Abstract
A systematic review was conducted in December 2013 to examine the extent to which health research has been focused on the eyehealth issues of fishing communities. We searched multiple databases to identify relevant citations, using a combination of Medical Subject Headings (MeSH) and text words representing eye health, fishing populations and measures of disease frequency. The search yielded only 4 studies, described in 5 articles. Three studies (one each in Turkey, Egypt and Spain) provided data on self-reported eye problems in fishermen or fishery workers, with prevalence ranging from 38% to 81%. There was only one study in the literature that objectively assessed the burden and causes of vision impairment and blindness in fishing communities. None of the studies examined availability, accessibility, acceptability and quality of eye care services. We conclude that marginalized fishing communities are almost non-existent in eye health literature. Eye health needs of these and other marginalized populations must be identified and addressed in post-2015 health and development agenda

Ahmad, Khabir

Chand, Bal

Tarantola,, Daniel J.

Zwi, Anthony B

English

eCommons@AKU

eCommons@AKUDepartment of Surgery Department of SurgeryOctober 2016A systematic review of epidemiological literature onthe eye health of marginalized fishing populationsKhabir AhmadAga Khan University, khabir.ahmad@aku.eduAnthony B. ZwiDaniel J. Tarantola,Universityof New SouthWalesBal ChandAga Khan University, bal.chand@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surgPart of the Ophthalmology CommonsRecommended CitationAhmad, K., Zwi, A. B., Tarantola,, D. J., Chand, B. (2016). A systematic review of epidemiological literature on the eye health ofmarginalized fishing populations. JPMA: Journal of Pakistan Medical Association, 66(10), S-81-S-82.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surg/103AbstractA systematic review was conducted in December 2013 toexamine the extent to which health research has beenfocused on the eye health issues of fishing communities.We searched multiple databases to identify relevantcitations, using a combination of Medical SubjectHeadings (MeSH) and text words representing eye health,fishing populations and measures of disease frequency.The search yielded only 4 studies, described in 5 articles.Three studies (one each in Turkey, Egypt and Spain)provided data on self-reported eye problems in fishermenor fishery workers, with prevalence ranging from 38% to81%. There was only one study in the literature thatobjectively assessed the burden and causes of visionimpairment and blindness in fishing communities. Noneof the studies examined availability, accessibility,acceptability and quality of eye care services. Weconclude that marginalized fishing communities arealmost non-existent in eye health literature. Eye healthneeds of these and other marginalized populations mustbe identified and addressed in post-2015 health anddevelopment agenda.Keywords: Systematic review, Eye health, Eye care,Access, Marginalised groups, Fishing communities.IntroductionFishing communities are among the most marginalisedgroups worldwide. These communities are frequentlycharacterised by disproportionate levels of poverty, lowlevels of school-based education, and segregation -although the size of these problem may vary from placeto place and from culture to culture.1,2 In 1974, the UnitedNations' Food and Agriculture Organisation emphasisedthat ''the people engaged in these activities and theirfamilies continue, with few exceptions, to live at themargin of subsistence and human dignity.''3 Four decadeslater, this situation has remained largely unchanged,despite the high demand for sea products and despiteunparalleled progress in poverty reduction in mostcountries in the world.While fishing communities make up a significant portionof world's population, they are grossly under representedin research on health and health outcomes.4 The currentstudy was planned to examine the extent to which healthresearch has been focussed on the eye health issues offishing communities, including the burden and causes ofvision impairment and blindness, and access to andquality of eye care services.Methods and ResultsThis review study was done in December 2013. Weconducted a literature search of multiple databases,including Medline (1966-2012), Embase (1980-2012),CINAHL (1983-2012), Science Citation Index (1945-2012)and Social Sciences Citation Index (1956-2012). Acombination ofmedical subject headings (MeSH) and textwords representing eye health (i.e. eye diseases, eyeproblems, cataract, eye trauma, visual impairment, andblindness), fishing populations (fishers, fishermen andfishing communities) and measures of disease frequency(incidence, prevalence) were used to generate relevantVol. 66, No.10 (Suppl. 