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Prevalence of childhood ocular morbidity in a peri-urban setting in Bangladesh: a community-based study
A H M E Hussain1, T Roy2, N Ferdausi3
1Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh.
Insights
Community health workers can effectively identify childhood eye diseases through screening programs. Early detection and integrated care are crucial for improving pediatric eye health in underserved areas.
Area of Science:
- Ophthalmology
- Public Health
- Global Health
Background:
- Childhood ocular morbidity is a significant public health concern, particularly in resource-limited settings.
- Integrated care models are essential for addressing the complex needs of pediatric eye conditions.
- Peri-urban areas often face challenges in accessing specialized healthcare services, including eye care.
Purpose of the Study:
- To evaluate an integrated pediatric eye care delivery model in a peri-urban setting in Bangladesh.
- To determine the prevalence of childhood ocular morbidity and associated risk factors.
- To assess the effectiveness of community health workers (CHWs) in screening and referral.
Main Methods:
- A cross-sectional, population-based study involving children aged 15 years and younger.
- Trained CHWs conducted awareness interventions and identified children with ocular problems.
- Referral to ophthalmologists for diagnosis and treatment, with complex cases managed at a tertiary eye hospital.
Main Results:
- A total of 33,549 children were screened, identifying 1887 cases of ocular morbidity (5.63%).
- Refractive errors, allergic eye conditions, and nasolacrimal duct obstruction were the most common morbidities.
- Blindness prevalence was 0.060%, with higher rates in children under 5 years; causes included corneal opacity and congenital anomalies.
Conclusions:
- Well-designed community-based screening programs utilizing trained CHWs can effectively identify childhood eye diseases.
- Community mobilization, awareness campaigns, and early detection are vital for improving pediatric eye service delivery.
- Establishing robust referral mechanisms ensures timely access to appropriate eye care for children.
Objectives:
To test a model of integrated pediatric eye care delivery and examine the prevalence and factors associated with childhood ocular morbidity in a peri-urban setting in Bangladesh.
Study Design:
Cross-sectional, population-based study.
Methods:
The study was conducted in three phases among children aged ≤15 years. Trained community health workers (CHWs) conducted awareness intervention and identified children with ocular problems. These children were then referred to the base hospital for examination and treatment by ophthalmologists. A pediatric ophthalmologist further examined the children with complicated eye diseases and ensured treatment at a tertiary public eye hospital. Awareness, referral patterns, and health-seeking behavior were also examined. All data were analyzed statistically using Statistical Package for Social Sciences.
Results:
CHWs screened 33,549 eligible children and identified 1887 cases with ocular morbidity. The prevalence of ocular morbidity and childhood blindness were 5.63% (95% confidence interval [CI] = 5.27-6.16) and 0.060% (95% CI = 0.03-0.11), respectively. The most commonly observed ocular morbidities were refractive error (3.24%; 95% CI = 3.11-3.45), allergic eye conditions (1.2%; 95% = CI 0.74-1.27), and nasolacrimal duct obstruction (0.52%; 95% CI = 0.25-0.74). Blindness was more frequently seen in children aged <5 years than in those aged 5-15 years (χ2 = 7.25; P = 0.007). The causes of blindness were corneal opacity, congenital eye anomaly, cataract, retinopathy of prematurity, and retinoblastoma. The prevalence of ocular morbidity was higher among older children, boys, children with low parental education and income, and children from households dwelling in slums.
Conclusions:
This study demonstrated that in a setting where screening and treatment for vision problems remain low, ocular morbidity among children could be easily identified through well-designed community-based screening programs involving appropriately trained CHWs. Community mobilization, awareness, and early detection of childhood eye diseases, with effective referral mechanisms for accessing appropriate care, are crucially important to improve service delivery.
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