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?

Agroup of researchers from the London School of Hygiene and Tropical Medicineand Hinchingbrooke Hospital, in the UK, and thePakistan Institute of Community Opthalmology, set outto investigate the association between blindness and deprivation among adultsaged over 30 in Pakistan. They used data collected between 2001 and 2004 toexamine how blindness, access to eye care services and poverty wereinterlinked. 

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

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

Thesefindings show a clear association between poverty and blindness in Pakistan. Afactor that contributes to this is unequal access to eye care. Policyimplications include the following.

• Optical services must be expanded in Pakistan, to ensure that allsectors of the adult population can access them.
• In this survey respondents cited cost as a barrier despite theavailability of free or subsidised surgery. Other factors contributing to lowuptake of cataract surgery, such as fear of treatment, need to be clarified andovercome.

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