|Year : 1974 | Volume
| Issue : 3 | Page : 4-8
Prevalence and pattern of blindness in the field practice area of a rural health training centre
J Chakrabarti, AC Garg, CMS Siddhu
K. G. Medical College, Lucknow, India
K. G. Medical College, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chakrabarti J, Garg A C, Siddhu C. Prevalence and pattern of blindness in the field practice area of a rural health training centre. Indian J Ophthalmol 1974;22:4-8
|How to cite this URL:|
Chakrabarti J, Garg A C, Siddhu C. Prevalence and pattern of blindness in the field practice area of a rural health training centre. Indian J Ophthalmol [serial online] 1974 [cited 2020 Jul 10];22:4-8. Available from: http://www.ijo.in/text.asp?1974/22/3/4/31353
The problem of blindness in this country is of great immensity and propensity and shows great variation in its prevalence and pattern from one part to another part of the country due to factors such as geology, climate socio-economic-cultural conditions, communication, availability of medical care facilities etc. The national figure of 4.5 million blind and 5 cases of partial visual impairment for every case of blindness estimated in 1963 by I.C.M.R. are considered by Gupta  , Venkataswamy  and many others as an underestimate. Chhabra  , Malik and Gupta  estimated that India is housing one-fifth to one-third of global blind population:
The above quoted I.C.M.R. survey also revealed that cataract followed in order by trachoma, smallpox, malnutrition and injury were the leading causes of blindness.
Gupta  estimated that 80% of blindness in the country is preventable if cataract is excluded from the list of causes of blindness.
The economic implications are also staggering. Agarwal  estimated that more than Rs 10,000 crores of capital are lying blocked up in terms of curable and incurable blinds.
The main objective was to depict a fair picture of the prevalence and pattern of blindness in a rural population of Sarojini Nagar block in the Sadar Tehsil of district Lucknow, Uttar Pradesh. It was also aimed at collecting base line data and improving training techniques for interns and paramedical workers engaged in various preventive and curative programmes in the field practice area of rural health training centre of the King George's Medical College, Lucknow.
| Material and Methods|| |
With these objectives in view, village Gauri, one of the ten villages comprising the field practice area of the centre which is located near the 13 km. stone on Lucknow-Kanpur highway, was selected by a randomised sampling technique. The study was undertaken during the period January 1973 to October 1973, The total population of the village which numbered to 1307 were the subject of study. Household data were collected and recorded on household cards while pretreated individual schedules were used for each and every person.
A person was considered blind if his central visual acuity was 6/60 or worse in the better eye or had limitation in the field of vision such that the widest diameter of the visual field subtended an angular distance no greater than 20 degrees. Similarly a person who had a central visual acuity of 6/60 or less in the worse eye was termed as uniocularly sighted. Since testing of vision for children below 5 years of age could not be carried out effectively by Suellen's optotypes, the miniature toy test was employed.
In spite of best possible efforts only 1060 persons i. e. 79.9 per cent of the total population could be examined.
| Observations|| |
These are presented in the following 3 tables
Etiology shown as "unknown to science" comprised of cases of senile cataract, aphakia, primary glaucoma and retinal diseases. Similarly etiology shown as undetermined comprised of cases of iridocyclitis. optic nerve degeneration, phthisis bulbi and squint where etiology could not be established by the investigators.
A blind person was considered curable if his sight could be reasonably expected to be restored above 6/60 with a field more than 30 degrees in one or both eyes by surgery/therapy.
| Discussion|| |
Comparison of a study with another though very important is unfortunately be-set with difficulty due to lack of widely accepted definition on blindness. Hence the prevalence rates detected in this study have been compared to few relevant though not so strictly comparable ones conducted amongest rural masses in the northern region of the country.
