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Rapid Assessment of Avoidable Blindness in Western Rwanda: Blindness in a Postconflict Setting

BACKGROUND: The World Health Organization estimates that there were 37 million blind people in 2002 and that the prevalence of blindness was 9% among adults in Africa aged 50 years or older. Recent surveys indicate that this figure may be overestimated, while a survey from southern Sudan suggested t...

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Autores principales: Mathenge, Wanjiku, Nkurikiye, John, Limburg, Hans, Kuper, Hannah
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1904464/
https://www.ncbi.nlm.nih.gov/pubmed/17608561
http://dx.doi.org/10.1371/journal.pmed.0040217
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author Mathenge, Wanjiku
Nkurikiye, John
Limburg, Hans
Kuper, Hannah
author_facet Mathenge, Wanjiku
Nkurikiye, John
Limburg, Hans
Kuper, Hannah
author_sort Mathenge, Wanjiku
collection PubMed
description BACKGROUND: The World Health Organization estimates that there were 37 million blind people in 2002 and that the prevalence of blindness was 9% among adults in Africa aged 50 years or older. Recent surveys indicate that this figure may be overestimated, while a survey from southern Sudan suggested that postconflict areas are particularly vulnerable to blindness. The aim of this study was to conduct a Rapid Assessment for Avoidable Blindness to estimate the magnitude and causes of visual impairment in people aged ≥ 50 y in the postconflict area of the Western Province of Rwanda, which includes one-quarter of the population of Rwanda. METHODS AND FINDINGS: Clusters of 50 people aged ≥ 50 y were selected through probability proportionate to size sampling. Households within clusters were selected through compact segment sampling. Visual acuity (VA) was measured with a tumbling “E” chart, and those with VA below 6/18 in either eye were examined by an ophthalmologist. The teams examined 2,206 people (response rate 98.0%). The unadjusted prevalence of bilateral blindness was 1.8% (95% confidence interval [CI] 1.2%–2.4%), 1.3% (0.8%–1.7%) for severe visual impairment, and 5.3% (4.2%–6.4%) for visual impairment. Most bilateral blindness (65%) was due to cataract. Overall, the vast majority of cases of blindness (80.0%), severe visual impairment (67.9%), and visual impairment (87.2%) were avoidable (i.e.. due to cataract, refractive error, aphakia, trachoma, or corneal scar). The cataract surgical coverage was moderate; 47% of people with bilateral cataract blindness (VA < 3/60) had undergone surgery. Of the 29 eyes that had undergone cataract surgery, nine (31%) had a best-corrected poor outcome (i.e., VA < 6/60). Extrapolating these estimates to Rwanda's Western Province, among the people aged 50 years or above 2,565 are expected to be blind, 1,824 to have severe visual impairment, and 8,055 to have visual impairment. CONCLUSIONS: The prevalence of blindness and visual impairment in this postconflict area in the Western Province of Rwanda was far lower than expected. Most of the cases of blindness and visual impairment remain avoidable, however, suggesting that the implementation of an effective eye care service could reduce the prevalence further.
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spelling pubmed-19044642007-07-07 Rapid Assessment of Avoidable Blindness in Western Rwanda: Blindness in a Postconflict Setting Mathenge, Wanjiku Nkurikiye, John Limburg, Hans Kuper, Hannah PLoS Med Research Article BACKGROUND: The World Health Organization estimates that there were 37 million blind people in 2002 and that the prevalence of blindness was 9% among adults in Africa aged 50 years or older. Recent surveys indicate that this figure may be overestimated, while a survey from southern Sudan suggested that postconflict areas are particularly vulnerable to blindness. The aim of this study was to conduct a Rapid Assessment for Avoidable Blindness to estimate the magnitude and causes of visual impairment in people aged ≥ 50 y in the postconflict area of the Western Province of Rwanda, which includes one-quarter of the population of Rwanda. METHODS AND FINDINGS: Clusters of 50 people aged ≥ 50 y were selected through probability proportionate to size sampling. Households within clusters were selected through compact segment sampling. Visual acuity (VA) was measured with a tumbling “E” chart, and those with VA below 6/18 in either eye were examined by an ophthalmologist. The teams examined 2,206 people (response rate 98.0%). The unadjusted prevalence of bilateral blindness was 1.8% (95% confidence interval [CI] 1.2%–2.4%), 1.3% (0.8%–1.7%) for severe visual impairment, and 5.3% (4.2%–6.4%) for visual impairment. Most bilateral blindness (65%) was due to cataract. Overall, the vast majority of cases of blindness (80.0%), severe visual impairment (67.9%), and visual impairment (87.2%) were avoidable (i.e.. due to cataract, refractive error, aphakia, trachoma, or corneal scar). The cataract surgical coverage was moderate; 47% of people with bilateral cataract blindness (VA < 3/60) had undergone surgery. Of the 29 eyes that had undergone cataract surgery, nine (31%) had a best-corrected poor outcome (i.e., VA < 6/60). Extrapolating these estimates to Rwanda's Western Province, among the people aged 50 years or above 2,565 are expected to be blind, 1,824 to have severe visual impairment, and 8,055 to have visual impairment. CONCLUSIONS: The prevalence of blindness and visual impairment in this postconflict area in the Western Province of Rwanda was far lower than expected. Most of the cases of blindness and visual impairment remain avoidable, however, suggesting that the implementation of an effective eye care service could reduce the prevalence further. Public Library of Science 2007-07 2007-07-03 /pmc/articles/PMC1904464/ /pubmed/17608561 http://dx.doi.org/10.1371/journal.pmed.0040217 Text en © 2007 Mathenge et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Mathenge, Wanjiku
Nkurikiye, John
Limburg, Hans
Kuper, Hannah
Rapid Assessment of Avoidable Blindness in Western Rwanda: Blindness in a Postconflict Setting
title Rapid Assessment of Avoidable Blindness in Western Rwanda: Blindness in a Postconflict Setting
title_full Rapid Assessment of Avoidable Blindness in Western Rwanda: Blindness in a Postconflict Setting
title_fullStr Rapid Assessment of Avoidable Blindness in Western Rwanda: Blindness in a Postconflict Setting
title_full_unstemmed Rapid Assessment of Avoidable Blindness in Western Rwanda: Blindness in a Postconflict Setting
title_short Rapid Assessment of Avoidable Blindness in Western Rwanda: Blindness in a Postconflict Setting
title_sort rapid assessment of avoidable blindness in western rwanda: blindness in a postconflict setting
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1904464/
https://www.ncbi.nlm.nih.gov/pubmed/17608561
http://dx.doi.org/10.1371/journal.pmed.0040217
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