impressions of bangladesh

Impressions of Bangladesh

Further impressions / realities

Malnutrition

Eye care needs

Tackling blindness in Bangladesh

Vision for Blindness

National Blindness and Low Vision Survey of Bangladesh

Project AimTo determine the national prevalence and causes of blindness and low vision amongst persons aged 30 years and older in Bangladesh, based on a nationally representative sample.

Demographic InformationPopulation (2000) 130 million

Adults 30 and older - 44 million (33.6%)

Six administrative divisions

64 districts (zilas) / 490 thanas / 4491 unions

59,900 villages (mauzas) and urban wards (603)

Rural villages

Urban slums

Urban slum areas

Coastal areas

Chittagong Hill Tracts

Research DesignCross-sectional, descriptive study of 12,900 subjects

Multi-stage, random cluster sampling with PPS

Proportional allocation of clusters to rural (84.4%) and urban (15.6%) areas

Enumeration of 100 subjects per rural cluster (104)

Enumeration of 50 individuals per urban cluster (50)

Logistics - Survey Personnel3 Ophthalmologists3 Ophthalmic Nurses6 Medical Assistants6 Logisticians / Supervisors3 Interviewers6 Enumerators2 Data Processors1 Consultant Ophthalmologist1 UK Registrar-grade Ophthalmologist1 Bilingual Secretary

Operational Definitions for Blindness / Low Vision

Blindness Presenting visual acuity < 3/60 in the better eye

Low visionPresenting visual acuity < 6/12 but 3/60 in better eye

Interviewing SchedulesPersonal and socio-demographic data (age, sex, occupation, religion, land tenency, location)

WHO / PBL III modified questionnaire

Visual Functioning and Quality of Life instruments

Figure 1. Data Collection Procedures

Prevalence survey

It is simple but it will not be easy.

Professor Syed Modasser AliDhaka, Bangladesh

Urban settings

Examination ProceduresALL SUBJECTSVisual AcuityAuto-refractionPrevious eye health historyOptic disc assessment

LOW VISION / BLIND SUBJECTSVisual acuity re-testedCataractIOP / Diabetic Retinopathy / Retinal Disease

Results11,624 subjects examined

90.9% response rate

Response rate equally high in rural and urban areas

Visual acuity in the better eye (Presenting and Corrected)

Visual Acuity

Snellen Equivalent (logMAR)

Presenting Vision

n / %

(95% CI)

Corrected Vision

n / %

(95% CI)

Age-standardised prevalence

(95% CI)

Normal

(6/12

(

Presenting VA by 10-year age groups

Causes of blindness in adults

Mature / Hyper-mature Cataract

Blindness prevalence in Bangladeshi adults30 years and older 1.53% (age-standardised prevalence)

There are approximately 675,000 blind adults in the country (2000)

95% Confidence interval of 587,000 784,000 blind adults

79.6% is due to cataract about 550,000 cataract blind

In persons 50 years and older 4.0% blindness prevalence

Estimated number of cataract blind persons 50+ years is 450,000

Age-specific blindness prevalence

Blindness Prevalence by Division

Low Vision Cut-off of

Main cause of low vision in persons with

Refractive Errors in AdultsSecond leading cause of visual impairment (18.87%)

Spectacle use is low (3.0%)

Refractive correction shown to be beneficial in survey

Risk factors for blindness / low visionIncreased age, particularly after 60 years of age

Female gender (95% CI 1.18 - 2.29)

Rural resident (95% CI OR 1.34 - 1.79)

Illiteracy (95% CI OR 5.86 - 9.20)

Manual labour in men (95% CI OR 1.11 - 9.35)

Need for Low Vision Services in AdultsWHO definitionVA

Cataract surgical coverage Population based evaluation:

Proportion of need for cataract surgery being met

Number of aphakic eyes x100% Number of aphakic eyes + operable eyes

Ideally should be 100% which means that all those who need surgery have had surgery