| Prevalence|| |
The rates of blindness and uniocular loss of sight in the present study were 2.07 and 3.30 per cent respectively [Table - 1] Chatterjee et al  observed similar trends (blindness 2.7 per cent and uniocular loss of sight 3.1 per cent) in the Lauhaul and Spiti valley of Himachal Pradesh. Agarwal' reported a similar prevalence rate of blindness (2.5 per cent) amongst the population of a village near Delhi. If both the rates of the present study are combined together (5.7 per cent) it is then some what comparable and fairly similar to the total blindness rate of 5.13 per cent observed by Sharma and Prasad  at Barabanki district of Uttar Pradesh. The combined prevalence rate of economic and moderately binocular loss of vision (3.2 per cent) observed by Sharma et al  in the year 1962 amongst 1,105 persons of 4 villages in the same area as the present one is higher in comparison to the present blindness rate of 2.7 per cent. The present improvement is probably attributable to the better medical and health care facilities extended to the area by the centre since its inception a decade earlier or so.
The progressive increase of both rates with age [Table - 1] was statistically significant. This was so as the main bulk was made up of trachoma, cataract and glaucoma. The later two diseases are the frequent maladies of aging. Similar trend was also observed by several workers. No significant difference between the sexes was observed.
Another important observation was that there were only 4 cases of uniocular loss of sight with no case of blindness amongst children up to 14 years of age [Table - 1]. This indicates a happy trend towards improving blindness situation in the area attributable in part to the increased health care facilities provided.
| Pattern of blindness and uniocular loss of sight|| |
According to this classification corneal opacity was the main cause. For every case of blindness there were two cases of uniocular loss of sight [Table - 2]. Trachoma and associated conjunctivitis comprised about 89 per cent of this condition. All India estimate of "blindness due to diseases of cornea by Dhanda and Kalevar  is certainly much less. (15 per cent of 4.5 million) It is well known that trachoma has wide variation in its prevalence ranging from 79 per cent in Punjab to 0.5 per cent in West Bengal.
In order of importance cataract and aphakia came next [Table - 2]. Sharma and Prasad  and Chatterjee et a1  observed higher rates, The all India rate as per earlier quoted I.C.M.R. survey was also higher (57.97 per cent). Ophthalmic camps which are being held in the area annually are probably responsible for lower prevalence of cataract.
Primary glaucoma, optic nerve and retinal affections are also emerging as important causes as may le noted from [Table - 2]. In developed countries, however these are the foremost causes of blindness. Figures on 1,000 consecutive new registrants in the blindness register of Denmark  showed that 50.2 per cent and 15.2 per cent were blinded by retinal affections and glaucoma respectively. Report of the Ministry of England and Wales  for the year 1964 revealed that out of 2,014 newly registered blind persons, under the age of 65 years 48.31 per cent was due to retinal and optic nerve diseases.
| Etiological classification|| |
According to this classification trachoma was the singular most important cause [Table - 2]. It had recorded practically no overall decrease from the decade earlier observations of Sharma and Prasad  , Sharma et al  and Chhabra  . Its ravages, however is recording progressive decline in some other highly endamic states like Punjab and Haryana.
Ophthalmia neonatorum fortunately occupied an insignificant position [Table - 2] in this area. Similar picture from various parts of the country had been shown by Bagchi  , Mehrey  , Dutta  , Sharma and Prasad  , Chhabra  and others. The reason for the country wide low prevalence is yet to be known though confinement in rural areas conducted even today mostly by untrained dais under primitive conditions to whom credes proplyaxis is almost unknown.
Smallpox as a cause has lost its importance [Table - 2]. A decade earlier observations of Chhabra  , Sharma and Prasad  were double or even more. The decline is obviously due to extensive vaccination and containment measure being taken in the area.
Congenital and prenatal conditions were also found of not much significant [Table - 2] and coroborated well with the observation of Sharma and Prasad  , Chatterjee et al  , Somerset and Ghosh  . In developed countries, however, these are very important causes. According to Macdonald  these were responsible for 32 per cent of total blind in Canada.
