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Distribution and causes of blindness and severe visual impairment in children at a tertiary referral centre in Rwanda
Sylvain El-Khoury1,2, Sophia Strittmatter3, Theophile Tuyisabe4
1Eye Unit, Kabgayi Hospital, Muhanga, Rwanda s.el_khoury@ch-grasse.fr.
Insights
Severe visual impairment and blindness (SVI/BL) affects 10.9% of children in Rwanda, with 87% of cases being avoidable. Key causes include trauma, cataract, and refractive errors, highlighting the need for preventative strategies.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Severe visual impairment and blindness (SVI/BL) in children poses a significant global health challenge.
- Understanding the prevalence and causes of SVI/BL in specific regions is crucial for targeted interventions.
Purpose of the Study:
- To determine the prevalence and causes of SVI/BL in children presenting to a tertiary referral center in Rwanda.
Main Methods:
- A retrospective study analyzed patient records of children under 18 with SVI/BL presenting in 2019.
- Data collected included age, sex, laterality, origin, and cause of SVI/BL, categorized using WHO standards.
Main Results:
- 10.9% of 3939 children presented with SVI/BL (bilateral: 4.2%, unilateral: 6.7%).
- Main causes of bilateral SVI/BL were cataract (18%), refractive error (18%), and keratoconus (13%).
- Trauma (46%) was the leading cause of unilateral SVI/BL, followed by cataract (8%) and keratoconus (8%).
- Avoidable causes accounted for 87% of all SVI/BL cases.
Conclusions:
- A high proportion of childhood SVI/BL in Rwanda is preventable.
- Cost-effective strategies targeting avoidable causes like trauma and refractive errors are essential.
Aim:
To determine the prevalence and the causes of severe visual impairment and blindness (SVI/BL) in children at a tertiary referral centre in Rwanda.
Methods:
In this retrospective study, files of all patients <18 years presenting during the year 2019 at the Kabgayi Eye Unit in Rwanda with SVI/BL (presenting visual acuity of <6/60 Snellen or lack of preferential looking behaviour) in at least one eye were analysed for age, sex, laterality, province of origin and cause of SVI/BL. Causes were categorised according to WHO standard classification.
Results:
Out of 3939 children presenting to the clinic, 428 (10.9%) had SVI/BL in at least one eye. 165 (4.2%) patients had bilateral and 263 (6.7%) had unilateral condition. Of patients with BL/SVI, 36.7% were below the age of 6 years. In bilateral BL/SVI, the main causes were cataract (18%), refractive error (18%), keratoconus (13%), congenital eye anomaly (9%), glaucoma (8%), cortical blindness (8%) and retinoblastoma (6%). In unilateral BL/SVI it was trauma (46%), cataract (8%), keratoconus (8%), infectious corneal disease (7%) and retinoblastoma (7%). In preschool children, retinopathy of prematurity accounted for 7% of bilateral BL/SVI. Avoidable BL/SVI accounted for 87% of all cases.
Conclusion:
The high number of avoidable causes for SVI/BL may be reduced through several cost-effective ways.
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