Mid Sweden University

Background: Childhood visual impairment and blindness impose substantial health, educational, social, and economic burdens on affected children and their families. An estimated 19 million children worldwide are visually impaired, of whom 1.4 million are permanently blind. This thesis aimed to generate comprehensive evidence on the epidemiology, health-seeking behavior, economic burden, and health-system barriers related to pediatric eye care in Bangladesh, and to develop an integrated framework to reduce childhood ocular morbidity and blindness.

Methods: Five complementary studies were conducted, including a population-based survey of childhood blindness, a school-based survey of refractive error, mixed-methods assessments of health-seeking behavior and economic burden, and a framework development study that combined a literature review with expert consultation. Quantitative data were analyzed using descriptive and multivariable statistical methods, and qualitative data were analyzed using thematic analysis.

Results: Study I detected 6.3 blind per 10,000 children. Of 198 detected cases, only 87 (44%) had parents who sought care; over half sought no services. Key barriers were poor knowledge, financial constraints, and taboo (Study II). Refractive error prevalence was 5.3%, predominantly myopia (78.8%); urban children were most affected (9.9%), and only 15.7% of affected children wore spectacles; secondary school girls were at higher risk (Study III). Nearly 90% of families experienced catastrophic health expenditure (CHE); median out-of-pocket costs were highest for squint (BDT 65,000) and cataract (BDT 50,000). Families bypassed local facilities due to low trust, inadequate equipment, and a lack of awareness, traveling to tertiary centers in the capital at great expense (Study IV). An integrated framework based on the WHO six building blocks was developed, emphasizing multi sectoral collaboration, task shifting, community financing, and the strengthening of health information systems (Study V).

Conclusion: Childhood blindness and ocular morbidity in Bangladesh persist due to socioeconomic inequities, limited awareness, delayed care-seeking, and health-system weaknesses. Strengthening pediatric eye care through an integrated, multisector health-system approach is essential to prevent avoidable blindness and ensure equitable access to services.

Background

Blindness affects 1.4 million children worldwide between the ages of 0 and 14 years; in Bangladesh, the prevalence rate is 6.3 per 10,000 children. Thus, this study aimed to develop a framework with an integrated approach to strengthen paediatric eye services in Bangladesh to address childhood blindness.

Methods

To develop the framework for paediatric eye care services, the study primarily adopted a literature review on existing eye care frameworks including results of authors own previous research work and then conducted three day-long workshops and consultation meetings with experts and stakeholders to finalize the framework. At the initial two workshops, a draft framework was presented and a discussion took place to suggest the necessary measures to strengthen the existing paediatric eye care. After incorporating all the suggestions and measures in the last workshop, the framework was finalized and validated.

Results

To design this framework, this study adopted the World Health Organization’s six-building block approach for strengthening the pediatric eye care system. The government of Bangladesh has a strong political commitment to address the prevention of blindness and they have already adopted an action plan called the National Eye Care Plan. Financial support to beneficiaries from the Government and Non-government sectors is crucial to mitigate financial challenges. By desk review, it was found that human resources were inadequate in number and there was geographical uneven distribution of both service facilities and human resources., so task shifting and sharing of human resources based on the geographical location should be ensured.

Conclusion

The workshop recommended multiple approaches, which were incorporated into the framework. A large-scale piloting program is required to evaluate the framework’s feasibility and effectiveness in lowering morbidity associated with pediatric eye diseases.

Background: According to recent statistics from WHO, 150 million people globally have visual impairments caused by uncorrected refractive errors. This study aimed to estimate the prevalence rate of refractive error in Bangladesh's urban, rural, and marginalized populations (tea gardens). Methods: This was a cross-sectional study conducted among all school-going children (Class I-X) aged 5 to 18. The study adopted the stratified cluster sampling method to recruit study subjects. A pre-tested semi-structured questionnaire was used for face-to-face interviews. Trained optometrists carried out vision screening and refraction to identify children with vision impairment. Results: The prevalence of refractive error is 5.3 per 100 population in which myopia is the most common form of refractive error found in 125 (78.6%, 95% CI: 77.1–80.1), followed by astigmatism in 20 (12.6%, 95% CI: 11.4–13.8) and the rest of the cases are hyperopia among 14 (8.8%, 95% CI: 7.8–9.8) children. At the time of the vision screening, only 25 (15.7%) children using spectacles were found. The study findings also showed that urban areas had the highest percentage of refractive error (9.9%), and rural and tea gardens had 3.9% and 2.1% refractive error, respectively. Refractive error was relatively higher among girls’ (AOR = 1.5, p < 0.01, 95%CI: 1.07–2.11) in comparison with boys’ and the percentage of refractive error was three times higher within the secondary school-going children (AOR = 3.2, p < 0.01, 95%CI: 1.23–8.08) compared to primary school children. Conclusion: The prevalence of refractive error was higher in the above-ten-year-old age group and significantly lower in rural and tea garden populations. To resolve these challenges, an assortment of comprehensive strategies must be implemented. 

