Blindness above and below the Poverty Line: Reflections form Sofala, Mozambique
Accepted: 18 August 2020
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Although the correlation between visual impairment and poverty has been established, economic assessment is not a standard component of blindness surveys. The purpose of this study was to determine the prevalence of avoidable blindness and its association with poverty in Sofala province of Mozambique. As part of a Rapid Assessment of Avoidable Blindness, 94% of a random sample of 3600 people >50 years responded to questions regarding daily per capita expenditure. The WHO definition of blindness (presenting visual acuity <3/60) was used to determine the visual status of participants, and the World Bank’s threshold of living on <$1.25 International Dollar a day demarcated the poverty line. The prevalence of blindness was 3.2% [95% Confidence Interval (CI): 2.6, 3.8]. People living below the poverty line had significantly greater odds of being blind [Odds Ratio (OR): 2.6 (CI: 1.6 to 4.5)]. Age above 60 [OR: 7.0 [CI: 4.6 to 10.80] predicted blindness but the association with illiteracy, gender or rural residence was not significant. Blindness disproportionately affects people living below the poverty line. Development initiatives could augment the impact of blindness prevention programs. Measuring poverty should become a standard component of visual impairment surveys.
Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, et al.; Vision Loss Expert Group. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017 Sep;5(9):e888–97.
Fricke TR, Tahhan N, Resnikoff S, Papas E, Burnett A, Ho SM, et al. Global Prevalence of Presbyopia and Vision Impairment from Uncorrected Presbyopia. Ophthalmology. 2018;125(10):1492–9. DOI: https://doi.org/10.1016/j.ophtha.2018.04.013
Ulldemolins AR, Lansingh VC, Valencia LG, Carter MJ, Eckert KA. Social inequalities in blindness and visual impairment: a review of social determinants. Indian J Ophthalmol. 2012;60(5):368-75. DOI: https://doi.org/10.4103/0301-4738.100529
Naidoo K. Poverty and blindness in Africa. Clin Exp Optom. 2007; 90(6):415-21. DOI: https://doi.org/10.1111/j.1444-0938.2007.00197.x
Kuper H, Polack S, Eusebio C et al. A Case-Control Study to Assess the Relationship between Poverty and Visual Impairment from Cataract in Kenya, the Philippines, and Bangladesh. PLoS Med. 2008; 5(12): e244. DOI: https://doi.org/10.1371/journal.pmed.0050244
Gilbert C, Shah S, Jadoon M, et al. Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey. BMJ. 2008 5; 336(7634): 29–32
Banks LM, Kuper H, Polack S. Poverty and disability in low- and middle-income countries: A systematic review. PLoS One. 2017;12(12):e0189996. DOI: https://doi.org/10.1371/journal.pone.0189996
Frick KD. What the comprehensive economics of blindness and visual impairment can help us understand. Indian J Ophthalmol. 2012;60(5):406-10. DOI: https://doi.org/10.4103/0301-4738.100535
Rao G.N. (2019) VISION 2020: Past, Present and Future. In: Khanna R., Rao G., Marmamula S. (eds) Innovative Approaches in the Delivery of Primary and Secondary Eye Care. Essentials in Ophthalmology. Springer, Cham DOI: https://doi.org/10.1007/978-3-319-98014-0_1
United Nations. Transforming our world: the 2030 Agenda for Sustainable Development (2015) [Retrieved on 05/10/2019 from https://sustainabledevelopment.un.org/post2015/transformingourworld
National Institute of Statistics of Mozambique. Synopsis of definitive results of the 3rd Census of Population and Housing: Province of Sofala. 2009, Beira, Mozambique.
Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012 May;96(5):614-8.
Dineen B, Foster A, Faal H. A Proposed Rapid Methodology to Assess the Prevalence and Causes of Blindness and Visual Impairment. Ophthalmic Epidemiology. 2006;13(1):31–4. DOI: https://doi.org/10.1080/09286580500473787
Kuper H, Polack S, Limburg H. Rapid assessment of avoidable blindness.Community Eye Health J 2006;19(60):68-69.
