Chapter 3 Priorities and objectives - What do we want to achieve?
3.5.3 Childhood blindness
Childhood blindness is one of the main priorities in VISION 2020 for the following reasons:
- causes of blindness in children differ from those in adults and require different strategies;
- delay or absence of treatment in the early stages leads to conditions which are not treatable or not easily treatable in adults, such as amblyopia;
- treatment requires specific training, knowledge, skills, and equipment;
- the number of ‘blind years’ in children is much greater than blindness occurring in adults.
There are an estimated 1.5 million blind children in the world, of whom approximately 1 million live in Asia and approximately 300 000 in Africa. Each year, an estimated half a million children become blind, of whom up to 60% die in childhood.
Childhood blindness is caused mainly by vitamin A deficiency, measles, conjunctivitis in the newborn, congenital cataract, and retinopathy of prematurity (ROP). ROP is an established problem in developed countries because of the ever-increasing survival rate of low- and very low-birth-weight infants. For the same reason, it is also emerging as a problem in economically-developing parts of the world, especially in urban settings. Other causes of childhood blindness are congenital or genetically determined. It should be noted that the causes of childhood blindness vary from country to country and over time.
Because of the wide range of causes of childhood blindness, intervention must be disease-specific and directed at more than one level of the eye-care delivery system. Accordingly, vitamin A deficiency and measles, treatment of simple eye infections, prevention of corneal trauma, and immunization are best managed at the primary level. Relevant activities should be integrated with existing maternal and child health programmes, immunization programmes, and other community- directed health services.
Management of ocular injuries and corneal ulcers, and the provision of spectacles, take place at the secondary level. Prevention of ROP, surgical treatment of eye conditions, and provision of optical devices all take place at the tertiary level. Close cooperation with other specialists, such as neonatologists and paediatricians, is essential.
One of the objectives set by the World Summit for Children in 1990 was to eliminate blindness resulting from vitamin A deficiency by the year 2000. This objective has been achieved in some countries. However, there are still 78 countries where vitamin A deficiency remains a public health problem.
If no valid survey data on vitamin A deficiency are available, a fairly accurate estimate can be based upon the under-5 mortality rate. This alternative has been included in the “Planning spreadsheet”.
Documents
Preventing
blindness in children
A
five-year project for the prevention of childhood blindness
Sight
and Life manual on vitamin A deficiency disorders
The
child, measles and the eye
Slide sets
Slides
on vitamin A deficiency disorders
Explanation
on slide set of vitamin A deficiency disorders
Articles
Childhood
blindness in the context of VISION 2020: The Right to Sight
New
issues in childhood blindness
Prevalence
of vitamin A deficiency in children aged 6-9 years in Wukro, northern
Ethiopia
Is
Credé’s prophylaxis for ophthalmia neonatorum still valid?
The
increasing problem of retinopathy of prematurity
Intraocular
lens implants in children
The
importance of primary eye care (JCEH, Issue 26)
Web sites
Deafblindness
resources on the net
Templates
Coding
instructions for the WHO childhood blindness form
Estimating
childhood blindness from under 5 mortality rates
Available from WHO
Vitamin
A deficiencies and its consequences: a field guide to detection and control