Misconceptions of Pediatric Eye Care in Orissa, India
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GRF 2nd One Health Summit 2013: Presentation by Shoshanna Goldin, Wake Forest University
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Misconceptions of Pediatric Eye Care in Orissa, India
- 1. Misconceptions of Pediatric Eye Care in Orissa, India Shoshanna Goldin Wake Forest University
- 3. Kalinga Eye Hospital & Research Centre
- 5. Part II: Children’s Eye History Have any children in your household had any problems with their eyes? If yes, which age? Please describe the problem. No Yes: _______________________ Do any children in your household wear eyeglasses? If yes, which age? Where did you receive the glasses? No Yes: _______________________ How did you find out about Kalinga Eye Hospital? (ex. Family doctor, school, friends, family, internet, etc.)
- 6. Misconceptions regarding: child eyeglass usage, warning symptoms of a pediatric refractive error childhood cataracts, Preventative care
- 8. Pediatric Cataracts Can children have cataracts? % Yes 21.4 No 59.7 Don't Know 18.8
- 10. Preventative Care? Frequency of Eye Exam Percentage When Problem Arises 48.7 One time a year 11.0 Two times a year 20.7 Three times a year 2.6 Four times a year 2.6 Other response (once in childhood, every ten years, don't know, etc.) 3.9
- 11. Further Research: Determine overall quality & functionality of local healthcare clinics Potential for a community based preventative care program?
- 12. Next Steps: Education program for parents (partner with local schools) Partnerships between local clinics and specialized healthcare providers
- 13. Research- Wake Forest University
- 14. Thank you
Editor's Notes
- Of the more than 1.4 million blind children worldwide, 75% percent live in developing countries. . India, the second largest country by population, is home to 21% of the world’s blind and 23% of the visually impaired9,11.
- India is experiencing a shortage in pediatric ophthalmologic specialists and facilities. There isone pediatric ophthalmology center for every 16 million individuals while The World Health Organization recommends one center for every 10 million residents. This study was specific to the state of Orissa. The second poorest state in India, Orissa is mainly rural villages and forest communities. Of the 36 million residents of Orissa, more than 14 million of them live below the poverty line according to the United Nations Development Program. With almost 70% illiteracy and consistently high unemployment, Orissa holds one of India’s lowest attainments in health and education. Photocredit: Kalinga Eye Hospital
- Since 2000, India’s National Population Policy has prioritized developing local health-care services to provide primary care18. TheWHO listed primary health care development as the most important factor for early identification of eye disease symptoms10. Founded in 2002, Kalinga provides quality eye care to families in the state of Orissa. 94% of the surgeries conducted at Kalinga are sponsored by Unite for Sight or other non-profits. A Vision 2020 registered hospital, Kalinga Eye Hospital & Research Centre treats adult and pediatric ophthalmological issues in Orissa, India. To reach out to these populations, Kalinga conducts 3-4 outreach camps every week.
- Recent estimates suggest as many as 200,000 blind children live in India. A 2008 study of pediatric eye care services in India found the pediatric eye care system in India severely inadequate. An epidemiological, economic, and humanitarian issue, reduction of pediatric blindness and impaired vision has become a global public health priority. One of few pediatric eye care center in the state of Orissa, Kalinga provides a unique glimpse at pediatric health and research for pediatric eye health issues. Families I surveyed journeyed up to 250 kilometers (a 5+ hour trek across dirt roads) to receive care at Kalinga Eye Hospital. While a Unite for Sight Fellow Global Impact Fellow at Kalinga, I was asked to analyze potential misconceptions families hard regarding pediatric eye care. Photocredit: Kalinga Eye Hospital
- During my stay atKalinga Eye Hospital, I surveyed 154 families about pediatric eye care. Thesurvey was composed of two parts– the first calculated a rough standard of living while the second provided insight into the previous eye health history and perceptions of Orissa residents. The study was conducted In Orya with the assistance of paramedics as translators.
- Several misconceptions consistently appeared. The families tended to unaware the benefits of refraction for children, were unaware of several of the warning symptoms for pediatric refractice error, were unaware of the potential for pediatric cataracts, and did not consider preventative care as important to the eye health of their children.
- One of the most significant issues for pediatric eye care worldwide is uncorrected refractive error. Recent studies have found that pediatric refractive errors cause up to 77% of blindness in urban India. A 2000-2001 study of rural populations recorded 61% of the four thousand children studied were living with uncorrected refractive disorders.Survey respondents considered spectacles to be for adult use. When asked the age at which an individual requires eyeglasses, the average age stated was 39.6 years old. Less than 6% of individuals surveyed thought that children could require spectacles.This pi chart shows the breakdown of responses. Kalinga, in connection with several school outreach programs, has noticed this lack of eyeglass usage. The hospital is now working on an initiative to combat the perception that eye glasses can damage children’s long term vision.
- Pediatric cataracts are responsible for10% of childhood blindness in India. Many of the families surveyed in rural Orissa were not aware that children can be afflicted by cataracts, let alone the triggers that can cause the condition or the warning symptoms to identify the problem. 59.7% of patients studied responded to the question, “Can children have cataracts?” with a firm “no”. An additional 18.8% responded that they did not know if children could have cataracts. Add pi chart
- One of the most interesting results of the study was the reaction to sunglasses. Prior studies have found that sunglasses are not used in India, particularly, in rural communities. One of the questions on the study was designed to determine awareness of sunglasses use in preventative care. 23% of individuals believed that “dark glasses” should be used to provide coolness to the face. Another 14% thought that “dark glasses” are intended for protection from dust. Only 42% of individuals knew that dark glasses were related to the sun or protection from light. 57% of respondents said that they and their children never wear sunglasses.
- This study’s dataindicates that families in rural Orissa will take their child to the eye hospital to treat a specific problem, but do not perceive preventative care, e.g. routine eye exams, necessary. When asked how often a child should receive a routine eye exam, 48.7% said, “Only when a problem arises.” Only 32% of individuals’ surveyed considered an annual or semiannual eye exam beneficial. So what is being missed when families don’t bring their children in for routine eye exams? Half of childhood blindness is preventable with prenatal care, eyeglasses, and treatment. With proper education of pediatric eye care issues, and timely care, a number of pediatric ophthalmologic issues could be identified and treated before the problem became debilitating.
- This study was funded by Wake Forest University. I would like to thank the university and my research mentors for this assistance in this study!The paramedics translated the survey and patients’ responses from English to both Orya and Hindi. These paramedics are local women aged between 18-30 whose families were unable to provide for their education or marriage dowry. When first created, Kalinga Eye Hospital’s manager decided to offer these families a chance for their daughters to be educated and provided a small stipend in exchange for living and working at Kalinga. The paramedics all speak Orya, the local language of Orissa, and many speak enough English and Hindi to translate back and forth.