Causes of childhood blindness in east africa: Results in 491 pupils attending 17 schools for the blind in Malawi, kenya and uganda

Pupils attending 12 schools for the blind in Malawi, 3 schools in Kenya and 2 schools in Uganda were examined to determine the causes of severe visual impairment or blindness (visual acuity in the better eye of less than 6/60). A total of 491 pupils aged 3-22 years was examined. Visual acuity was measured in each eye using a Snellen E chart. The anatomical site of abnormality and underlying cause of visual loss were determined by clinical examination for each eye, and for the child. Information was recorded on a standard reporting form (the WHO/PBL Eye Examination Record for Children with Blindness and Low Vision). Data were analysed for those aged less than 16 years using a database which accompanies the form. Preventable and treatable causes were identified. 260 pupils aged 5-20 years were examined in Malawi, 163 pupils aged 3-19 years were examined in Kenya and 68 pupils aged 6-22 years were examined in Uganda. Of the 491 students included in the study 309 (62.9%were blind (BL) and 69 (14.1%were severely visually impaired (svi). 244 were aged less than 16 years and had SVI/BL. In these 244 children 35.2%of visual loss was due to corneal pathology, 13.5%was due to cataract and 14.8%to diseases of the retina. Corneal pathology, attributed to vitamin A deficiency and measles infection in the majority, was responsible for proportionally more SVI/BL in students in Malawi than in Uganda or Kenya. Overall, 131 (53.7%of students aged 0-15 years with s vi/ BL had causes which could be avoided through the provision of adequate primary health care services and specialist ophthalmic services. Conclusions: 1 Approximately 1 in 5 students attending schools for the blind in this study had a visual acuity in the better eye of 6/60 or better. 2 Vitamin A deficiency and measles infection were the major causes of s v 1 / B L in children in Malawi, but were found to be relatively less important in this study population in Uganda and Kenya. These findings should be interpreted with caution as they may reflect selection bias in Kenya and Uganda. 3 Cataracts and their sequelae are the major surgically correctable cause of SVI/BL in all 3 countries (10.4%26.7%4 One in 4 pupils in Kenya, 1 in 2 in Uganda and 2 in 3 in Malawi are severely visually impaired or blind from conditions which are potentially avoidable, e.g. measles infection, vitamin A deficiency and cataract. © 1995 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.