Cataract surgical coverage (eyes)

Analysis of needs for, and output of cataract surgical services in BangladeshBetween 2,400 and 3,000 cataract operations are required / million population / year in Bangladesh to control cataract blindness

This translates to a total of 307,000 - 384,000 cataract operations annually

Currently 50-55,000 cataract operations are being done, which represents

Persons having had cataract surgery

Functional visual acuity in (pseudo)aphakic eyes (Presenting and Corrected)

Visual resultSnellen equivalentPresenting vision n / (%)Corrected vision n / (%)

GOOD> or = 6/18 99 (43.8)114 (63.3)BORDERLINE

Quantity and qualityPossible relationships between quantity and quality

Quantity sacrificed for quality Quality sacrificed for quantity Quality and quantity both improving

Low Vision RehabilitationAccording to the World Health Organisation definition, aperson with low vision is one who has impairment of visual function even after treatment or refractive correction and has visual acuity of less than 6/18 to perception of light or visual field of less than 10 in the better eye, who uses or is potentially able to use vision for planning or execution of a task.

Estimates of Visual Impairment in Bangladesh

Summary of ResultsMajor cause of blindness / low vision is cataract

Need for high quantity / quality cataract service delivery

Approximately 550,000 blind due to cataract

Refractive error is an important cause of low vision

Higher prevalences in Districts in rural areas

Disproportionate visual impairment amongst women

Bangladesh population projection - 2020Estimated total of 190 million population

85 million persons aged 30 years and older

32 million persons 50 years and older

In 2000, 4% of 50+ were bilaterally blind

1,280,000 million blind persons 50 years and older

Barriers to up-take of cataract surgery

BarriersCosts both direct and indirect

Fear of damage to the eye due to undergoing surgery

Attitude of being able to cope with daily activities

Attitude of ageism by the person and the family

Belief that it has been due to Gods will / curse

Data considerationsNational Blindness and Low Vision Prevalence Survey

Mehra - Minassian Cataract Grading System

2B or 3 grading degree of obfuscation of red reflex

Mature or Hyper-mature lens opacity

Principal reason for not accessing cataract services

Chart2

48.7441130298

12.8728414443

6.9858712716

6.9858712716

6.2009419152

4.8665620094

3.2967032967

2.8257456829

2.5117739403

2.0408163265

1.8838304553

0.6279434851

0.1569858713

Percentage

Barriers to up-take of cataract services in Bangladeshi adults (n = 1,274)

Sheet1

CLSTRSUJETOIDCOMMENT1

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102.000061.00000230VISION IS DECREASED DUE TO BEING OLD, 'NATURAL'









415.000033.00000214WAITING FOR MATURATION OF CATARACT
























608.000020.0000081WAITING TO BE ADVISED TO ATTEND FOR TREATMENT



COMMENT1

CLSTRSUJETOIDCOMMENT1ReasonFrequencyPercentageReasonFrequencyPercentageWomenReasonFrequencyPercentage

103.000041.0000062ADEQUATE VISION ACCORDING TO SUBJECTXPoverty63448.6Poverty48.6Poverty62148.7PovertyPoverty33926.0COMMENT1 * RURALURBAN Crosstabulation

103.000042.0000015ADEQUATE VISION ACCORDING TO SUBJECTXDoes not know about having cataract16612.7Does not know about having cataract12.7Does not know about having cataract16412.9Does not know about having cataractNo accompanying person725.5Count

103.000090.00000110ADEQUATE VISION ACCORDING TO SUBJECTXAdequate vision according to subject927.0Adequate vision according to subject7.0Adequate vision according to subject897.0Adequate vision according to subjectDoes not know about having cataract665.1RURALURBANTotal

104.000024.0000038ADEQUATE VISION ACCORDING TO SUBJECTXCarelessness917.0Not interested in undergoing surgery7.0Lack of interest897.0Not interested in undergoing surgeryAdequate vision according to subject413.1RRUU

