Abstract:
Background: Inter-regional trends of visual loss in most developing countries remain
largely unknown. We compared the causes of childhood blindness among children attending
blind schools in the northern (one school) and southern (two schools) regions of Ghana
and assessed their need for spectacles and low-vision devices.
Methods: Using a standardised methodology, children were examined by an ophthalmologist
and optometrists in each location. Causes of visual loss were classified anatomically
and by time of onset, and avoidable causes identified. Children identified with functional
low vision were assessed and provided with low-vision devices.
Results: A total of 252 children under 16 years of age were examined in the schools. The
overall prevalence of total blindness was 73 (29.0 per cent), with similar proportions
(p = 0.87) in the north (29 [28.4 per cent]) and south (44 [29.3 per cent]); 92 (36.5 per cent)
had functional low vision. Two children improved with spectacles and 35 benefited from
low-vision devices. Corneal scarring was significantly (p = 0.045) more prevalent in southern
Ghana (n = 150) than in the north (n = 102), responsible for visual loss in 36 (24.0 per cent,
95% CI 17.2–30.8 per cent) and 14 (13.7 per cent, 95% CI 7.0–20.4 per cent) cases, respectively.
No significant difference (p = 0.321) was observed in the prevalence of cataract
between northern (28: 27.5 per cent, 95% CI 18.3–36.2 per cent) and southern Ghana (33:
22.0 per cent, 95% CI 15.4–28.6 per cent). Over 87 per cent of children had ‘avoidable’ causes
of visual loss, with a higher proportion being treatable (124: 49.2 per cent) than preventable
(96: 38 per cent).
Conclusion: Cataract was the major cause of visual loss in the overall population. The south
had a higher proportion of corneal scarring and late-onset blindness compared with the
north. More than one-third of blindness in blind schools in Ghana could have been
prevented by primary care interventions and nearly half could have been treated surgically
to prevent visual loss. Two in five children in blind schools in Ghana could benefit from optical
intervention.
