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Survey of childhood blindness and visual impairment in Botswana
  1. Sudha Nallasamy1,
  2. William V Anninger1,
  3. Graham E Quinn1,
  4. Brian Kroener2,
  5. Nicola M Zetola3,
  6. Oathokwa Nkomazana4
  1. 1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2University of Pennsylvania School of Arts and Science, Philadelphia, Pennsylvania, USA
  3. 3Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4University of Botswana, School of Medicine, Gaborone, Botswana
  1. Correspondence to Oathokwa Nkomazana, University of Botswana, School of Medicine, P/Bag 00713, Gaborone, Botswana; nkomazanao{at}


Background/aims In terms of blind-person years, the worldwide burden of childhood blindness is second only to cataracts. In many developing countries, 30–72% of childhood blindness is avoidable. The authors conducted this study to determine the causes of childhood blindness and visual impairment (VI) in Botswana, a middle-income country with limited access to ophthalmic care.

Methods This study was conducted over 4 weeks in eight cities and villages in Botswana. Children were recruited through a radio advertisement and local outreach programmes. Those ≤15 years of age with visual acuity <6/18 in either eye were enrolled. The WHO/Prevention of Blindness Eye Examination Record for Children with Blindness and Low Vision was used to record data.

Results The authors enrolled 241 children, 79 with unilateral and 162 with bilateral VI. Of unilateral cases, 89% were avoidable: 23% preventable (83% trauma-related) and 66% treatable (40% refractive error and 31% amblyopia). Of bilateral cases, 63% were avoidable: 5% preventable and 58% treatable (33% refractive error and 31% congenital cataracts).

Conclusion Refractive error, which is easily correctable with glasses, is the most common cause of bilateral VI, with cataracts a close second. A nationwide intervention is currently being planned to reduce the burden of avoidable childhood VI in Botswana.

  • Botswana
  • childhood blindness
  • childhood visual impairment
  • public health
  • child health (paediatrics)

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  • Funding The study was made possible by the in-kind contributions of the Prevention of Blindness Programme of the Ministry of Health (MoH) and the Special Education Unit of the Ministry of Education and Skills Development (MoESD) in Botswana. The MoESD provided transport and teachers to take children to the examination sites and supported the Low Vision Officer to participate in the field survey for the full four weeks as well as perform post-study follow ups. The MoH supported ophthalmic nurses to conduct pre-study outreach, participate in the study and do post-study follow ups. The ministry also provided transport for the children and the research team as well as subsistence for all their employees who participated in the field work.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Children's Hospital of Philadelphia Institutional Review Board, Princess Marina Hospital Institutional Review Board and Ministry of Health of Botswana.

  • Provenance and peer review Not commissioned; externally peer reviewed.