Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment surveyBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39395.500046.AE (Published 03 January 2008) Cite this as: BMJ 2008;336:29
- Clare E Gilbert, reader in international eye health1,
- S P Shah, research fellow in ophthalmology 1,
- M Z Jadoon, consultant epidemiologist2,
- R Bourne, consultant ophthalmologist3,
- B Dineen, research fellow in epidemiology 1,
- M A Khan, executive director 2,
- G J Johnson, professor in ophthalmology 1,
- M D Khan, professor in ophthalmology 2
- on behalf of the Pakistan National Eye Survey Study Group
- 1International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT
- 2Pakistan Institute of Community Ophthalmology, Peshawar, Pakistan
- 3Ophthalmology Department, Hinchingbrooke Hospital, Huntingdon, Cambridge
- Correspondence to: C E Gilbert
- Accepted 17 October 2007
Objective To explore the association between blindness and deprivation in a nationally representative sample of adults in Pakistan.
Design Cross sectional population based survey.
Setting 221 rural and urban clusters selected randomly throughout Pakistan.
Participants Nationally representative sample of 16 507 adults aged 30 or above (95.3% response rate).
Main outcome measures Associations between visual impairment and poverty assessed by a cluster level deprivation index and a household level poverty indicator; prevalence and causes of blindness; measures of the rate of uptake and quality of eye care services.
Results 561 blind participants (<3/60 in the better eye) were identified during the survey. Clusters in urban Sindh province were the most affluent, whereas rural areas in Balochistan were the poorest. The prevalence of blindness in adults living in affluent clusters was 2.2%, compared with 3.7% in medium clusters and 3.9% in poor clusters (P<0.001 for affluent v poor). The highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence of total blindness (bilateral no light perception) was more than three times higher in poor clusters than in affluent clusters (0.24% v 0.07%, P<0.001). The prevalences of blindness caused by cataract, glaucoma, and corneal opacity were lower in affluent clusters and households. Reflecting access to eye care services, cataract surgical coverage was higher in affluent clusters (80.6%) than in medium (76.8%) and poor areas (75.1%). Intraocular lens implantation rates were significantly lower in participants from poorer households. 10.2% of adults living in affluent clusters presented to the examination station wearing spectacles, compared with 6.7% in medium clusters and 4.4% in poor cluster areas. Spectacle coverage in affluent areas was more than double that in poor clusters (23.5% v 11.1%, P<0.001).
Conclusion Blindness is associated with poverty in Pakistan; lower access to eye care services was one contributory factor. To reduce blindness, strategies targeting poor people will be needed. These interventions may have an impact on deprivation in Pakistan.
We are grateful for the contribution of the Pakistan National Eye Survey Study Group, which consisted of Shad Mohammed, Zia Uddin Sheik, Asad Aslam, Nasim Panazai, Shabbir Mir Niaz Ali, Pak Sang Lee (technical coordinator, International Centre for Eye Health, London), Ikram Ullah Khan (biomedical engineer, Pakistan Institute of Community Ophthalmology), Haroon Awan (Sightsavers International), Rubina Gillani (Fred Hollows Foundation), Babar Qureshi (Christoffel Blindenmission), Mohammed Shabbir and Falak Naz (clinical and community ophthalmologists, North West Frontier Province Team), Abdul Ghafoor and Kiramatullah (survey ophthalmologists, Punjab and Baluchistan Teams), Waheed Shaikh and Amjad Shaikh (survey ophthalmologists, Sindh Team). We also thank Tauqeer Abbas and Fakhre-e Alam for data entry; Mahwash Akhtar-Khan, Yelena Alexander, and Rahul Shah for assisting in data cleaning; and Fazl-Subhan and Jyoti Shah for assisting with financial management. Heidelberg Engineering (Heidelberg, Germany) kindly lent two HRT-II instruments. Lateef Brothers and S Haji Ameerdin and Sons, both based in Lahore, Pakistan, were generous in their instrument support. The NWFP divisions of the companies Remington and Kobec Ophthalmic generously donated drugs.
Contributors: CEG had the idea for the paper and the analyses and wrote the first draft. SPS did all the analyses and contributed to writing the first draft. MZJ contributed to the design of the survey and was responsible for managing the field teams in Pakistan. RB was responsible for clinical training and quality control during the survey. BD contributed to the design of the survey and had overall responsibility for setting up and overseeing the survey. MAK assisted in clinical training and managing the logistics in Pakistan. GJJ had overall responsibility for the survey in the UK. MDK initiated the survey and had overall responsibility for the survey in Pakistan. CEG is the guarantor.
Funding: Sightsavers International, Christoffel Blinden Mission, Fred Hollows Foundation, World Health Organization—Pakistan Office.
Competing interests: None declared.
Ethical approval: Pakistan Medical Research Council.
Provenance and peer review: Not commissioned; externally peer reviewed.
- Accepted 17 October 2007