Ravallion M, Chen S and Sangraula P. Dollar a Day Revisited. The World Bank Economic Review, 2009, 23; 2, 1:163–184, DOI: https://doi.org/10.1093/wber/lhp007
International Monetary Fund. Republic of Mozambique: Poverty Reduction Strategy Paper. Washington DC, 2011. Accessed on 20/12/2018 at https://www.imf.org/external/pubs/ft/scr/2011/cr11132.pdf
Ministry of Planning and Development of Mozambique. Poverty and well being in Mozambique: Third National Poverty Assessment.. Maputo, 2009. Accessd on 20/12/2018 at http://www.unicef.org.mz/cpd/references/39-THIRD%20NATIONAL%20POVERTY%20ASSESSMENT.pdf
Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96(5):614-8. DOI: https://doi.org/10.1136/bjophthalmol-2011-300539
Lewallen S, Williams TD; Dray A, Stock BC, Mathenge,et al. Estimating Incidence of Vision-Reducing Cataract in Africa:A New Model With Implications for Program Targets. Arch Ophthalmol. 2010; 128(12):1584-89. DOI: https://doi.org/10.1001/archophthalmol.2010.307
Sight savers International. The Nampula RAAB Survey (2018). Retrieved on 05/114/2019 from https://research.sightsavers.org/wp-content/uploads/sites/8/2018/05/Nampula-RAAB-report-Mozambique-2018.pdf
Stevens GA, White RA, Flaxman SR, Price H, Jonas JB, et al. Global Prevalence of Vision Impairment and Blindness: Magnitude and Temporal Trends, 1990-2010.Ophthalmology. 2013 Dec;120(12):2377-84. DOI: https://doi.org/10.1016/j.ophtha.2013.05.025
Kalua K, Lindfield R, Mtupanyama M, Mtumodzi D, Msiska V. Findings from a Rapid Assessment of Avoidable Blindness (RAAB) in Southern Malawi. PLoS ONE. 2011;6(4). DOI: https://doi.org/10.1371/journal.pone.0019226
Habiyakire C, Kabona G, Courtright P, Lewallen S. Rapid assessment of avoidable blindness and cataract surgical services in kilimanjaro region, Tanzania. Ophthalmic Epidemiol. 2010;17:90–94. DOI: https://doi.org/10.3109/09286580903453514
Lindfield R, Griffiths U, Bozzani F, Mumba M, Munsanje J (2012) A Rapid Assessment of Avoidable Blindness in Southern Zambia. PLoS ONE 7(6): e38483. DOI: https://doi.org/10.1371/journal.pone.0038483
Danquah L, Kuper H, Eusebio C, Rashid MA, Bowen L, Foster A, Polack S. The long term impact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines. PLoS One. 2014 Apr 18;9(4):e94140. DOI: https://doi.org/10.1371/journal.pone.0094140
Gilbert CE, Shah SP, Jadoon MZ, et al. Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey. BMJ. 2008 Jan 5;336(7634):29-32. DOI: https://doi.org/10.1136/bmj.39395.500046.AE
Tafida A, Kyari F, Abdull M, Sivasubramaniam S, Murthy G, Kana I et al. Poverty and Blindness in Nigeria: Results from the National Survey of Blindness and Visual Impairment. Ophthalmic Epidemiology. 2015;22(5):333-341. DOI: https://doi.org/10.3109/09286586.2015.1077259
Wang W, Yan W, Müller A, He M. A Global View on Output and Outcomes of Cataract Surgery with National Indices of Socioeconomic Development. Invest Ophthalmol Vis Sci. 2017 1;58(9):3669-76.
Chakraborty, Nirali M, Kenzo Fry, Rasika Behl, and Kim Longfield. 2016. "Simplified Asset Indices to Measure Wealth and Equity in Health Programs: A Reliability and Validity Analysis Using Survey Data From 16 Countries." Global Health: Science and Practice 4 (1):141-54. DOI: https://doi.org/10.9745/GHSP-D-15-00384
Buchan JC, Dean WH, Foster A, Burton MJ. What are the priorities for improving cataract surgical outcomes in Africa? Results of a Delphi exercise. Int Ophthalmol. 2018 Aug;38(4):1409-1414. DOI: https://doi.org/10.1007/s10792-017-0599-y