Prevalence and causes of visual impairment in Dongaria indigenous (tribal) community. Tribal Odisha eye disease study # 12

Purpose

To document the spectrum and magnitude of eye disorders and visual impairment in the Dongaria-a Particularly Vulnerable Tribal Group in the Rayagada district of Odisha, India.

Methods

A door-to-door screening protocol included a record of basic health parameters, visual acuity for distance, and near and flashlight examination of the eyes. Spectacles were dispensed to those who improved; those who failed the screening were referred to fixed (primary and secondary) eye care centers.

Results

We examined 89% (n = 9872/11,085) of people who consented for screening. The mean age was 25.5 ± 18.8 years; 55% (n = 5391) were female; 13.8% (n = 1361) were under-five children, and 39% (n = 3884) were 6 to 16 years. 86% (n = 8515) were illiterate. 12.4% (n = 1224) were visually impaired, of which 9.9% had early moderate VI, and 2.5% had severe VI and blindness. Uncorrected refractive error was detected in 7.5% (n = 744) and cataracts in 7.6% (n = 754); among the adults, 41.5% (n = 924/2227) had presbyopia. In children, 20% (n = 790) had vitamin A deficiency, 17% (n = 234) had global acute malnutrition, and 18% (n = 244) were stunted for their age. Almost two-thirds (62%, n = 6144) confirmed habitual intake of alcohol, and 4% (n = 389) of adults had essential hypertension. Following the screening, 43.5% (n = 837) of referred patients reported to the fixed centers, and 55% (134/243) of people advised underwent cataract surgery. Spectacles were dispensed to 1496 individuals.

Conclusion

Visual impairment and malnutrition are high in Dongaria indigenous community. Permanent health facilities and advocacy would improve this community's health and health-seeking behavior.

Program protocol and validation

Purpose:

To describe and validate the eye health program protocol of Dongria tribal community, a particularly vulnerable tribal group (PVTG) in Rayagada district, Odisha, India.

Methods:

The program would consist of three segments. At people’s residences, trained community health workers (CHWs) will measure the vision and collect demographic data. In addition, vision technicians (VTs) will refract using a hand-held device and prescribe spectacles to people who improve to >6/12, N8. Others would be referred to the vision center (VC). At VC, the VT will perform a slit-lamp examination and re-refract. They would refer people with vision ≤6/12 to the secondary center (SC). At SC, referred people will receive a comprehensive eye examination and treatment. The ophthalmologist will assign the cause of blindness and visual impairment for people with visual acuity <6/12. The entire process was rehearsed in a pilot study.

Results:

The target population is approximately 10,000 people residing in 101 hutments on the hills of Rayagada district. The pilot study included 126 people. The mean age was 44 ± 18 years; 70% of the people were illiterate, and in this cohort, 97.6% (n = 123) had never worn spectacles. In the pilot study, 41% of the people had cataract, and 12% had pterygium. The agreements between optometrist versus VTs and between optometrist versus CHWs were good (k = ~0.8–1.0) in all eye conditions except for strabismus (k = ~0.56–0.65)

Conclusion:

The pilot study confirms the program modality, and when completed, it would help in the planning and resource allocation of Odisha PVTG eye care.