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| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 7
| Issue : 1 | Page : 1-3 |
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Social determinants of blindness in Sudan- 2019
Mohanad Kamaleldin Mahmoud Ibrahim
Department of Community Medicine Khartoum, Faculty of Medicine, Ibn Sina University, Khartoum, Sudan
| Date of Submission | 14-Jun-2020 |
| Date of Acceptance | 26-Aug-2020 |
| Date of Web Publication | 31-Dec-2020 |
Correspondence Address:
Dr. Mohanad Kamaleldin Mahmoud Ibrahim
Department of Community Medicine Khartoum, Faculty of Medicine, Ibn Sina University, Khartoum
Sudan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/bijo.bijo_5_20
Background: The term blindness is used for complete or nearly complete vision loss. The number of people estimated to be visually impaired worldwide is 285 million; 39 million are blind and 246 have low vision. About 90% of the world visually impaired lives in low-income settings. The overall objective of this study was to identify the social determinants of blindness in Sudan, aiming for prevention and control.
Methodology: This was an outreached service cross-sectional study conducted among 858 participants selected using multistage cluster sampling and drawn proportionate to size among four cities in Sudan using probability sampling technique. The data were collected using closed-ended administered questionnaires, and data were analyzed using the Statistical Package for the Social Sciences version 21. The analysis included uni-variate for all determinants and bi-variate cross-tabulation using Chi-square test to reveal associations between variables of interest. The study was estimated at 95% confidence level.
Results: The overall socioeconomic profile of the study group was low. The mean monthly income of the blind participants was only 1991 sustainable development goal. The majority of the blind participants were unemployed, where they represented >70% and there was a significant association between occupation and blindness (P = 0.000). More than half of the blind participants (58%) were living in rural areas, and the study revealed a significant association between blindness and living are (P = 0.000).
Conclusion: The socioeconomic status in terms of income, occupation, and living area and is significantly associated with blindness. A majority of the blind participants are living in rural areas, unemployed, and earn low monthly income.
Keywords: Blindness, social determinants of blindness, socioeconomic status
How to cite this article:
Ibrahim MK. Social determinants of blindness in Sudan- 2019. Albasar Int J Ophthalmol 2020;7:1-3 |
| Introduction | |  |
Visual impairment, also known as vision impairment or vision loss, is a decreased vision to a degree that causes problems not fixable by glasses or contact lenses. Those who have a decreased ability to see because they do not have access to glasses or contact lenses are also included. Visual impairment is often defined as a best-corrected visual acuity of worse than either 20/40 or 20/60. The term blindness is used for complete or nearly complete vision loss. Visual impairment may cause people difficulties with normal daily activities such as driving, reading, socializing, and walking.[1]
Globally, at least 2.2 billion people have a vision impairment or blindness, of which at least one billion have preventable or has yet to be addressed vision impairment. This one billion people includes those with moderate or severe distance vision impairment or blindness due to refractive errors.[2]
Reduced eyesight can be caused by a number of factors, including diabetes, trachoma, trauma to the eyes, age-related macular degeneration, and cataracts. The predominant affected people with visual impairment are those over 50 years of age; however, vision loss can affect people of all ages. Blindness and vision loss are felt more acutely by people in low- and middle-income countries where accessibility and specific government services may be lacking.[3]
The progress of blindness prevention in Northern Sudan shows good progress in most of the components of Vision 2020, namely cataract, trachoma, onchocerciasis, refractive errors, and low vision. However, scaling up and attention to diabetic retinopathy and glaucoma are still needed to reach all the targets.[4]
Objective
The overall objective of this study was to identify the most common social determinants of blindness aiming to reveal information for prevention and control.
| Methodology | | |
This was an outreached service cross-sectional study conducted in four cities in Sudan. The study included 858 Sudanese adult participants estimated using the population formula n = N/1+ (N × D2) with consideration of the design effect and the response rate at 10%. The sampling was performed as multi-stage cluster sampling, and the participants were drawn using a systematic probability sampling technique.
The data were collected using closed-ended, administered questionnaire, and included clinical assessment which performed by consultants ophthalmologist to identify the clinically blinds.
