CSF Global, Dhaka, Bangladesh.
Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.
Dev Med Child Neurol. 2022 Feb;64(2):209-219. doi: 10.1111/dmcn.15041. Epub 2021 Sep 1.
To describe the epidemiology of eye diseases among children with disability in rural Bangladesh.
We established a population-based cohort of children with disability using the key informant method. Children younger than 18 years with disability (i.e. physical, visual, hearing, speech, epilepsy) were included. We used detailed ophthalmological assessments following World Health Organization (WHO) protocols by a multidisciplinary team including an ophthalmologist, optometrist, physician, and physiotherapist. Visual impairment, blindness, and severe visual impairment (SVI) were defined by following WHO categories.
Between October 2017 and February 2018, 1274 children were assessed (43.6% female; median [interquartile range] age 9y 10mo [6y -13y 7mo]). Overall, 6.5% (n=83) had blindness/SVI, and 5.6% (n=71) had visual impairment. In the group with blindness/SVI, 47% (n=39) had cortical blindness; of those, 79.5% (n=31) had cerebral palsy (CP). The other main anatomical sites of abnormalities in this group included lens (13.3%, n=11), cornea (10.8%, n=9), and optic nerve (9.6%, n=8). In the group with visual impairment, 90.1% (n=64) had refractive error. Overall, 83.1% (n=69) and 78.8% (n=56) of those with blindness/SVI and visual impairment had avoidable causes. Most children with blindness/SVI and visual impairment lacked access to education.
The burden of blindness/SVI/visual impairment is high among children with disability in rural Bangladesh, mostly due to avoidable causes. Overrepresentation of CP and cortical blindness in the group with blindness/SVI and refractive error in the group with visual impairment highlights the need for integration of ophthalmology assessment, eye care, and refraction services in comprehensive health care for children with disability including CP in rural Bangladesh.
描述孟加拉国农村地区残疾儿童眼病的流行病学情况。
我们采用关键知情人方法建立了一个残疾儿童的基于人群的队列。包括年龄在 18 岁以下的患有残疾（即身体、视力、听力、言语、癫痫）的儿童。我们使用多学科团队根据世界卫生组织（WHO）协议进行详细的眼科评估，该团队包括眼科医生、验光师、医生和物理治疗师。视力损害、失明和重度视力损害（SVI）是根据 WHO 类别定义的。
2017 年 10 月至 2018 年 2 月，共评估了 1274 名儿童（43.6%为女性；中位数[四分位间距]年龄为 9 岁 10 个月[6 岁-13 岁 7 个月]）。总体而言，6.5%（n=83）有失明/SVI，5.6%（n=71）有视力损害。在失明/SVI 组中，47%（n=39）有皮质盲；其中，79.5%（n=31）有脑瘫（CP）。该组中其他主要的异常解剖部位包括晶状体（13.3%，n=11）、角膜（10.8%，n=9）和视神经（9.6%，n=8）。在视力损害组中，90.1%（n=64）有屈光不正。总体而言，失明/SVI 和视力损害组中 83.1%（n=69）和 78.8%（n=56）的儿童有可避免的原因。大多数失明/SVI 和视力损害的儿童无法接受教育。
孟加拉国农村地区残疾儿童的失明/SVI/视力损害负担很高，主要是由于可避免的原因。失明/SVI 组中 CP 和皮质盲的高比例以及视力损害组中屈光不正的高比例突出表明，需要将眼科评估、眼保健和屈光服务纳入孟加拉国农村地区包括 CP 在内的残疾儿童全面保健中。