104.000049.0000092ADEQUATE VISION ACCORDING TO SUBJECTXNo accompanying person796.1No accompanying person6.1No accompanying person796.2No accompanying personCarelessness413.1Adequate visionADEQUATE VISION ACCORDING TO SUBJECT721789

106.000059.0000071ADEQUATE VISION ACCORDING TO SUBJECTXFear624.8Fear4.8Fear624.9FearFear372.8Lack of interestCARELESSNESS791089

109.000089.0000081ADEQUATE VISION ACCORDING TO SUBJECTXNo time443.4No time3.4No time423.3No timeOld age181.4Does not know about having cataractDOES NOT KNOW ABOUT HAVING CATARACT13430164

111.00002.000001ADEQUATE VISION ACCORDING TO SUBJECTXOther reasons382.9Other reasons2.9Old age362.8Old ageIll with other disease181.4FearFEAR451762

113.00004.0000043ADEQUATE VISION ACCORDING TO SUBJECTXOld age362.8Old age2.8Other reasons322.5Other reasonsOther reasons171.3God's willGOD'S WILL22

113.000063.00000139ADEQUATE VISION ACCORDING TO SUBJECTXIll with other disease282.1Ill with other disease2.1Ill with other disease262.0Ill with other diseaseNo time131.0IllILL24226

113.000086.00000183ADEQUATE VISION ACCORDING TO SUBJECTXWaiting for maturation of cataract241.8Cataract not yet 'mature'1.8Waiting for maturation of cataract241.9Cataract not yet 'mature'Waiting for maturation of cataract50.4No accompanying personNO ACCOMPANYING PERSON75479

120.000019.00000104ADEQUATE VISION ACCORDING TO SUBJECTXVision is decreased due to being old, 'natural'90.7Vision is decreased due to being old, 'natural'0.7Vision is decreased due to being old, 'natural'80.6Vision is decreased due to being old, 'natural'Vision is decreased due to being old, 'natural'50.4No timeNO TIME34842

120.000083.00000141ADEQUATE VISION ACCORDING TO SUBJECTXGod's will20.2God's will0.2God's will20.2God's willGod's will10.1Old ageOLD AGE32436

122.000043.000001ADEQUATE VISION ACCORDING TO SUBJECTTOTAL1305100.0100.0TOTAL1274100.0TOTAL67351.6Other reasonsOTHER28432

122.000051.00000205ADEQUATE VISION ACCORDING TO SUBJECT1274PovertyPOVERTY54675621

123.000026.00000159ADEQUATE VISION ACCORDING TO SUBJECTXNo reason provided631274COMMENT1Vision is decreased due to being old, 'natural'VISION IS DECREASED DUE TO BEING OLD, 'NATURAL'718

126.000014.00000261ADEQUATE VISION ACCORDING TO SUBJECTXAlready attended961274FrequencyPercentValid PercentCumulative PercentWaiting for maturation of cataractWAITING FOR MATURATION OF CATARACT22224

128.000038.0000026ADEQUATE VISION ACCORDING TO SUBJECT1591274ValidPOVERTY62148.744113029848.744113029897.4882260597Total11001741274

131.000017.00000134ADEQUATE VISION ACCORDING TO SUBJECT13051274DOES NOT KNOW ABOUT HAVING CATARACT16412.872841444312.872841444326.8445839874

134.000013.0000061ADEQUATE VISION ACCORDING TO SUBJECT14641274CARELESSNESS896.98587127166.985871271613.9717425432

201.00002.0000030ADEQUATE VISION ACCORDING TO SUBJECT1274ADEQUATE VISION ACCORDING TO SUBJECT896.98587127166.98587127166.9858712716

