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370
© 2023 Indian Journal of Medical Research, published by Wolters Kluwer - Medknow for Director-General, Indian Council of Medical Research
Ocular morbidity among children (aged 6-18 yr) of the tribal area of
Melghat, India: A community-based study
Kavita A. Satav1, Ashish R. Satav2,3, Vibhawari S. Dani4, Parikshit M. Gogate5, Shraddha D. Kumbhare1 &
Pradeep Reddy1
Departments of 1Ophthalmology, 2Community Health & 3Medicine, Mahatma Gandhi Tribal Hospital, MAHAN
Trust, 4Department of Research, MAHAN Trust, Dharni, Amravati, Maharashtra, 5D. Y. Patil Medical College,
Hospital & Research Centre, Pimpri, Pune, India
Received November 4, 2021
Background & objectives: Most of the ocular morbidities among school children are preventable or
treatable. Melghat, a dicult to access, hilly, forest, tribal area with poorly developed infrastructure in
the Amravati district of Maharashtra. Scarcity of ophthalmologists and low health-seeking behaviour of
tribal people contributes to the high burden of ocular morbidity. Given the lack of published studies on
the ocular morbidity among children in Melghat, outreach programmes are essential to diagnose and
treat visual impairments promptly. The objective was to determine the prevalence of ocular morbidity
among children in the tribal area of Melghat.
Methods: A community-based observational study was carried out in the Chikhaldara and Dharni blocks
of Melghat. Children from 15 tribal villages were screened for eye disorders by trained paramedics. Most
of the children were examined by an ophthalmologist. We used Chi-square test for categorical variables.
Results: A total of 4357 children aged between 6 and 18 yr were examined. Of these 2336 (53.6%) were
females and 2021 (46.4%) were males. Out of 4357 children, 507 (11.63%) had an ocular morbidity. The
prevalence of ocular morbidity and refractive error increased in the age group of 8-10 yr (P<0.05 and
<0.001, respectively). Refractive error was the most common ocular morbidity (n=339; 7.8%), followed
by vitamin A deciency (VAD) (n=120; 2.8%).
Interpretation & conclusions: The prevalence of refractive error and VAD in this study was signicantly
higher than the rest of India and the world. For the prevention of childhood blindness, immediate
intervention programme, including eye screening by trained paramedics, treatment by an ophthalmologist
and prophylaxis, is crucial.
Key words Melghat - ocular morbidity - refractive error - tribal - vitamin A deciency
Indian J Med Res 158, October 2023, pp 370-377
DOI: 10.4103/ijmr.ijmr_3228_21
Quick Response Code:
Childhood blindness is an important problem due
to the blindness burden in terms of blind-person years1.
The denition of childhood blindness is ‘presenting
visual acuity (VA) of lower than 3/60 in the healthier
eye of a child, 16 yr and younger’2. Globally, around
1.4 million and 0.8 per 1000 children are suering
from blindness3 and visual impairment,4 respectively.
Globally, the most important causes of avoidable
SATAV et al: OCULAR MORBIDITY AMONG CHILDREN IN TRIBAL MELGHAT 371
childhood blindness are corneal scarring, followed
by cataract and ROP5 . Uncorrected refractive error is
reportedly the cause of visual impairment globally in
13 million children aged 5-15 yr, as per World Health
Organization (WHO)6. Based on WHO criteria for
childhood blindness7, out of 1.5 million blind children
worldwide, one million are in Asia, 0.3 million in
Africa and 0.2 million in rest of the world8. Out of the
total global burden of visual impairment in 2010, the
preventable causes were as high as 80 per cent9.
Globally, vitamin A deciency (VAD) is a
signicant contributor to the burden of diseases10. In
low- and middle- income countries (LMICs), 7-31 per
cent of childhood blindness and visual impairment is
reportedly avoidable, 10-58 per cent is treatable and
3-28 per cent is preventable11. At a rural eye hospital in
Central Ethiopia between August and October 2012, the
most common ocular morbidities among under 15 yr
children included conjunctivitis (35%), refractive error
(11.4%), ocular trauma (11.8%), and trachoma (7.6%).
