A pioneering model of community health
There are around 1.7 million blind people and 5 million suffering from impaired vision in Pakistan. Un-operated cataract remains the most common cause of blindness (53%) while corneal opacity (12%) and glaucoma (7%) are the next common causes.
Poverty and female gender are important determinants for blindness in Pakistan. After adjustment for age differences, women were found to have a significant excess of severe visual impairment and blindness.1 Another study2 also revealed that women had a 2.1-fold greater prevalence of bilateral cataract blindness than men (7.1% Vs 3.4%) as the cataract surgical coverage rates were lower for women than men.
However special efforts were needed to cross the gender barrier. Since blindness in old women does not affect the earnings of the family, and since illiteracy and resulting cultural beliefs discourage treatment away from their home, greater numbers of women remain untreated. We noticed that as compared to males, more women had cataracts, but fewer women than men were ready to be transported for free operation at hospital. We used special counselling, focus group discussions and community elders' participation to affect this gender imbalance. At times an escort from the family was allowed to accompany the women for cataract surgery.
Similarly, during school screening we had to face the problem of low compliance for vision glasses in girls. We used parent-teacher groups to undo this barrier and at the same time provide subsidised glasses to girls at much cheaper rates.
Gender does influence the community health in Pakistan. It is worse in areas with illiteracy and extreme poverty, which are the major issues to be addressed.
1. Jadoon MZ, Dineen B, Bourne RR, et al. Prevalence of blindness and visual impairment in Pakistan: the Pakistan National Blindness and Visual Impairment Survey. Invest Ophthalmol Vis Sci. 2006 Nov; 47(11):4749-55.
2. Anjum KM, Qureshi MB, Khan MA, et al. Cataract blindness and visual outcome of cataract surgery in a tribal area in Pakistan . Br J Ophthalmol. 2006 Feb;90(2):135-8.