ORIGINAL ARTICLES
Refractive error study in children: results from Mechi Zone, Nepal

Preliminary data from this study were presented at the 17th Congress of the Asia Pacific Academy of Ophthalmology in Manila, March 7 to 12, 1999.
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Abstract

PURPOSE:

To assess the prevalence of refractive error and vision impairment in school age children in the terai area of the Mechi zone in Eastern Nepal.

METHODS:

Random selection of village-based clusters was used to identify a sample of children 5 to 15 years of age. Children in the 25 selected clusters were enumerated through a door-to-door household survey and invited to village sites for examination. Visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and anterior segment, media, and fundus examinations were done from May 1998 through July 1998. Independent replicate examinations for quality assurance monitoring took place in all children with reduced vision and in a sample of those with normal vision in seven villages.

RESULTS:

A total of 5,526 children from 3,724 households were enumerated, and 5,067 children (91.7%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.5 (20/40) or worse in at least one eye was 2.9%, 2.8%, and 1.4%, respectively; 0.4% had best visual acuity 0.5 or worse in both eyes. Refractive error was the cause in 56% of the 200 eyes with reduced uncorrected vision, amblyopia in 9%, other causes in 19%, with unexplained causes in the remaining 16%. Myopia −0.5 diopter or less in either eye or hyperopia 2 diopters or greater was observed in less than 3% of children. Hyperopia risk was associated with female gender and myopia risk with older age.

CONCLUSIONS:

The prevalence of reduced vision is very low in school-age children in Nepal, most of it because of correctable refractive error. Further studies are needed to determine whether the prevalence of myopia will be higher for more recent birth cohorts.

Section snippets

Methods

The entire Jhapa District, with 47 village development committees and three municipalities, was used as the sampling frame. Both village development committees and municipalities are divided into wards, which were used in creating sampling clusters. Using 1996 population projections from the 1991 national census, the population of each ward was estimated. Assuming that children 5 to 15 years of age represented 26% of the ward population, wards with fewer than 200 projected children were

Results

A total of 3,724 households were identifiedin the 25 clusters, 2,592 with one or more eligible children. Of those with children, 34% had one eligible child, 33% had two, 22% had three, and 11% had four or more eligible children. The largest household had seven eligible children. A total of 5,526 eligible children were enumerated (Table 1). The number of children per cluster ranged from 198 to 233.

The age distribution of enumerated females was not significantly different from a uniform

Discussion

This survey provides reliable evidence that the prevalence of reduced vision is very low in school-age children in the Jhapa District of Nepal: 2.9% of children had visual acuity 0.5 or worse in one or both eyes without correction. This compares with the 12.8% and 15.8% found in the China and Chile surveys, respectively.2, 3 In large measure, the difference is the result of a much lower prevalence of refractive error in Nepal. The prevalence of all uncorrectable causes of vision impairment was

Acknowledgements

Thanks are due to Foundation Eye Care Himalaya for providing logistical support and to Dr Sanjaya Singh for providing treatment for children referred to the Mechi Eye Center. The authors also acknowledge the clerical assistance of Jeanne King, National Eye Institute, in the preparation of this manuscript.

References (6)

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This work was supported by the World Health Organization under the National Institutes of Health Contract N01-EY-2103.

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