The various ophthalmic presentations of VAD in South
Asia include Bitot’s spots, night blindness and later on,
keratomalacia, leading to xerophthalmia which was the
major contributor of preventable childhood blindness4.
In Asia, cataract is a more common cause of treatable
childhood blindness due to decline in VAD. Myopia
is the most common economically treatable cause of
visual impairment, followed by amblyopia and other
uncorrected refractive errors12.
A systematic review of 30 community-based
studies in India revealed that the prevalence of visual
impairment was 2.05 to 13.6 per thousand and that
of childhood blindness was 0.6 to 1.06 per thousand,
respectively13. In north India, preventable and/or
treatable conditions contributed to 50 per cent of the
blind school children14. In Jawadhi hills, southern
India, out of 260 tribal children less than 15 yr, ocular
morbidity was seen in 10.8 per cent of cases. VAD
was the most common disease (4.6%), followed by
refractive error (2.7%)1,15.
The causes of childhood blindness and severe
visual impairment and prevalence data are required for
planning preventive, curative, special education and
low vision services and for evaluation. Preliminary
literature search did not show any study on visual
impairment and ophthalmic diseases in tribal children
of Melghat and Korku tribes of India. Due to a scarcity
of ophthalmologists and the low health-seeking
behaviour of tribals in Melghat16, most of the individuals
with eye diseases, including blindness typically did not
receive timely medical treatment due to which many
of them were becoming permanently blind. For the
prevention of childhood blindness, early identication
of eye disorders and treatment is important. The early
identication in this age group will improve the vision
of school going children, their scholastic performance
and productivity.
On this premise, the primary objective of this
study was to evaluate the prevalence of various
ophthalmic disorders (particularly preventable or
treatable diseases) of Melghat tribal children, such that
the preventable blindness can be identied and treated
early.
Material & Methods
The present study was an observational study of
6-18 yr age group children carried out in 15 villages of
Melghat from July to September 2019 after receiving
approval of an independent Institutioanl Review
Board, MAHAN IRB, Mahan Trust, Dharni, Melghat,
Amaravati, Maharashtra.
Study population: Melghat is a mountainous, hard
to reach, highly penurious forest tribal region in the
Amravati district of Maharashtra and comprises two
blocks, i.e. Chikhaldara and Dharni. The population is
3,00,000, spreads over 4000 square km. Poor tribals
constitute 84 per cent of the total population and 50 per
cent of them are semi-illiterate or illiterate4,17-19. The
scarcity of ophthalmologists and low health-seeking
behaviour of tribals19 leads to the high burden of visual
impairment.
Sample size estimation: The sample size was calculated
using the formula, n = z2×P×(1−P)/d2. Where ‘n’
is the sample size, P is expected prevalence, z is
the 95 per cent condence level (z=1.96) and ‘d’ is
the margin of error (corresponding to eect size)20.
To make the data more robust, we assumed ‘d’ to
be 1.2 per cent = 0.012, P = 20.55 per cent (the
collective prevalence of 7 Indian studies: Prevalence of
ophthalmic disorders in students of India)21-27. Hence,
n = 1.96×1.96×0.205×(1-0.205)/(0.012)2 = 4348. A
minimum of 4348 children were needed to conduct
the study. Considering an average of 275 children
per village, a sample of 15-16 villages was sucient.
However, given issues such as refusal by the child for
examination, refusal from parents and local community
leaders and other operational diculties faced by non-
medical supervisors, 4357 children were randomly
372 INDIAN J MED RES, OCTOBER 2023
selected from 15 out of 300 villages in Melghat. This
also captured the diversity across villages in terms of
health and village-level infrastructure and included
both tribal and non-tribal communities.
