GLOBAL SURVEY

The negative attitudes of others and lack of support are among the most disabling factors faced by children who are blind in developing countries, according to a study presented at the World Society of Paediatric Ophthalmology and Strabismus (WSPOS) Sub Specialty Day in London.

Clare Gilbert FRCOphth, MD, Disability and Eye Health Group at the London School of Hygiene and Tropical Medicine, told delegates attending the session that more needs to be done to overcome negative attitudes that lead to social exclusion and marginalisation of blind children.

“The research work carried out by Mohammad A Muhit in Bangladesh clearly showed that attitudinal barriers were the most important barriers to participation amongst blind children in that country. Interventions which promote participation need to be developed and evaluated to give these children the best possible chance of development, education and participation in broader social life,” she said.

Prof Gilbert stressed that she was not speaking as an expert in the field of rehabilitation or education of children, but simply wished to highlight the findings of projects that she or her colleagues at the Disability and Eye Health Group had been involved in over the years in relation to the impact of blindness in children in developing countries.

She noted that Dr Muhit’s research also collected some telling insights into the attitudinal barriers facing blind children in their daily activities. “From the supervisor who remarked that ‘those who can see or are sighted do not get any job after completing education… so what will the blind people achieve through education?’ to the mother who wondered ‘what would the child do with education… he is earning good money [begging] and contributing to the cost of the family’, the barriers to inclusion are many and varied,” said Prof Gilbert.

Mainstream activities

In terms of measures that could be taken to overcome such attitudinal barriers, Prof Gilbert told EuroTimes that a lot can be done.

“Some ideas that spring to mind are buddying at school; organising sports events for children who are blind or visually impaired; providing opportunities for parents and children to talk about their experiences, and having more people who are blind in positions of influence in mainstream activities. Moreover, community group sessions with role play has been successful in other areas of disability in children,” she said.

More research is also needed to provide evidence of the best approach for educating children who are blind in low income settings, said Prof Gilbert.

“Is inclusive education alone the best approach, or is a mixed approach better, with some time spent in schools for the blind for intensive skills learning, such as Braille for instance?” she asked.

In a wider context, Prof Gilbert sees some grounds for optimism in the implementation of specific measures for the control of visual loss amongst children.

For instance, programmes for the control of retinopathy of prematurity are expanding in many middle and low income countries, and countries such as China, Russia, Peru, Colombia, Brazil and Mexico now have national guidelines. Mexico and Peru have also passed legislation making eye examination of pre-term infants mandatory.

“Paediatric tertiary level services are expanding, as are school eye health programmes. Several of the international non-government organisations are focusing on visual loss in children, supporting eye care provision for children from community level up to tertiary care. However, there are gender differences in the uptake of treatment, with more boys undergoing cataract surgery than girls, for example, although there is no evidence that non-traumatic cataracts are more common in boys. Reasons for this need to be explored together with interventions which improve uptake of services by parents of girls,” she said.

Clare Gilbert: Clare.Gilbert@lshtm.ac.uk