Trauma also fortunately occupied a low position [Table - 2] probably due to agrarian nature of the community. The national prevalence under the I.C.M.R. survey of 1963 was 2.96 per cent.
No case due to keratomalacia was detected though vitamin A deficiency was known to be fairly prevalent in that community. Nil to very low prevalence of this condition was also detected by Sharma and Prasad  and Chatterjee et al  . Govil  observed the condition in only 0.2 per cent amongst 18,000 school children spread over 18 districts of this State. In southern states of the country, this is, however, an important cause. Venkateswamy and Rajagopalan  observed this in 7.0 per cent of 110 blind cases in the outpatient department of Erskine Hospital, Madurai.
| Preventability/Curability|| |
The present study also revealed that 82 per cent of blind cases were either preventable or curable [Table - 3]. This observation is in conformity with the observations of Gupta  , Mehrey  , Somerset, Ghosh  ., and Chatterjee et al  . These studies reflect the tremendous scope of preventive, curative and restorative services for amelioration of the tragedy in this country. Unfortunately even the paramount task of early detection of visual defects is at present critically challenged by acute shortage of professional medical and paramedical workers, clinic and hospital facilities, transportation and low level of living of the masses etc.
| Summary|| |
A survey on blindness covering 79 per cent of the total population of a village selected at random out of the ten villages in the field practice area of Sarojini Nagar, Lucknow district was undertaken. The objectives of the study were to find out prevalence and pattern of blindness, collection of base line data and improvement of training techniques for interns and paramedical workers engaged in various preventive and curative programmes of the centre. The study revealed that visual loss was high, 2.07 per cent for blindness and 3.30 per cent for uniocular loss of sight. Etiologically trachoma with topographically corneal opacity comprised the main' bulk of loss of sight. Smallpox, an earlier important cause, had lost its place considerably. While congenital and prenatal conditions, trauma and ophthalmia neonatorum had occupied low position, primary glaucoma, retinal and optic nerve diseases had occupied considerably high position indicating a gradual shift in the pattern. Fortunately 82 per cent of blindness detected was either preventable or curable showing tremendous scope of preventive, curative and restorative services.
| References|| |
Agarwal, L.P. (1967) Proceedings of the 1st annual conference of National Symposium, National Society for the prevention of blindness.
Agarwal, L.P. (1970) Proceedings of the IV annual conference of National Symposium, National society for the prevention of blindness New Delhi-16.
Bagchi, S. (1934-1935) Calcutta Med. Jour.,
29 : 283.
Blindness register in Denmark (1964) Sight Sav. Review 34,
Chatterjee et al
(1968) Amer. Jour. Ophthal.
Chhabra, H.N. (1967) Proc. 1st Annual Conference, N.S.P.B.
Dhanda, R.P. and Kalevar, V. (1968) Swasth Hind, 13,
Dutta, L.C. (1962) Jour. Ind. Med. Ass.,
39 :9, 464.
Govil, K.K. (1952) Ind. Med. Gaz., 87,
Gupta. U.C. (1970) Proc. IV Annual Conferance,
N. S. P. B.
Macdonald (1965) Canada Med. Ass.,
Malik, S.R.K. and Gupta, A.K. (1967) Proc. Ist Annual Conference,
Mehrey, M.P. (1961) Report on State of Health, U.P. with particular reference to certain diseases, Supdt. of Printing and Stationary, U.P., Lucknow.
Report of Min. of Health, England & Wales (1964) Sight Sav. Review
Sharma, K.L. and Prasad. B.G. (1962) Ind. Jour. Med. Res.,
Sharma et al
(1963) Jour. Ind. Med. Ass., 40,
Somerset, E.J. and Ghosh, N. (1951) Proc. All India Ophthal. Soc. 12,
Venkateswamy, G. (1972) Paper read at the IV General Assembly of the World Council for the Welfare of the blind.
Venkateswamy, G. and Rajagopalan, A.V. (1961) Jour. All India Oph. Soc.,
[Table - 1], [Table - 2], [Table - 3]