Inclusion and exclusion criteria: Children of 6-18
yr age group, present in the randomly chosen tribal
villages, were included in this study after obtaining
parents’ or teachers’ permission. Children with a
learning disability who could not cooperate during the
examination and whose parents or teachers refused
permission were excluded.
Evaluation methodology: For eld supervision local
tribal individuals who had successfully completed
education upto 10th standard were preferred.
These supervisors were trained by our ophthalmic
surgeon in the study hospital, schools and villages,
and was an ongoing process throughout the study.
Training methods were lectures, group discussions,
demonstrations, ipcharts, etc. These supervisors
were certied by an ophthalmologist after theory and
practical examination. Ophthalmologists regularly
cross-checked cases identied by the supervisors. The
supervisors were extensively trained for communication
skills with illiterate/semiliterate (able to read and
write on an elementary level, it usually encompasses
grades 1-7 of schooling) community, assessment of
visual acuity, identication of chalazion, hordeolum,
microophthalmia, macroophthalmia, entropion,
ectropion, ptosis, proptosis, pterygium, bitot’s spots,
conjunctivitis, corneal opacity, iridocyclitis, cataract,
dacryocystitis, squint, etc. Night blindness, bitot’s spot
and corneal opacity were the criteria used for dening
VAD. Trained supervisors could diagnose congenital
cataract, chalazion and strabismus.
Screening and consent: During the village screening, the
study team visited all the houses in the selected villages
to assess all school going children present during the
screening. The children were identied by door-to-
door screening of all houses and schools. Before the
examination, permission and informed consent were
taken from parents/teachers. Consent was always sought
from the parents while examining a child at his/her
home. In the case of illiterate parents, verbal consent was
obtained from parents, and his/her thumb impression
was obtained on the consent form followed by the school
teacher’s signature on the educated nearby relatives or
villager same, or the village Gram Sabha who could
read the Hindi consent form and gave the permission.
During the examination of the children in schools, the
teachers, tribal development department, father or close
relatives who were educated, present in the school and
could read the Hindi form, gave the permission.
All children whose permission was given by
parents/elderly or school teachers were selected and
a date for screening was xed. The eld supervisors
examined children in schools and villages in clean,
quiet and well lit rooms. They set up eye examination
centres in each school/village that was visited and
examined only those children who were available at
the time of screening. The eld supervisors screened
and examined the children by torch light examination
(anterior segmental pathologies) and Snellen visual
acuity chart (near and distant) at 6 m in both eyes
separately. They did an inspection and palpation of
eyeball and eyelids, and applied pressure over the
nasolacrimal passage. Supervisors did not conduct
fundus examination.
Children who were found to have vision less
than 6/6 and/or any anterior segmental pathology
were brought to the base hospital (Mahatma Gandhi
Tribal Hospital, Karmgram) for further assessment
by the ophthalmologist. Slit lamp examination and
autorefractometer-based refraction were performed. An
expert, well-experienced ophthalmologist examined
them under dilated pupil in case of suspected posterior
segmental pathology or if they do not accept subjective
refractive correction. Eye surgeons regularly cross-
checked cases identied by supervisors. Suspected
cases of nystagmus, trauma, iridocyclitis and other
pathologies were conrmed by the eye surgeon. The
qualied ophthalmologist examined all children
(n=372) brought to the hospital. The ophthalmologist
also visited all 15 villages and examined 50 per cent
(n=68) of all children with ocular morbidity who did
not come to the hospital. In the process, 35 per cent
(n=1348) of normal children in the villages and schools
were also examined as a quality control of the data.
The diagnosis by the eld supervisors was correct in
87 per cent of cases, as per the cross-examination by
the ophthalmologist. Most of the pterygium cases
were conrmed by the ophthalmologist. There were a
few cases of pseudo pterygium which were, however,
conrmed by the ophthalmologist and excluded from
the list of participants with pterygium. Free treatment
was provided in the trust hospital, either spectacles,
drugs or surgery to the children diagnosed with an
eye disorder during or as a result of the study. If the
surgeries were not possible in the study hospital, then
SATAV et al: OCULAR MORBIDITY AMONG CHILDREN IN TRIBAL MELGHAT 373
participants were referred to higher centres in cities
and was extended help for the referral.