201.000061.0000050ADEQUATE VISION ACCORDING TO SUBJECT1274NO ACCOMPANYING PERSON796.20094191526.200941915240.1098901099

204.000034.00000165ADEQUATE VISION ACCORDING TO SUBJECT1274FEAR624.86656200944.866562009431.7111459969

204.000035.00000207ADEQUATE VISION ACCORDING TO SUBJECT1274NO TIME423.29670329673.296703296743.4065934066

204.000060.00000113ADEQUATE VISION ACCORDING TO SUBJECT1274OLD AGE362.82574568292.825745682946.2323390895

204.000089.00000138ADEQUATE VISION ACCORDING TO SUBJECT1274OTHER322.51177394032.511773940348.7441130298

208.000078.00000202ADEQUATE VISION ACCORDING TO SUBJECT1274ILL262.04081632652.040816326533.9089481947

209.00005.00000111ADEQUATE VISION ACCORDING TO SUBJECTWAITING FOR MATURATION OF CATARACT241.88383045531.8838304553100

209.000063.00000207ADEQUATE VISION ACCORDING TO SUBJECTVISION IS DECREASED DUE TO BEING OLD, 'NATURAL'80.62794348510.627943485198.1161695447

210.000081.0000084ADEQUATE VISION ACCORDING TO SUBJECTGOD'S WILL20.15698587130.156985871331.8681318681

211.00008.0000084ADEQUATE VISION ACCORDING TO SUBJECTTotal1274100100














419.00007.00000103ADEQUATE VISION ACCORDING TO SUBJECTCOMMENT1

419.00008.00000194ADEQUATE VISION ACCORDING TO SUBJECTFrequencyPercentValid PercentCumulative Percent

419.000029.00000129ADEQUATE VISION ACCORDING TO SUBJECTValidADEQUATE VISION ACCORDING TO SUBJECT896.98587127166.98587127166.9858712716

419.000034.00000107ADEQUATE VISION ACCORDING TO SUBJECTCARELESSNESS896.98587127166.985871271613.9717425432

419.000056.00000116ADEQUATE VISION ACCORDING TO SUBJECTDOES NOT KNOW ABOUT HAVING CATARACT16412.872841444312.872841444326.8445839874

419.000084.00000202ADEQUATE VISION ACCORDING TO SUBJECTFEAR624.86656200944.866562009431.7111459969

420.000040.00000133ADEQUATE VISION ACCORDING TO SUBJECTGOD'S WILL20.15698587130.156985871331.8681318681

420.000058.00000166ADEQUATE VISION ACCORDING TO SUBJECTILL262.04081632652.040816326533.9089481947

420.000066.00000202ADEQUATE VISION ACCORDING TO SUBJECTNO ACCOMPANYING PERSON796.20094191526.200941915240.1098901099

421.000030.00000168ADEQUATE VISION ACCORDING TO SUBJECTNO TIME423.29670329673.296703296743.4065934066

421.000040.00000261ADEQUATE VISION ACCORDING TO SUBJECTOLD AGE362.82574568292.825745682946.2323390895

422.000058.00000219ADEQUATE VISION ACCORDING TO SUBJECTOTHER322.51177394032.511773940348.7441130298

423.000016.0000022ADEQUATE VISION ACCORDING TO SUBJECTPOVERTY62148.744113029848.744113029897.4882260597

423.000033.00000114ADEQUATE VISION ACCORDING TO SUBJECTVISION IS DECREASED DUE TO BEING OLD, 'NATURAL'80.62794348510.627943485198.1161695447

423.000050.000008ADEQUATE VISION ACCORDING TO SUBJECTWAITING FOR MATURATION OF CATARACT241.88383045531.8838304553100

423.000062.0000066ADEQUATE VISION ACCORDING TO SUBJECTTotal1274100100

































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102.000037.00000212CARELESSNESS









108.000065.00000162CARELESSNESS

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303.000054.00000134CARELESSNESS



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419.000032.00000130CARELESSNESS

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423.000030.00000243CARELESSNESS

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432.000018.00000153CARELESSNESS







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520.000021.0000032DOES NOT

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