Introduction: Childhood eye morbidity is a great public health problem, especially in low-income countries. This study aimed to determine the economic burden of childhood ocular morbidity on attending tertiary hospitals in Bangladesh. This study also assessed the catastrophic health expenditure (CHE) for childhood ocular morbidity in Bangladesh. Methods: A cross-sectional mixed method was used for this study from April to October 2023 at two tertiary hospitals in Bangladesh, one government-funded and one private. Face-to-face interviews using a semi-structured quantitative questionnaire with the caregivers/parents and in-depth interviews (IDIs) were conducted among the same respondents of these two hospitals, and a workshop was conducted with the stakeholders during the study period. Results: This was the first study in Bangladesh to determine the cost of pediatric ocular morbidity. Among 335 patients, the total median direct cost at a single time was 3740 ± 18,285 BDT (34 ± 166.2 USD) at the government hospital and 7300 ± 40,630 BDT (66.36 ± 369.36 USD) at the private hospital. The disease-specific median overall cost from diagnosis of the disease was 65,000 BDT (591 USD) for squint, 50,000 BDT (454.54 USD) for cataract, and 30,000 BDT (272.72 USD) for eye injury. Almost 90% of the caregivers/parents faced CHE due to different pediatric ocular morbidity. Conclusions: These cost estimates can be used as an initial basis for financial decisions that aim to enhance access to care, management, and follow-up of children with ocular morbidity. These cost estimates also offer helpful information for organizational and financial sustainability initiatives. Policymakers can consider serious immediate interventions for securing ocular health services in Bangladesh and prevent families from CHE. 

Globally, ocular morbidity and disability among children are major public health concerns.This study was designed to explore the health-seeking behaviours of parents in Bangladesh whose children have ocular problems. A cross-sectional mixed method was followed for this study. The method was designed to measure the eye health care-seeking practices of caregivers/parents with children with ocular morbidity in three unions (the lowest administrative geographical area comprising 30,000–50,000 population) of the Raiganj Upazila under the Sirajganj District of Bangladesh. The study period was from January to April 2017. Face-to face interviews using a semi-structured quantitative questionnaire with the caregivers and KI were conducted among the health service providers during the study period. This was the first community-based study conducted in Bangladesh to find out caregivers’ health-seeking behaviour with identified ocular morbidity. Among 198 confirmed cases of childhood ocular problems, only 87 (43.9%) parents sought health care for their children’s ocular morbidities. Better health-seeking behavior was found among the wealthier families. Proportions were 55.3% and 36% among wealthy and low-income families, respectively. Affluent families sought care from qualified service providers. Educated household heads chose qualified service providers for their children at a higher rate than illiterate household heads. Lack of knowledge, lack of awareness and financial constraints are significant barriers to seeking proper health care. More than half of the caregivers did not seek any eye care services for their children. Socio-demographic factors, and financial constraints play an essential role in the health-seeking behaviour of the parents.

This study aimed to investigate the prevalence and causes of childhood blindness in a rural area of Bangladesh. We adopted a cross-sectional quantitative study design for this study, which was performed in three unions (sub-districts) located in Raiganj Upazila of the Sirajganj district in Bangladesh. Using a validated tool, a screening program was conducted at the household level. After initial screening, a team of ophthalmologists confirmed the diagnoses by clinical examinations. The prevalence of childhood blindness was observed to be 6.3 per 10,000 children, whereas the rate of uniocular blindness was 4.8 per 10,000 children. Congenital problems were the major causes of both uniocular and binocular blindness (uniocular blindness: 84% and binocular blindness: 92%). The whole globe was the site responsible for binocular blindness (28.0%, 95% confidence interval [CI]: 13.1, 47.7), whereas the cornea was responsible for uniocular blindness (57.8%, 95% CI: 35.3, 78.1). Childhood blindness is a public health problem in Bangladesh and is highly prevalent, regardless of sex. The major causes of childhood blindness are congenital. © 2019 Hussain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.