Statistical analysis: Statistical analysis was performed
using R-commander version is R 3.6.2. Chi-square test
was used for categorical data analysis. For calculation
of P value Fisher’s exact test was used after Chi-square
test wherever applicable.
Results
Figure 1 reveals a ow diagram of the recruitment
of the research subjects. A total of 4357 children
of 6-18 yr age range from 15 villages with a mean
age of 13.5 yr were screened. Out of the 15 villages
screened, children from 11 villages were brought to
the base hospital (Mahatma Gandhi Tribal Hospital)
for eye examination by the ophthalmologist. Children
from four villages did not turn up for the examination
even after repeated counselling and constant eorts.
However, the ophthalmologist visited those particular
villages and schools and examined the children.
Table I reveals that there were a total of 2021
(46.4%) males and 2336 (53.6%) females. Maximum
and minimum ocular morbidities were seen in
14-16 yr (33.26%) and 6-7 yr (5.65%) age brackets,
respectively.
Table II reveals that the overall prevalence of
ophthalmic disorders was 11.64 per cent (n=507) in
6-18 yr age bracket. The most common ophthalmic
disorder was refractive error, with the prevalence of
7.78 per cent (n=339), followed by VAD: 2.75 per cent
(n=120). The types of refractive errors seen in this
study were myopia, astigmatism and hypermetropia.
The frequency of various stages of VAD was, however,
not recorded. The ndings of this study revealed ve
children were suering from partial blindness. About
95.84 per cent of childhood ophthalmic morbidities in
this study were found to be preventable or treatable.
Table III shows the overall prevalence of ophthalmic
disorders in children between 6-18 yr age group. It
was slightly lower in males (11.3%) than in females
(11.9%) (P=0.5587). The prevalence of refractive error
was lower in males (6.38%) than in females (8.99%)
and the dierence was signicant (χ2=10.26, P<0.05).
VAD was less prevalent in females (2.01%) than
males (3.61%) with a signicant dierence (χ2=10.36,
P<0.05).
Table I. Gender and age distribution
Age groups (yr) Male (%) Female (%) Total (%)
6-7 116 (5.74) 130 (5.57) 246 (5.65)
8-10 259 (12.82) 244 (10.45) 503 (11.54)
11-13 551 (27.26) 527 (22.56) 1078 (27.04)
14-16 615 (30.43) 834 (35.7) 1449 (33.26)
17-18 480 (23.75) 601 (25.73) 1081 (24.81)
Total 2021 2336 4357
Total children in 15 villages =4586
Total children screened by paramedics in 15 villages =4357 (M=2021, F=2336)
Children with ocular morbidity
from 11 villages: brought to
hospital for examination (372)
(M=168, F=204)
Children with ocular
morbidity from 4 villages
who did not come to hospital
for examination (135)
Children without ocular
morbidity from 15 villages who
did not come to hospital for
examination (3850)
Children examined by trained
ophthalmologist in hospital (372)
(M=168, F=204)
Children examined by
trained ophthalmologist in
village/school (68)
(M=31, F=37)
Children examined by trained
ophthalmologist in village/school
(1348) (M=609, F=739)
Fig. 1. Flow diagram of recruitment of study subjects. M, males; F, females.
374 INDIAN J MED RES, OCTOBER 2023
The refractive error prevalence was maximum in
the 17-18 yr (10.55%) age bracket and was lowest in the
age group 6-7 yr (1.22%), the dierence was signicant
(χ2=28.02, P<0.001) between these groups (Table IV).
Reverse trend was seen with VAD, the VAD prevalence
was maximum in the 8-10 yr age bracket (4.97%) and
was minimum in the 17-18 yr age bracket (0.93%),
the dierence being signicant (χ2=35.86, P<0.001).
