Changing pattern of  Childhood blindness in India and service delivery needs
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Changing pattern of Childhood blindness in India and service delivery needs Asim kumar Sil MBBS, DO, DNB, M Sc Netra Niramay Niketan,Vivekananda Mission Ashram Chaitanyapur , West Bengal. Will Bilkis see again?. Bilkis revisited. Her suffering could have been avoided. Childhood Blindness.

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Changing pattern of Childhood blindness in India and service delivery needs Asimkumar Sil MBBS, DO, DNB, M ScNetraNiramayNiketan,Vivekananda Mission AshramChaitanyapur, West Bengal


Will bilkis see again
Will Bilkis see again? service delivery needs


Bilkis revisited
Bilkis revisited service delivery needs



Childhood blindness
Childhood Blindness service delivery needs

  • Rarer than blindness in adults

  • Total number of blind-years suffered by blind children is second only to that due to cataract in adults

  • Reliable data is not available from all geographic regions


Childhood blindness1
Childhood Blindness service delivery needs

  • Possible sources of data

  • Available data on childhood blindness in India - prevalence & causes

  • Change in the trend over time


Prevalence sources of data
Prevalence - Sources of data service delivery needs

  • Blindness Registration

  • Birth cohort studies

  • Surveillance

  • Population based survey

  • Community Based Rehabilitation (CBR) programme


Population based survey
Population Based Survey service delivery needs


Community based rehabilitation
Community Based Rehabilitation service delivery needs

  • Prevention and treatment of preventable and treatable visual impairment

  • Rehabilitation of incurably blind individuals


CBR service delivery needs

  • Baseline door-to-door surveys of whole population

  • Visual screening by qualified ophthalmologists and optometrists

  • Includes all age groups



Prevalence of childhood blindness in india
Prevalence of Childhood Blindness in India service delivery needs

  • 0.61/1000 children(95% CI0.51-0.82) in Andhra Pradesh (CBR)

  • 0.51/1000 children(95% CI 0.37-0.65) in West Bengal (CBR)

  • 1/1000 children(95% CI 0.094 - 0.106) in Orissa (Survey)

  • 1/1000 children (East Delhi)

  • 1.06/1000 children (Karnataka)




Incidence of childhood blindness
Incidence of Childhood Blindness Children in the World

  • Insufficient information

  • In industrialized countries 2/100,000 children/year due to acquired diseases

  • Globally 500,000 children become blind every year

  • 50 - 60% blind children die early in their childhood


Classification of causes of blindness in children
Classification of Causes of Blindness in Children Children in the World

  • Anatomical Classification - Takes into account the part of the eye most affected

  • AetiologicalClassification - Takes into account the time of onset of the condition leading to blindness


Causes of childhood blindness sources of data used in india
Causes of Childhood Blindness - Sources of Data used in India

  • Blind School Studies

  • CBR

  • Population based Survey




Some recent findings from different parts of india
Some recent findings from different parts of India studies in India

  • Congenital whole globe abnormality is as high as 41% in Maharastra

  • VAD is still a major cause of blindness in North East

  • Uncorrected Refractive error is major cause of blindness among children in West Bengal in Sarva Siksha Abhiyan ( universal education drive), - unpublished . Results from surveys in Gujarat and west Bengal in 2005 also shows similar results.


Whole globe abnormality
Whole Globe Abnormality studies in India


Whole globe abnormality1
Whole globe Abnormality studies in India


Corneal blindness
Corneal blindness studies in India


Aetiological categories
Aetiological Categories studies in India


Commonest causes of blindness in children in india
Commonest Causes of Blindness in Children in India studies in India

  • Corneal scarring mainly due to VAD

  • Congenital anomalies of the whole globe, usually of unknown cause, but where genetic factors may play a role

  • Retinal dystrophies mainly hereditary

  • Cataract and amblyopia



Avoidable childhood blindness in india
Avoidable Childhood Blindness in India schools for the blind in India

  • Up to 30% Preventable

  • 20% causes treatable



Change of trend in the causes of childhood blindness in india
Change of trend in the causes of childhood blindness in India

  • Corneal blindness is decreasing

  • Congenital whole globe abnormalities are becoming proportionately higher

  • ROP is likely increase in urban areas

  • Uncorrected refractive errors could be a major cause if detected properly


How to reach children issues
How to reach children- Issues India

  • Need vs. availability of service

  • Need vs. uptake of service

  • Availability of service vs. affordability


Ways to reach children
Ways to reach children India

  • School health programme

  • Through health workers working in MCH

  • ICDS – helps early detection

  • CBR

  • Outreach camps

  • Key informants

  • Public education in various forms

  • Networking with physicians

  • Utilising Immunisation days

  • Sensitising all levels of workers even priests





Why early rehabilitation
Why Early Rehabilitation? India

  • When a mother brings a visually impaired child to a doctor she doesn’t know whether the disease is curable or incurable. She needs help.

  • All our efforts to restore vision may fail, but we should not fail to give proper guidance to parents about the child’s overall development.

  • Outcome is always better if the process is started early


Low vision devices have greater role to play
Low vision devices have greater role to play India

  • Exhaust maximum medical management and continue follow-up

  • Find out suitable LVD (optical and non optical) at the earliest opportunity

  • Give overall training



Practical approach
Practical approach India

  • Awareness generation

  • Active Case finding utilising all sources

  • Early intervention

  • Individualised approach

  • Making devices affordable




Cataract
Cataract Blind



Thank you
Thank you Blind


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