3), October 20162nd Annual Surgical Meeting 2016 S-81SHORT REPORTA systematic review of epidemiological literature on the eye health ofmarginalized fishing populationsKhabir Ahmad,1,2 Anthony B. Zwi,1 Daniel J. M. Tarantola,3 Bal Chand21Health, Rights and Development (HEARD@UNSW), School of Social Sciences,Faculty of Arts and Social Sciences, The University of New SouthWales, Sydney,NSW, Australia, 2Section of Ophthalmology, Department of Surgery, Aga KhanUniversity, Karachi, Pakistan, 3School of Public Health and CommunityMedicine, Faculty of Medicine, The University of New South Wales, Sydney,NSW, Australia.Correspondence: Khabir Ahmad. Email: khabir.ahmad@aku.edu Figure: Flow diagram for selection of studies.citations. A database was constructed in EndNote X7(Thomson Reuters, Inc., Carlsbad, CA, USA). The referencelists of all known primary and review articles wereexamined to identify additional citations.The search yielded 142 records (Figure). Two additionalrecords were identified through other sources. A total of 5articles describing 4 different studies5-9 were deemedrelevant (Table). There was only one study in the literaturethat objectively assessed the burden and causes of visionimpairment and blindness in fishing communities.5 Thatcross-sectional study surveyed 1560 persons aged >40years, in fishing communities in the Prakasam district ofAndhra Pradesh in India, and found that 356(22.8%) (95%confidence interval [CI], 20.7-24.9) of them had bilateralmoderate vision impairment (MVI) and another 111(7.1%)(95% CI, 5.8 - 8.4) had bilateral severe vision impairment(SVI) or blindness. Cataract accounted for 1204(77.2%)cases of moderate vision impairment (MVI) and1448(92.8%) cases of severe vision impairment(SVI)/blindness.We identified three cross-sectional surveys7-9 thatexamined self-reported eye problems besides other healthproblems among fishery workers and fishermen. Onestudy7 interviewed 1166 small-scale fishermen (mean age:46 ± 12 years) working along the Aegean Sea coast inTurkey and found that 471 (40.4%) of them had an eyeproblem (one attended to by a physician in the precedingone year). This concernwas second only tomusculoskeletalproblems 984(84.4%). While 991(85%) fishermen reportedeyeproblemsdue to light reflection off the sea surface, only396(34%) said they used sunglasses.7The second survey8 interviewed 686 fishermen in El-Maaddiya fishing port, Egypt, in 2008. The prevalence ofself-reported eye problems was 553(80.6%) (95% CI, 77.5-83.5). The main self-perceived causes of eye problemswere solar radiation 514(75%), sea water 453(66%), wind302(44.1%), and the need to focus on sea surface269(39.2%). The third study9 had 247 fishery workers(mean age: 40.3±11.5 years) employed in 19 of the 23ports in Andalusia, Spain, and found the prevalence ofself-reported eye problems to be 38.1%.Discussion and ConclusionThis systematic review examined the extent to whichglobal health research has been focussed on the eyehealth issues of fishing communities, i.e. burden andcauses of vision impairment and blindness, and access toand quality of eye care services. It was disappointing tonote that so little research has been carried out on thissubject to date. Even in high-income countries, there hasbeen a failure to provide such information. Most of thesepopulations live in low and middle income countries(LMICs) where, directly or indirectly, the livelihood ofmore than 500 million people depends on fisheries andaquaculture.Our review found only one study in the literature that hasobjectively assessed the burden and causes of visionimpairment and blindness in fishing communities.5 Thatstudy found the prevalence of bilateral moderate visionimpairment to be 22.8% and of bilateral SVI/blindness tobe 7.1% in people aged 40 years or older. The higherprevalence of vision loss estimated in the survey,compared with national estimates,10 might reflect aJ Pak Med Assoc (Suppl. 3)S-82 2nd Annual Surgical Meeting 2016Table: Key findings of the included studies in systematic review on the eye health of fishing communities.Study identifier Population Key findingsMarmamula(2011, 2012)*5,6Percin (2012)7Zytoon (2012)8Novalbos (2008)9*Values obtained by personal communication with the authors.†MVI = moderate vision impairment SVI = moderate vision impairment.1560 persons > 40 years of age in fishing communities inPrakasam district, Andhra Pradesh, India1166 small-scale fishermen (mean age ± SD: 46 year ± 12years) working along the Aegean Sea coast in 76 fishingports in Turkey686 fishermen in El-Maaddiya fishing port, Egypt.247 fishery workers (mean age ± SD: 40.3 ± 11.5 years)employed in 19 of the 23 ports in Andalusia, Spain.Prevalence of MVI†: 22.8% (95% CI, 20.7-24.9)Prevalence of SVI/blindness†: 7.1% (95% CI, 5.8 - 8.4).Leading causes of MVI: Cataract (77.2%) and uncorrected refractive error (21.4%), surgeryrelated complications (1.4%)Leading causes of SVI/blindness: Cataract (92.8%), surgery related complications (4.5%),and uncorrected refractive error (0.9%)Prevalence of self-reported eye problems (one attended to by a physician in the last oneyear): 40.4%Prevalence of self-reported eye problems: 80.6% (95% CI, 77.5-83.5).Self-perceived causes of eye problems: Sun radiation (75.0%), sea water (66.0%), wind(44.1%), eye focus on sea surface (39.2%), night work (24.6%), jelly fish (15.4%), netshaking (14.6%), and fuel combustion exhaust (10.7%).Prevalence of self-reported eye problems: 38.1%relatively poor access to eye care services among