Furthermore, the VAD prevalence in the 11-13 yr age
range was 4.36 per cent, which was also high. The
prevalence of ophthalmic disorders was signicantly
higher in the 8-10 yr and 11-13 yr age brackets.
Discussion
The present study provides an understanding of
the details of various ophthalmic morbidities among
tribal children in Melghat, Maharashtra. The ndings
of this study suggest that ophthalmic disorders are
highly prevalent among the tribal children. Most of
the morbidities (95.84%) were either preventable
or treatable, for example, VAD or refractive errors,
respectively. As per our knowledge this is the rst study
of the Melghat tribal belt of Maharashtra documenting
the ophthalmic disorder prevalence among children.
In this study, prevalence of ophthalmic disorders
was 11.64 per cent, which is similar to the ndings
of earlier studies21,28. A low prevalence (2.66%) of
ocular morbidities was seen in another study in south
India29. Dierent prevalence was seen in dierent areas
because of the disparities in the geographical locations,
socioeconomic status, availability of ophthalmic
services and the dierence in criteria of age group
considered for the study. In our study, ocular morbidity
(with and without visual impairment) was the highest
in the 11-13 yr age range (13.45%).
The ndings of the refractive error prevalence
(7.78%) in the present study were comparable to the
prevalence of 8.1 per cent of students of Kathmandu,
Nepal10. This was comparatively higher than that found
in similar studies29,30. Higher refractive error prevalence
was noted in several studies22,26.
VAD is a matter of concern and a chief reason for
childhood blindness in India as well as globally. An
estimated 2,50,000 to 5,00,000 children with vitamin
A deciency, become blind each year, and 50 per cent
of the children die within 12 months of losing their
sight24. VAD is known to be associated with signicant
illness and deaths from common childhood infections
and is the leading preventable cause of childhood
blindness globally. VAD is an important cause of
maternal deaths and other poor outcomes of pregnancy
and lactation. It also reduces the immunity. Children
with mild/subclinical VAD are also prone to respiratory
and diarrhoeal infections, reduced growth rates,
sluggish bone development and increased mortality
from serious diseases.
Figure 2 shows that prevalence of VAD induced
ocular morbidity in the present study is 2.75 per cent,
which is of moderate public health problem as per
the WHO25. This is much higher than the prevalence
in India (<1%)13 and the world (in the age group of
5-19 yr <0.1%)26. In the adolescent tribal population
of India, VAD prevalence was bitot’s spots (2%) and
conjunctival xerosis (4.9%). The National Vitamin
A Prophylaxis Programme (NVAPP) is unable to
reach dicult-to-approach tribal areas, inadequate
medical services, parents without knowledge about
vitamin A prophylaxis, poverty, poor nutrition
especially less intake of leafy vegetables in diet and
unemployment, leading to emigration for long time27.
In the present study, VAD was signicantly higher in
boys as compared to girls. A similar trend was noted
in the case of severe malnutrition (0-5 yr age), which
was less common in females as compared to males
as per the previous study by MAHAN Trust18. This
reects the need of in depth studies to measure the
VAD prevalence across all age groups of children
Table II. Prevalence of eye disorders
Type Number of children
(n=4357); n (%)
Total ocular morbidity 507 (11.64)
Uncorrected refractive error 339 (7.78)
Vitamin A deciency 120 (2.75)
Strabismus 18 (0.41)
Pterygium 14 (0.32)
Chalazion 9 (0.21)
Corneal opacity 8 (0.18)
Ptosis 7 (0.16)
Hordeolum 5 (0.11)
Coloboma of iris 3 (0.07)
Nystagmus 2 (0.04)
Congenital cataract 2 (0.04)
Amblyopia 1 (0.02)
Traumatic iridodialysis 1 (0.02)
Congenital nevus 1 (0.02)
SATAV et al: OCULAR MORBIDITY AMONG CHILDREN IN TRIBAL MELGHAT 375
in Melghat. This will help to plan additional proper
strategies to reduce VAD, prevent blindness, other
infections and deaths. High prevalence of VAD
warrants urgent holistic interventions in the form of
behaviour change communication of nutrition, regular
vitamin A supplementation and nutrition garden for
the production of vitamin A-rich food.
