1 / 78

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 Aim.

dillon
Download Presentation

Impressions of Bangladesh

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Impressions of Bangladesh

  2. Further impressions / realities

  3. Malnutrition

  4. Eye care needs

  5. Tackling blindness in Bangladesh

  6. Vision for Blindness

  7. National Blindness and Low Vision Survey of Bangladesh

  8. Project Aim To 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.

  9. DemographicInformation • Population (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)

  10. Rural villages

  11. Urban slums

  12. Urban slum areas

  13. Coastal areas

  14. Chittagong Hill Tracts

  15. Rural Cluster Sites (104) Urban Cluster Sites (50)

  16. Research Design • Cross-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)

  17. Logistics - Survey Personnel • 3 Ophthalmologists • 3 Ophthalmic Nurses • 6 Medical Assistants • 6 Logisticians / Supervisors • 3 Interviewers • 6 Enumerators • 2 Data Processors • 1 Consultant Ophthalmologist • 1 UK Registrar-grade Ophthalmologist • 1 Bilingual Secretary

  18. Operational Definitions for Blindness / Low Vision • Blindness Presenting visual acuity < 3/60 in the better eye • Low vision Presenting visual acuity < 6/12 but  3/60 in better eye

  19. Interviewing Schedules • Personal and socio-demographic data (age, sex, occupation, religion, land tenency, location) • WHO / PBL III modified questionnaire • Visual Functioning and Quality of Life instruments

  20. Prevalence survey “It is simple but it will not be easy.” Professor Syed Modasser Ali Dhaka, Bangladesh

  21. Urban settings

  22. Results 11,624 subjects examined 90.9% response rate Response rate equally high in rural and urban areas

  23. Visual acuity in the ‘better eye’ (Presenting and Corrected)

  24. Presenting VA by 10-year age groups

  25. Causes of blindness in adults

  26. Mature / Hyper-mature Cataract

  27. Blindness prevalence in Bangladeshi adults 30 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

  28. Age-specific blindness prevalence

  29. Blindness Prevalence by Division

  30. Low Vision ‘Cut-off’ of <6/12 presenting visual acuity Vision in the better eye 16.4% prevalence (age-standardised) Estimated 6.8 – 7.5 million persons <6/12

  31. Main cause of low vision in persons with <6/12 visual acuity in either eye

  32. Refractive Errors in Adults Second leading cause of visual impairment (18.87%) Spectacle use is low (3.0%) Refractive correction shown to be beneficial in survey

  33. Risk factors for blindness / low vision • Increased 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)

  34. Need for Low Vision Services in Adults WHO definition VA <6/18 - PL after surgical treatment +/or refraction Prevalence of 0.56% - estimated 250,000 cases in country Causes: Retinal diseases (38.4%) Corneal diseases (21.5%) Glaucoma (15.4%) Optic atrophy (10.8%)

  35. 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

  36. Cataract surgical coverage (eyes)

  37. Analysis of needs for, and output of cataract surgical services in Bangladesh • Between 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 <20% of the estimated need

  38. Persons having had cataract surgery

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

  40. Quantity and quality Possible relationships between quantity and quality Quantity sacrificed for quality Quality sacrificed for quantity Quality and quantity both improving

  41. Estimates of Visual Impairment in Bangladesh

  42. Summary of Results • Major 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

  43. Bangladesh population projection - 2020 Estimated 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

More Related