Finding children who are blind.

Children who are blind need to be found as early as possible so they can be examined, treated, referred, or rehabilitated. This is crucial if they are to have the best possible chance of proper childhood development, education, and participation in broader social life

Blindness and cataract in children in developing countries

Blindness in children is considered a priority area for VISION 2020, as visually impaired children have a lifetime of blindness ahead of them. Various studies across the globe show that one-third to half of childhood blindness is either preventable or treatable1 and that cataract is the leading treatable cause of blindness in children.The 8th General Assembly of the International Agency for the Prevention of Blindness (IAPB) provided an opportunity to be acquainted with recent research and programme development work in the prevention of childhood blindness

Assessing the prevalence of sensory and motor impairments in childhood in Bangladesh using key informants.

OBJECTIVES: The study was conducted to determine whether trained key informants (KI) could identify children with impairments. DESIGN: Trained KI identified children with defined impairments/epilepsy who were then examined by a medical team at a nearby assessment centre (Key Informant Methodology: KIM). A population-based household randomised sample survey was also conducted for comparing the prevalence estimates. SETTING: Three districts in North Bangladesh. PARTICIPANTS: Study population of approximately 258 000 children aged 0-<18 years, within which 3910 children were identified by KI, 94.8% of whom attended assessment camps. In the household survey, 8120 children were examined, of whom 119 were identified with an impairment/epilepsy. MAIN OUTCOME MEASURES: Prevalence estimates of severe visual impairment (SVI), moderate/severe hearing impairment (HI), substantial physical impairment (PI) and epilepsy. RESULTS: Overall prevalence estimates of impairments, including presumed HI, showed significant differences comparing KIM (9.0/1000 (95% CI 8.7 to 9.4)) with the household survey (14.7/1000 (95% CI 12.0 to 17.3)). Good agreement was observed for SVI (KIM 0.7/1000 children: survey 0.5/1000), PI (KIM 6.2/1000 children: survey 8.0/1000) and epilepsy (KIM 1.5/1000 children: survey 2.2/1000). Prevalence estimates for HI were much lower using KIM (2/1000) compared to the survey (6.4/1000). Excluding HI, overall prevalence estimates were similar (KIM: 7.5/1000 children (95% CI 7.2 to 7.8) survey: 8.4/1000 (95% CI 6.4 to 10.4)). CONCLUSIONS: KIM offers a low cost and relatively rapid way to identify children with SVI, PI and epilepsy in Bangladesh. HI is underestimated using KIM, requiring further research

Causes of blindness among children identified through village key informants in Malawi.

BACKGROUND: To determine the causes of blindness among children in rural Malawi. METHODS: This was a cross-sectional study of children in communities of Chikwawa district, Malawi. Children were identified through trained, community-based key informants. All identified children were examined by an ophthalmologist and the cause of blindness determined. RESULTS: In total, 151 children were identified, of whom 37 (25%) were blind. Among the blind, 21 (60%) were girls and 16 (40%) were boys. Cataract (congenital/developmental) was the leading cause of blindness (35%), followed by corneal conditions (22%). INTERPRETATION: In an area once noted for vitamin A deficiency in children, cataract is now the leading cause of blindness in children, replacing cornea blindness. Priorities for early cataract detection and intervention need to be considered for restoration of sight in children

Interventions to prevent respiratory diseases - Nutrition and the developing world

Malnutrition is a major cause of morbidity and mortality in developing countries and nutrition plays a critical role in both acute and chronic respiratory conditions. Inadequacies in the nutritional requirements of a developing lung in utero and in early life can compromise the respiratory system integrity and result in poor lung function, reduced protection against infections, greater likelihood of acute illnesses in childhood and chronic illness in adulthood. Nutritional interventions harness great potential in reducing respiratory illness related morbidity and mortality in the developing world. In this review we have summarized the findings from published systematic reviews/meta-analysis, experimental and observational studies that looked into different nutritional interventions for preventing respiratory diseases in developing countries

Prevalence and causes of severe visual impairment and blindness among children in the lorestan province of iran, using the key informant method.

PURPOSE: To estimate the prevalence and causes of severe visual impairment and blindness among children in Lorestan province of Iran, and to assess the feasibility of the Key Informant Method in this setting. METHODS: Potential cases were identified using the Key Informant Method, in 3 counties of Lorestan province during June through August 2008, and referred for examination. Causes of severe visual impairment/blindness were determined and categorized using standard World Health Organization methods. RESULTS: Of 123 children referred for examination, 27 children were confirmed to have severe visual impairment/blindness or blindness. The median age was11 years (interquartile range 6-13), and 59% were girls. After adjusting for non-attenders, the estimated prevalence of severe visual impairment/blindness was 0.04% (0.03-0.05). The main site of abnormality was retina (44%), followed by disorders of the whole eye (33%). The majority of causes had a hereditary etiology (70%), which was associated with a family history of blindness (P = 0.002). Potentially avoidable causes of severe visual impairment/blindness were found in 14 children (52%). Almost all children with severe visual impairment/blindness had a history of parental consanguinity (93%). CONCLUSIONS: Our findings suggest a moderate prevalence of childhood blindness in the Lorestan province of Iran, a high proportion of which may be avoidable, given improved access to ophthalmic and genetic counselling services in rural areas. The Key Informant Method is feasible in Iran; future research is discussed

Childhood Cataract: Home to Hospital

Globally, there are 190,000 children who are blind from cataract.1 Cataract in children may be present at birth (congenital cataract) or may appear anytime during the first few years of life (developmental cataract). Childhood cataract is the most common treatable cause of childhood blindness, being responsible for 10-30% of all childhood blindness. A recent national study in Bangladesh showed that 1 in every 3 blind children is unnecessarily blind from congenital/developmental cataract

Bridging the 10/90 gap: can Bangladesh provide a developing world model for influenza and pneumonia research?

Despite the fact that developing countries carry more than 90 global disease burden, only a small fraction of global medical research addresses their problems. It is interesting to note that even in the field of acute respiratory tract infections, a leading cause of mortality in poor settings, there has been disproportionately little research performed in developing countries. Using Bangladesh as an example, we discuss how clinical trials to address the most important health problems of the developing world (that are also of relevance to the developed world) have been and can continue to be conducted in resource poor countries. To start with, we propose to conduct, in partnership with colleagues from resource rich countries, an influenza vaccine trial in Bangladesh to assess the efficacy of trivalent influenza vaccine, with and without the addition of supplementary measures like the promotion of hand hygiene in reducing pneumonia mortality among children under 5 years of age. Such research may produce a win-win situation for both developed and developing countries