Figure 2 shows that the non-corrected refractive
error prevalence is higher in Melghat (7.78%) in
contrast to the world gures (0.97%) and India
(0.63%)28,29. The possible underlying causes of
this high burden of uncorrected refractive error in
Melghat include less eye health-seeking behaviour,
social causes (superstitions, less awareness related
to eye health, high prevalence of illiteracy and
misperceptions related to spectacles use), poor
socioeconomic status (>80% of tribals are below
the poverty line, loss of wages to attend hospital,
cost of correction, replacement costs), grossly
inadequate healthcare facilities for the eye (scarcity
of ophthalmologists and spectacle shops) and
hereditary (unpublished data). In Melghat, there
was also a lack of coordination between parents and
school authorities for the referral of children with eye
diseases. All these factors contribute to an increase in
ocular morbidity and blindness in tribal Melghat. The
evolution of several folklores about the diagnosis and
treatment of ophthalmic disorders (e.g., strabismus as
a God’s gift) impacts the diagnosis and treatment of
ocular diseases by ophthalmologists29.
Table IV. Comparison of various morbidities across age groups
Morbidity Group 1 (%) Group 2 (%) Group 3 (%) Group 4 (%) Group 5 (%) χ2P
Overall ocular morbidity 13 (5.28) 60 (11.93) 145 (13.45) 150 (10.35) 139 (12.86) 17.04 <0.05
Uncorrected refractive error 3 (1.22) 32 (6.36) 83 (7.7) 107 (7.38) 114 (10.55) 28.02 <0.001
Vitamin A deciency 8 (3.25) 25 (4.97) 47 (4.36) 30 (2.07) 10 (0.93) 35.86 <0.001
Strabismus 1 (0.41) 4 (0.8) 4 (0.37) 6 (0.41) 3 (0.28) NS NS
Pterygium 1 (0.41) 2 (0.4) 5 (0.46) 1 (0.07) 5 (0.46) NS NS
Chalazion - - 2 (0.19) 3 (0.2) 4 (0.37) NS NS
Corneal opacity - 1 (0.2) 2 (0.19) 2 (0.14) 3 (0.28) NS NS
Ptosis - - 1 (0.09) 2 (0.14) 4 (0.37) NS NS
P value computed using Fisher’s exact test. Group 1=6-7 yr; Group 2=8-10 yr; Group 3=11-13 yr; Group 4=14-16 yr; Group 5=17-18
yr. NS, non signicant
7.78
2.75
0.63 1
0.97
0.1
0
1
2
3
4
5
6
7
8
9
Refractive error Vitamin A deficiency
Percentage (%)
Melghat India World
Fig. 2. Comparison of prevalence of refractive error(28) and vitamin
A deciency31,32 between World, India and Melghat.
Table III. Comparison of various morbidities between gender
Disease Male (%) Female (%) χ2P
Overall ophthalmic disorders 229 (11.33) 278 (11.9) 0.3419 0.56
Uncorrected refractive error 129 (6.38) 210 (8.99) 10.26 <0.05
Vitamin A deciency 73 (3.61) 47 (2.01) 10.36 <0.05
Strabismus 7 (0.35) 11 (0.47) 0.41 0.52
Pterygium 9 (0.45) 5 (0.21) 1.81 0.18
Chalazion 4 (0.2) 5 (0.21) NS NS
Corneal opacity 4 (0.2) 4 (0.17) NS NS
Ptosis 5 (0.25) 2 (0.09) NS NS
P value computed using Fisher’s exact test. NS, non signicant
376 INDIAN J MED RES, OCTOBER 2023
The prevalence of strabismus was 0.41 per cent
in the present study similar to that previously reported
(0.43%) in school going children in Dhulikhel, Nepal28.
