National Eye Survey of Trinidad and Tobago (NESTT): prevalence, causes and risk factors for presenting vision impairment in adults over 40 years

AimTo estimate the prevalence, causes and risk factors for presenting distance and near vision impairment (VI) in Trinidad and Tobago.MethodsThis is a national, population-based survey using multistage, cluster random sampling in 120 clusters with probability-proportionate-to-size methods. Stage 1 included standardised, community-based measurement of visual acuity. Stage 2 invited all 4263 people aged ≥40 years for comprehensive clinic-based assessment. The Moorfields Eye Hospital Reading Centre graded fundus photographs and optical coherence tomography images independently.ResultsThe response rates were 84.2% (n=3589) (stage 1) and 65.4% (n=2790) (stage 2), including 97.1% with VI. The mean age was 57.2 (SD 11.9) years, 54.5% were female, 42.6% were of African descent and 39.0% were of South Asian descent. 11.88% (95% CI 10.88 to 12.97, n=468) had distance VI (logarithm of the minimum angle of resolution [logMAR] >0.30), including blindness (logMAR >1.30) in 0.73% (95% CI 0.48 to 0.97, n=31), after adjustment for study design, non-response, age, sex and municipality. The leading causes of blindness included glaucoma (31.7%, 95% CI 18.7 to 44.8), cataract (28.8%, 95% CI 12.6 to 45.1) and diabetic retinopathy (19.1%, 95% CI 4.2 to 34.0). The leading cause of distance VI was uncorrected refractive error (47.4%, 95% CI 43.4 to 51.3). Potentially avoidable VI accounted for 86.1% (95% CI 82.88 to 88.81), an estimated 176 323 cases in the national population aged ≥40 years. 22.3% (95% CI 20.7 to 23.8, n=695) had uncorrected near VI (logMAR >0.30 at 40 cm with distance acuity <0.30). Significant independent associations with distance VI included increasing age, diagnosed diabetes and unemployment. Significant independent associations with near VI included male sex, no health insurance and unemployment.ConclusionsTrinidad and Tobago’s burden of avoidable VI exceeds that of other high-income countries. Population and health system priorities are identified to help close the gap.

Download Full-text

Rapid assessment of avoidable blindness in Papua New Guinea: a nationwide survey

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311802 ◽

2018 ◽

Vol 103 (3) ◽

pp. 338-342 ◽

Cited By ~ 5

Author(s):

Ling Lee ◽

Fabrizio D'Esposito ◽

Jambi Garap ◽

Geoffrey Wabulembo ◽

Samuel Peter Koim ◽

...

Keyword(s):

Papua New Guinea ◽

Refractive Error ◽

Rapid Assessment ◽

New Guinea ◽

Nationwide Survey ◽

Population Based ◽

Vision Impairment ◽

Cross Sectional ◽

National Capital ◽

Uncorrected Refractive Error

ObjectiveTo estimate the prevalence and main causes of blindness and vision impairment in people aged 50 years and older in Papua New Guinea (PNG).DesignNational cross-sectional population-based survey in National Capital District (NCD), Highlands, Coastal and Islands regions.MethodsAdults aged 50 years and above were recruited from 100 randomly selected clusters. Each participant underwent monocular presenting and pinhole visual acuity (VA) assessment and lens examination. Those with pinhole VA<6/12 in either eye had a dilated fundus examination to determine the primary cause of reduced vision. Those with obvious lens opacity were interviewed on barriers to cataract surgery.ResultsA total of 4818 adults were examined. The age-adjusted and sex-adjusted prevalence of blindness (VA <3/60), severe vision impairment (SVI, VA <6/60 but ≥3/60), moderate vision impairment (MVI, VA <6/18 but ≥6/60) and early vision impairment (EVI, VA <6/12 but ≥6/18) was 5.6% (95% CI 4.9% to 6.3%), 2.9% (95% CI 2.5% to 3.4%), 10.9% (95% CI 9.9% to 11.9%) and 7.3% (95% CI 6.6% to 8.0%), respectively. The main cause of blindness, SVI and MVI was cataract, while uncorrected refractive error was the main cause of EVI. A significantly higher prevalence of blindness, SVI and MVI occurred in the Highlands compared with NCD. Across all regions, women had lower cataract surgical coverage and spectacle coverage than men.ConclusionsPNG has one of the highest reported prevalence of blindness globally. Cataract and uncorrected refractive error are the main causes, suggesting a need for increased accessible services with improved resources and advocacy for enhancing eye health literacy.

Download Full-text

Risk factors and health consequences of physical and emotional violence against children in Zimbabwe: a nationally representative survey

BMJ Global Health ◽

10.1136/bmjgh-2017-000533 ◽

2018 ◽

Vol 3 (3) ◽

pp. e000533 ◽

Cited By ~ 4

Author(s):

Handrick Chigiji ◽

Deborah Fry ◽

Tinashe Enock Mwadiwa ◽

Aldo Elizalde ◽

Noriko Izumi ◽

...

Keyword(s):

Risk Factors ◽

Socioeconomic Status ◽

Health Outcomes ◽

Peer Relationships ◽

Emotional Abuse ◽

Physical Violence ◽

Significant Risk ◽

Population Based ◽

School Level ◽

National Population

IntroductionThis study provides, for the first time, comparable national population-based estimates that describe the nature and magnitude of physical and emotional violence during childhood in Zimbabwe.MethodsFrom August to September 2011, we conducted a national population-based survey of 2410 respondents aged 13–24 years, using a two-stage cluster sampling. Regression models were adjusted for relevant demographics to estimate the ORs for associations between violence, risk factors and various health-related outcomes.ResultsRespondents aged 18–24 years report a lifetime prevalence (before the age of 18) of 63.9% (among girls) to 76% (among boys) for physical violence by a parent or adult relative, 12.6% (girls) to 26.4% (boys) for humiliation in front of others, and 17.3% (girls) to 17.5% (boys) for feeling unwanted. Almost 50% of either sex aged 13–17 years experienced physical violence in the 12 months preceding the survey. Significant risk factors for experiencing physical violence for girls are ever experiencing emotional abuse prior to age 13, adult illness in the home, socioeconomic status and age. Boys’ risk factors include peer relationships and socioeconomic status, while caring teachers and trusted community members are protective factors. Risk factors for emotional abuse vary, including family relationships, teacher and school-level variables, socioeconomic status, and community trust and security. Emotional abuse is associated with increased suicide attempts for both boys and girls, among other health outcomes.ConclusionPhysical and emotional violence often work in tandem causing poor mental and physical health outcomes. Understanding risk factors for violence within the peer or family context is essential for improved violence prevention.

Download Full-text