Prevention of Childhood Blindness: Strengthening Primary Health Care

Dear Editor, Blindness is defined by the World Health Organization as visual acuity of less than 3/60 in the better eye. Overall, 39 million people are blind worldwide, out of which 1.4 million are children (less than 14 years of age). 1 Childhood blindness deserves public health attention as more than 50% of cases are avoidable, meaning that if effective measures are taken, quality of life can be improved by facilitating normal development and the economic burden on the individual, family, society and public health system can be reduced. 2,3 In a survey performed in Botswana, 89% and 63% of unilateral and bilateral childhood blindness was avoidable, respectively. 4 In a community based survey in India on children ≤15 years of age, the prevalence of childhood blindness was 0.17%, of which 33.3% was due to treatable refractive errors while 66.6% was secondary to other preventable causes. 5 The prevalence of blindness is correlated with the socioeconomic status of the country, ranging from 3/10,000 in developed nations to 15/10,000 in poorer countries. 6 Similarly, causes of childhood blindness also vary in different societies: refractive errors and corneal blindness due to malnutrition or infections are more prevalent in low income countries, 7 retinopathy of prematurity and cataracts are more common in middle income countries, 8 and retinal and neurologic disorders prevail in high income countries. 9 A study in Bangladesh stressed the need for reinforcement of parental awareness about common eye diseases in children and the importance of seeking timely advice including treatment since close to 90% of parents were unaware of schooling systems for blind children and only 5% sought treatment from an ophthalmologist, reflecting poor health care utilization. 10 Primary health care should be looked upon as the basic framework upon which other services should be built. 11 Primary health care programs should incorporate a wide range of cost-effective services such as eye examination at birth, eye screening for preschool and school children, early management of congenital cataracts, vaccination for infectious diseases in children, and initiatives to train health workers. 11 However, despite the success of these initiatives in countries like Oman and Portugal, their coverage is limited especially in African regions. All of the above findings clearly reflect that a comprehensive integration into all levels of service delivery including primary, secondary, and tertiary is of high priority. The strategy to combat childhood blindness should comprise of elements such as …