Sir,

One of the impediments to reducing blindness in developing countries is the limited access to eye-care services.1 This study is a part of a population-based prevalence survey, Pavagada Pediatric Eye Disease Study-2, with an aim to determine the prevalence of childhood blindness and ocular morbidity in children ≤15 years and to determine the barriers to access of paediatric eye care among mothers with children who were detected to have eye disease.

Case report

Eight thousand five hundred fifty-three children, residing in the two sub-districts of Pavagada and Madhugiri in Tumkur district, Karnataka state, south India were screened by a single ophthalmologist in makeshift eye clinics. Five hundred fifty-nine children (6.54%) were found to have ocular morbidity. Five hundred and ten mothers of the 559 children were requested to complete a questionnaire about the barriers they came across when they tried to access paediatric eye care. Forty-nine mothers with more than one child, answered the questionnaire separately for each child.

There was no statistically significant difference between the responses given by mothers with male or female children, those in urban or rural areas, and between literate or illiterate mothers (Tables 1 and 2).

Table 1 Responses to questions regarding perceptions of barriers to access of childhood eye-care services
Full size table
Table 2 Barrier to access of eye care: comparison between illiterate mothers to ≤8 yrs of schooling and those 9 to >12 years of schooling
Full size table

Comment

The paediatric eye-care service delivery in India is based on provision of tertiary eye care and school screening programs.2 The main drawback of this system is that it depends on the parents to recognise that their child has a problem and bring the child in for an examination. In a study by Nirmalan PK et al3 on the impact of visual impairment on functional vision in children, about 40% of the children with visual impairment, perceived themselves to have vision equivalent to their normal-sighted peers. It is also found that self-care activities were less dependent on vision than other tasks.4 We found 43.59% of the mothers with children who had an uncorrected visual acuity of <6/18 to no PL felt that their child was able to see adequately. Only 32.34% of the mothers who felt that their children did not have any serious eye problem were illiterate. The rest were literate and yet missed out the fact that their child was visually impaired. The other reason for not accessing eye care was due to the fatalistic attitude, that it is god’s will that the child has an eye disease. When we compared those with ≤8 years of schooling (including illiterates) vs the group with 9 to >12 years of schooling, we found that mothers in the former group had a fatalistic attitude. It is well documented that fatalistic attitude is prevalent in less educated societies and is a barrier to positive health behaviour and adversely affects health outcomes.5

Results from this study show that the main barrier to access of eye care was the parents’ inability to detect that the child had any eye problem. Hence it is important to develop awareness programs to educate the parents on various common eye diseases. Educating teachers and community workers in screening of eye diseases would also help in early detection.