However contrary to this high prevalence was reported
by Mahesh et al 2019 (7.10%) in tribal students, Jawadhi
Hills, south India15. Corneal opacities were seen in 0.18
per cent of cases in this study. The possible underlying
causes of corneal opacities are environmental (physical
and chemical injuries), social (unawareness, delay in
treatment and traditional medicine uses), economic
(cost of treatment) and medical (VAD).
The ocular morbidities started manifesting right
after the age of 6-7 yr in our study population. The
possible underlying causes of childhood blindness in
this study may include social (consanguinity, beliefs
and taboos), economic (poverty and cost of treatment)
and medical (incomplete immunization, very high
prevalence of malnutrition: 80%)18. Childhood
blindness is a public health issue and should be
addressed by routine examinations. Eye check-up
should be an integral part of routine school screening, as
it is easy and cost-eective. Furthermore, preventable
blindness can be avoided by early intervention. Most
of the ophthalmic diseases are curable and require
initial recognition by way of ophthalmic examination
along with appropriate management. Children should
be screened at the onset of preschool for refractive
errors by a trained professionals. It would be useful
in reducing amblyopia, as children generally have a
higher incidence of refractive errors. As per Vision
2020, the important diseases to be tackled urgently to
decrease childhood blindness in India are refractive
error, VAD, cataract-related amblyopia and corneal
diseases30.
Due to scarcity of ophthalmologists and low
health-seeking behaviour of tribals in Melghat, most of
the individuals with eye diseases, including blindness
do not get timely medical treatment and many of them
become permanently blind (unpublished data). For
prevention of childhood blindness, early identication
of eye disorders and treatment is important. This
study reects the need for regular eye screening of
school going children, especially in dicult to access,
tribal areas. The early detection in this age group
will improve the vision of school going children,
their scholastic performance, living standard and
productivity. This study will help policy-makers, other
voluntary organizations and institutes to administer
comparable research in other similar tribal settings in
India and policy-makers to develop sustainable public
health strategies. Government should initiate outreach
programmes to improve eye health indicators, in the
dicult to reach tribal areas of India. It is necessary
to screen and diagnose ocular morbidities in the
community and in schools by trained grass root health
workers and teachers. Training of school teachers for
regular eye screening of children will play a pivotal
role. It will assist for prompt diagnosis and management
of various types of ophthalmic disorders, for example,
refractive errors, common ocular infections; VAD,
etc. Proper prevention and promotion strategies, for
example, hygiene and diet modication, etc., can
prevent childhood blindness.
This study was not without some limitations.
Although it was undertaken to assess the prevalence of
ophthalmic morbidities in tribal areas of Melghat, but the
socioeconomic and demographical data of the screened
children were not collected. Hence, the correlation
between the ndings and the sociodemographic prole
of the children could not be done. Although the data
regarding the availability of TV (18.72%) and mobile
phones (29.54%) in households of villages of Melghat
are available, the screen time of the children could not
be assessed.
Overall, the ndings of this study show a
signicantly high, prevalence of refractive error and
VAD among the children in the tribal area of Melghat,
which requires immediate intervention with treatment
and prophylaxis. In this study, 95.84 per cent of
childhood ophthalmic morbidities were preventable
or treatable. In tribal areas, early eye screening and
diagnosis in the community and schools by trained
frontline workers can prevent childhood blindness,
enhance scholastic performance and overall quality of
life.
Financial support & sponsorship: This study received
funding support from Paul Hamlyn Foundation (Ref:17116/29217)
and Caring Friends (a coalition group who provided philanthropic
support).
Conicts of Interest: None.
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For correspondence: Dr Ashish Satav, Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Dharni, Amaravati 444 702, Maharashtra,
India
e-mail: drashish@mahantrust.org