fishingcommunities than the general population. Furthermore,the age structure of the sample surveyed was slightlyolder which is expected to have a higher prevalence ofage-related vision loss. The very high prevalence ofcataract-related vision loss in this population may bepartly attributable to the low cataract surgical coverage.In our review, three of the four studies reported data onself-reported eye problems in fishermen or fisheryworkers. None of the published studies providedinformation about the availability, accessibility,acceptability and quality of eye care services which arethe core contents of rights-based approaches to health.One reason why so little is known about the eye health offishermen and other members of this community is theirhard-to-reach nature.4 A particular challenge has been theremoteness of areas inhabited by fishing communitiesfrom the regional or sub-regional urban centres.Moreover, fishermen often spend long periods of time onthe sea. Their mobile and self-employed nature makes itextremely difficult to trace and include them in researchstudies as does their dynamic work schedule which issusceptible to changes due to weather, catch and anumber of other factors. Women in these populations arealso difficult to reach. A sizeable proportion of them, inaddition to taking major responsibility for housekeepingand childcare, work in fish processing or travel daily tomore affluent neighbourhoods to work as housemaidsand thus remain away from home for many hours. As aresult of these barriers, epidemiological research onfishing communities can be both labour- and capital-intensive, requiring careful planning and coordinatedeffort and time.4,11 The problem is also related to thegeneral lack of epidemiological research in LMICs wheremost of the fishing populations reside and wheremarginalised populations, those most at risk of ill-health,are often overlooked by health researchers, academia,health planners and funding agencies.Future systematic reviews should build on this work byencompassing other vulnerable and marginalised groupssuch as people living in poverty, ethnic, racial or religiousminorities, people with disabilities, undocumentedimmigrants, indigenous populations, refugees, prisoners,female sex workers and transgenders.This review has its limitations. First, the search wasrestricted to articles published in English language, whichcould have resulted in a language and/or publication bias.Second, experts were not contacted to identifyunpublished studies.AcknowledgementsWe are grateful to the Fred Hollows Foundation (FHF),Australia, for funding the study through a scholarshipgrant to the first author. Thanks are also due to to RashinChoudhry, Rubina Gillani, Virginia Sarah, Brian Doolan andMichael Johnson of FHF, and to Raza Zaidi for editorialassistance.References1. Kher A. Review of social science literature on risk and vulnerabilityto HIV/AIDS in fishing communities in Sub-Saharan Africa.Regional Programme Fisheries and HIV/AIDS in Africa: Investing inSustainable Solutions. Project Report 1966, 2008.2. Townsley P. Livelihoods and aquatic resource management. In:Carney D, ed. Sustainable rural livelihoods: what contribution canwe make. London: Department for International Development;1998: 139-54.3. Béné C, Macfadyen G, Allison EH. Increasing the Contribution ofSmall-Scale Fisheries to Poverty Alleviation and Food Security.FAO Fisheries, Technical paper 481. Rome: 2006.4. Matheson C, Morrison S, Murphy E, Lawrie T, Ritchie L, Bond C. Thehealth of fishermen in the catching sector of the fishing industry:a gap analysis. Occup Med (Lond) 2001; 51: 305-11.5. Marmamula S, Madala SR, Rao GN. Rapid assessment of visualimpairment (RAVI) in marine fishing communities in SouthIndia--study protocol and main findings. BMC Ophthalmol2011; 11: 26.6. Marmamula S, Madala SR, Rao GN. Prevalence of uncorrectedrefractive errors, presbyopia and spectacle coverage in marinefishing communities in South India: Rapid Assessment of VisualImpairment (RAVI) project. Ophthalmic Physiol Opt 2012; 32:149-55.7. Percin F, Akyol O, Davas A, Saygi H. Occupational health of TurkishAegean small-scale fishermen. Occupl Med 2012; 62: 148-51.8. Zytoon MA. Occupational injuries and health problems in theEgyptian Mediterranean fisheries. Safety Sci 2012; 50: 113-22.9. Novalbos J, Nogueroles P, Soriguer M, Piniella F. Occupationalhealth in the Andalusian Fisheries Sector. OccupMed (Lond) 2008;58: 141-3.10. Neena J, Rachel J, Praveen V, Murthy GV, Rapid Assessment ofAvoidable Blindness India Study G. Rapid Assessment ofAvoidable Blindness in India. PloS one 2008; 3: e2867.11. Lawrie T, Matheson C, Ritchie L, Murphy E, Bond C. The health andlifestyle of Scottish fishermen: a need for health promotion.Health Educ Res 2004; 19: 373-9.Vol. 66, No.10 (Suppl. 3), October 20162nd Annual Surgical Meeting 2016 S-83

A systematic review of epidemiological literature on the eye health of marginalized fishing populations

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A systematic review of epidemiological literature on the eye health of marginalized fishing populations

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