Special Report


Childhood Visual Impairment and Unmet Low-vision Care in Blind School Students in Ghana


Christine Teki Ntim-Amponsah, MBChB, FRCS, FWACS, MPhil Professor, Ophthalmology Unit, Department of Surgery, University of Ghana Medical School


Abstract


Most causes of childhood blindness in Ghana are avoidable. Over 40 % of the students in the school for the blind in Ghana have functional residual vision that requires low-vision care. Corneal blindness is the commonest form, followed by cataract. Retinal blindness is rare and is usually from hereditary or congenital causes. The Expanded Program of Immunization (EPI) in the Ghana health service has been very successful, with measles coverage for under one-year-olds of 95 %. This should now translate into a decline in measles-related corneal blindness, a common preventable occurrence. This then brings challenges in cataract management into focus. Provision of sustainable intervention services for low-vision care in children is a priority for the Prevention of Childhood Blindness program in Ghana. Barriers to access range from parents’ negative perceptions, societal/cultural misconceptions, and inadequate resources, to absence of collaboration and coordination between low-vision care providers and weak national support. Clients usually come from families within the lower socioeconomic groups and often find the low-vision devices unaffordable. A successful program for intervention is more likely to succeed when it is subsidized, at least until a reasonable impact has been made. One must, however, strike a good balance between cost recovery, which is more likely to ensure sustainability of the program, and subsidization.


Keywords Low vision, blindness, congenital cataract, corneal blindness, herbal medicine


Disclosure: The author has no conflicts of interest to declare. Received: January 12, 2011 Accepted: June 16, 2012 Citation: US Ophthalmic Review, 2012;5(1)11–3 Correspondence: Christine Teki Ntim-Amponsah, MBChB, FRCS, FWACS, MPhil, Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, PO Box GP 4236, Accra, Ghana. E: namponsah@chs.edu.gh


Ghana lies in the center of the West African coast, bordered on the south by the Gulf of Guinea and the Atlantic Ocean, between Ivory Coast to the west and Togo to the east. Its southernmost point is Cape Three Points, 4° 30’ N of the equator, from where it extends inland to latitude 11° N and extends between longitudes 1° E and 3° W, with the Greenwich Meridian passing through the capital, Accra. Overall, it covers an area of 238,533 square kilometers. The population is about 24 million. Children (under 16 years of age) form about 40 % of the population. Eye care is currently provided by 50 ophthalmologists (including one specialist in low vision), 67 optometrists, 295 ophthalmic nurses, and some primary healthcare workers. There is also variable collaboration between the Ghana Health Service and the Ghana Education Service in school eye health programs, including rehabilitation of students with low vision and blindness. In addition, some organizations play an active role in blindness prevention programs, notably WHO, Sightsavers, and Lions Clubs International. Our eye care system has its fair share of challenges experienced in developing countries. Since Vision 2020 was launched in Ghana in October 1999, Ghana has been further challenged to realize the goals of prevention of childhood blindness and provision of low-vision care. Most causes of childhood blindness in the country are avoidable.1


© TOUCH BRIEFINGS 2012


In June 2002, WHO launched the five-year childhood blindness prevention project. Centers for children’s eye care and low-vision care were established in 30 countries, including Ghana. Korle Bu Teaching Hospital is the center of the project covering the Greater Accra and Eastern regions of the country with a population of 5,200,000. The project area has one school for the blind that mainly caters for the southern parts of the country. The main partner is Sightsavers International that supports eye care, including low-vision care, in the Eastern and Volta regions. The National Eye Care Program had a low-vision care program, which was once supported by the Christian Blind Mission before the WHO/Lions center was established. The Society for the Blind and the sector for social welfare also carry out some low-vision care.


Personal communication with ophthalmologists in West and East Africa and some studies indicate that corneal opacities have been the commonest cause of blindness in sub-Saharan Africa.2


In students of


the Akropong School for the Blind in Ghana, visual impairment was noticed in the first year of life in 53 % of students and at the age of 1–5 years in 18 %, 6–10 years in 18 %, and 11–15 years in 11 %.3 blindness commonly occurred in the first year of life in 45 % (43/96) of the


Corneal 11


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