A paper published in this week’s British Medical Journal has established that poverty is significantly associated with blindness and visual impairment in Pakistan.
Led by staff at the Pakistan Institute of Community Ophthalmology in Peshawar with support from the International Centre for Eye Health in London, the Pakistan National Blindness and Visual Impairment Survey is the first of its kind to investigate the link between blindness and deprivation at both a micro and a macro level.
Ranked 134 out of 177 on the Human Development Index, Pakistan has the sixth largest population in the world and cataract is the commonest cause of blindness. Data from the survey indicates that there are approximately 900,000 people with operable cataract.
The prevalence of blindness is known to be three to four times higher in developing countries than in industrialised nations but, until now, only limited information on the link between poverty and visual impairment has been available.
The paper’s key findings are as follows:
– The prevalence of blindness is significantly higher in poorer households and in deprived areas in Pakistan. Lower access to eye care and poorer quality services are important contributory factors.
– Participants living in urban areas in Sindh province were found to be the most affluent and rural areas in Balochistan the poorest. All poor clusters were located in rural areas.
– The prevalence of total blindness in Balochistan is more than three times higher than in affluent areas.
– Spectacle coverage is low and most notably in poor households and among women. Cataract surgical coverage was also lower in poorer areas and among women.
– Cataract is the leading cause of visual impairment in poor and medium clusters; in affluent clusters the leading cause is uncorrected refractive error.
The paper recommends that:
– to reduce blindness in Pakistan, strategies targeting the least well-off and women in particular are required.
– as uncorrected refractive error is a common cause of visual impairment, and highly cost-effective interventions exist, the country’s refractive and optical services need to be expanded.
According to Dr Clare Gilbert, first author of the paper: “Poverty is both a cause and consequence of blindness. The findings in Pakistan illustrate how poorer people have lower access to eyecare services and how women in particular need to be the specific focus of eyecare programmes.”
Dr Haroon Awan, Pakistan representative for leading blindness charity Sightsavers International which co-funded the survey, commented: “This paper provides an unequivocal basis for greater investment in eye health as part of strengthening overall health systems as a strategy for reducing poverty, marginalization and social exclusion.”
Notes:
The Pakistan National Blindness and Visual Impairment Survey examined 16,507 adults over the age of 30 years, sampled from 221 clusters in 94 of Pakistan’s 106 districts between 2001 and 2004. 561 blind individuals were identified. The survey was co-funded by Sightsavers International, Christoffel Blinden Mission, Fred Hollows Foundation, and the Pakistan office of the World Health Organisation.
On behalf of the Pakistan National Eye Survey Study Group, the authors of the Poverty and Blindness in Pakistan paper are Miss CE Gilbert, Mr SP Shah, Dr MZ Jadoon, Mr R Bourne, Mr B Dineen, Dr MA Khan, Professor Johnson GJ and Professor MD Khan. Clare Gilbert from the International Centre for Eye Health and medical advisor to Sightsavers International is available for interview. Copies of the Poverty and Blindness in Pakistan paper are also available.
There are 37 million blind people in the world; 75% of all blindness can be prevented or cured.
Sightsavers International is a registered UK charity (number 207544) that works in more than 30 developing countries to prevent blindness, restore sight and advocate for inclusion for people who are blind and visually impaired.
Sightsavers International