Original article
The Kariapatti Pediatric Eye Evaluation Project: baseline ophthalmic data of children aged 15 years or younger in Southern India

https://doi.org/10.1016/S0002-9394(03)00421-5Get rights and content

Abstract

Purpose

To estimate the prevalence of ocular morbidity among children of rural southern India before developing a service delivery model for community-based pediatric eye care.

Design

Population-based cross sectional study.

Methods

Trained field-workers performed door-to-door enumeration in 74 randomly selected villages of the Kariapatti block in southern India to identify children aged 15 years or younger and performed visual acuity measurements using Cambridge crowded cards and external eye examination with torchlight. Pediatric ophthalmologists further examined subjects with ocular problems identified by the field-worker. The clinical team performed repeat visual acuity measurements with Cambridge crowded cards, refraction, slit-lamp anterior segment examinations, and dilated posterior segment examinations at the screening site. The ophthalmologist identified and recorded one major cause for each visually impaired eye.

Results

Field-workers screened 10,605 (94.6%) of 11,206 children enumerated, and identified 1,441 (13.6%) children as requiring further clinical examination. An additional 449 children identified as normal by the field-worker were randomly chosen for repeat examinations at the screening sites. In all, 1,578 (83.5%) of these 1,890 children were examined at the screening site. According to World Health Organization criteria, 6.2 of 10,000 children were blind; 42.9% of this blindness was potentially avoidable. Refractive errors (0.55%, 95% confidence interval: 0.41, 0.69) and strabismus (0.43%, 95% confidence interval: 0.30, 0.55) were the major ocular morbidity in this population.

Conclusions

Developing an appropriate service delivery model for this region will require a balance between the relatively low prevalence of morbidity and blindness and the need for service in this population.

Section snippets

Methods

For the purposes of the project, we divided Kariapatti into six sectors, each sector comprising a population of approximately 15,000 persons. The separation into six sectors was based on access to and geographical proximity between villages and was not necessarily based on population size. We randomly chose 74 hamlets with a total estimated 35,000 population, including 10,000 to 12,000 children from these six sectors for evaluating ocular morbidity. We did not stratify further within the

Results

We enumerated the population of 74 hamlets between July and December 2002. These 74 hamlets had a total population of 38,001, including 11,206 children (29.5%) aged 15 years or younger. The field-workers were able to screen 10,605 (94.6%) of these 11,206 children. The remaining 601 children could not be screened as they had temporarily migrated out of the region during the period of the survey. Children who could not be screened by the field-workers were more likely to be aged 10 years and

Discussion

Data from our project suggest that the prevalence of ocular morbidity among children is relatively low in this population. Nearly two thirds (according to the Indian criteria) and half (according to WHO criteria) of cases of blindness were either preventable or avoidable in this population.

The door-to-door enumeration and the high rate of response to screening by the field-worker (94.6%) and to clinical examinations of children identified by the fieldworker as requiring further examination

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This study was supported by Seva Canada Society, Canada, Seva Foundation, USA, and Aravind Medical Research Foundation, Madurai, India.

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