Poverty, blindness and access to treatment in Pakistan

Links between poverty and blindness are well documented.  It is known that blindness rates are three to four times higher in low income countries than in industrialised ones.  Furthermore, over 75 percent of blindness cases worldwide are preventable or treatable. What can the Pakistan national blindness and visual impairment survey teach us about the connection between poverty and blindness?

A group of researchers from the London School of Hygiene and Tropical Medicine and Hinchingbrooke Hospital, in the UK, and the Pakistan Institute of Community Opthalmology, set out to investigate the association between blindness and deprivation among adults aged over 30 in Pakistan. They used data collected between 2001 and 2004 to examine how blindness, access to eye care services and poverty were interlinked. 

The survey was based on a representative cross-section of 16,507 people in 221 locations (‘clusters’) randomly selected across Pakistan. Among these, 561 blind participants were identified. The survey team measured the height and weight of all participants and conducted detailed eye examinations. They provided free treatment of minor ailments and referred those who needed more treatment to the nearest eye hospital. Poverty was measured using district-level census data. The researchers also constructed a measure of household poverty using a combination of occupation and literacy of those living in the house. Significant findings include the following.

• Blindness rates were higher in poor clusters among participants aged both below and over 50.
• Prevalence of total blindness was three times higher in poor clusters than in affluent ones.
• The cause of blindness in 51.5 percent of cases was cataracts: the leading cause of visual impairment in poor and medium clusters.
• Cataract surgery coverage was higher in affluent areas. At all levels of poverty, cataract surgery coverage was higher for men than women.
• Spectacle coverage in affluent clusters was more than double the coverage in medium and poor clusters, and lowest among women living in poor households.
• There was no association between household poverty status and scores on ‘quality of life’ questionnaires.

These findings show a clear association between poverty and blindness in Pakistan. A factor that contributes to this is unequal access to eye care. Policy implications include the following.

• Optical services must be expanded in Pakistan, to ensure that all sectors of the adult population can access them.
• In this survey respondents cited cost as a barrier despite the availability of free or subsidised surgery. Other factors contributing to low uptake of cataract surgery, such as fear of treatment, need to be clarified and overcome.

Evidence of the cost effectiveness and economic benefit of cataract surgery can be used to help set policy priorities and to mobilise resources. A challenge is to ensure that poor people, and particularly women, are able to benefit.

Source(s):
‘Poverty and Blindness in Pakistan: Results from The Pakistan National Blindness and Visual Impairment Survey’, British Medical Journal, 336, pages 29-32, by Clare E Gilbert et al, 2008

Funded by: Sightsavers International, Christoffel Blinden Mission, Fred Hollows Foundation, World Health Organisation – Pakistan Office

id21 Research Highlight: 05 June 2008

Further Information:
Clare Gilbert

Tel: 0207 958 8332
Fax: 0207 958 8325
Contact the contributor: clare.gilbert@lshtm.ac.uk

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