The data were sorted, cleaned, categorized, and summarizing on the master sheet. Data were then analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM Corporate: Armonk, NY-USA). Uni-variate analysis for all determinants was prepared, Bi-variate analysis using Chi-square TEST was done for cross-tabulation to study the association between variables of interest, and the study was estimated at 95% confidence level.
The study was reviewed and approved by Albasar Institutional Review Board. All participants signed informed written consent before data collection and agreed to participate and on publication of the revealed information for scientific purposes. The author assured confidentiality and anonymous data.
| Results | | |
The overall socioeconomic profile of the study group was low; the predominant of the study candidates were non educated and unemployed with a monthly mean income of 3800. The mean monthly income of the blind participants was only 1991 sustainable development goals (SDG) compared to the relatively better one among the other nonblinds (4172 SDG) [Table 1]. The majority of the blind participants were unemployed, where they represented >70% compared to other occupations, and there was a significant association between occupation and blindness (P = 0.000) [Table 2]. More than half of the blind participants (58%) were living in rural areas, and the study revealed a significant association between blindness and living are (P = 0.000) [Table 3]. | Table 2: Cross-tabulation of blindness with occupation of study participants
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 | Table 3: Cross-tabulation of blindness with living area of the study participants
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| Discussion | | |
The study conducted to reveal information regarding the social determinants of blindness among the Sudanese population. Participants were 858, selected from four cities in Sudan proportionate to the size and drawn using a systematic probability sampling technique.
The overall socioeconomic profile of the study group was low; the predominant of the study candidates were non educated and unemployed with monthly mean income of 3800 SDG. Thus, the majority of participants are having social risk factors that contribute to ill health in general, as reported by the WHO that poverty creates ill-health.[5]
Blindness has significant negative physical impacts on the affected people and their families in terms of limitations, in addition to psychological effects and financial burden on the community and the countries with high prevalence. The direct and indirect costs of blindness were estimated in 2013 by >139 billion dollars.[6]
The occupation was an associated factor with blindness in Sudan (P = 0.000), with the majority of blind candidates were unemployed, followed by low work profile as laborers. Occupation may enhance the chance of becoming blind either due to financial problems (low income) that contribute to late or no presentation to seek medical care where the least percentage of blind persons of the study were of occupations with relatively good income. This was proved according to the results of this research; the estimated monthly mean income of the blind participants was low (only 1991 SDG) compared to the mean of other candidates of 4172 SDG. In the state, the highest percentage of unemployed was in 2009, all of them were less likely to have access to health-care coverage and were more likely to delay medical treatment due to cost when compared to employed people or those who were voluntarily out of the labor force.[7]
There was a significant association yielded between blindness and living area (P = 0.000) that makes a residency in rural areas an associated factor with blindness. More than half of the blind participants were living in rural areas, and this may be related to the unavailability of ophthalmic centers, trained professionals, or difficulty to access these services when needed as it may be linked to the poor socioeconomic reasons that limit the access. It could be related to the limited number of health-care institutes and professionals cadres; this was proved by Hashemi et al. in their study that estimated a higher prevalence of blindness in rural areas.[8]
| Conclusion | | |
The socioeconomic status in terms of income, occupation, and living area and is significantly associated with blindness. The majority of the blind participants is living in rural areas, unemployed, and earn low monthly income.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 2. | |
| 3. | |
| 4. | Binnawi K. Progress in blindness prevention in North Sudan (2003-2010). Sudanese J Ophthalmol 2013;5:3-6.  [Full text] |
| 5. | |
| 6. | Ibrahim M, Nimeiri M. Risk factors of blindness in Sudan-2019. Int J Progress Sci Technol 2019;15:195-9. |
| 7. | Jennifer R, Moonie S, Timothy J. The impact of unemployment on mental and physical health, access to health care and health risk behaviors. ISRN Public Health. 2012: 1-7. [Doi.org/10.5402/2012/483432]. |
| 8. | Hashemi H, Yekta A, Jafarzadehpur E, Doostdar A, Ostadimoghaddam H, Khabazkhoob M. The prevalence of visual impairment and blindness in underserved rural areas: A crucial issue for future. Eye (Lond) 2017;31:1221-8. |
[Table 1], [Table 2], [Table 3]
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