemic health

“…In the setting of severe ulceration and perforation from VAD, phthisis bulbi (PB) may also ensue. Given the inter-relatedness of these conditions, several studies combined VAD and measles as a collective cause of vision loss ( 13 , 17 , 19 , 20 ). The proportion of children with blindness due to this combination of VAD and measles ranged between 13.1 and 29% in these studies.…”

“…Of the 13 studies reviewed, the most common lenticular conditions leading to blindness—“cataract” and “aphakia”—were present in 11 and 5 studies, respectively. Cataract was observed to be an anatomic cause of blindness in 11 studies, leading to blindness from an estimated 7–40% of the VI/BL and notably was the leading cause of blindness in 5 studies ( 12 , 14 , 17 , 18 , 20 ). Patients were referred for surgery in several reports, but the outcomes were not reported in these manuscripts.…”

“…These diseases included retinoblastoma, retinitis pigmentosa (RP), retinopathy of prematurity (ROP), and retinal detachment. RP, a hereditary disease, was the most commonly appearing retinal cause of blindness while retinoblastoma and ROP were documented in <1% of cases in two independent studies ( 8 , 20 ). Of the 4 studies discussing RP, the percentage of blindness caused by RP ranged from 1.2 to 11.3%.…”