Biomedical subjects

Rakhi Dandona

Publications and source records attributed to Rakhi Dandona.

At least 19 recordsLinked to original sources

PubMed2006

Is the HIV burden in India being overestimated?

BACKGROUND: The HIV burden estimate for India has a very wide plausibility range. A recent population-based study in a south Indian district demonstrated that the official method used in India to estimate HIV burden in the population, which directly extrapolates annual sentinel surveillance data from large public sector antenatal and sexually transmitted infection (STI) clinics, led to a 2-3 times higher estimate than that based on population-based data. METHODS: We assessed the generalisability of the reasons found in the Guntur study for overestimation of HIV by the official sentinel surveillance based method: addition of substantial unnecessary HIV estimates from STI clinics, the common practice of referral of HIV positive/suspect patients by private practitioners to public hospitals, and a preferential use of public hospitals by lower socioeconomic strata. We derived conservative correction factors for the sentinel surveillance data and titrated these to the four major HIV states in India (Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu), and examined the impact on the overall HIV estimate for India. RESULTS: HIV data from STI clinics are not used elsewhere in the world as a component of HIV burden estimation in generalised epidemics, and the Guntur study verified that this was unnecessary. The referral of HIV positive/suspect patients from the private to the public sector is a widespread phenomenon in India, which is likely causing an upward distortion in HIV estimates from sentinel surveillance in other parts of India as well. Analysis of data from the nationwide Reproductive and Child Health Survey revealed that lower socioeconomic strata were over-represented among women seeking antenatal care at public hospitals in all major south Indian states, similar to the trend seen in the Guntur study. Application of conservative correction factors derived from the Guntur study reduced the 2005 official sentinel surveillance based HIV estimate of 3.7 million 15-49 years old persons in the four major states to 1.5-2.0 million, which would drop the official total estimate of 5.2 million 15-49 years old persons with HIV in India to 3-3.5 million. CONCLUSION: Plausible and cautious extrapolation of the trends seen in a recent large and rigorous population-based study of HIV in a south Indian district suggests that India is likely grossly overestimating its HIV burden with the current official sentinel surveillance based method. This method needs revision.

Adolescent↗

PubMed2006

A population-based study of human immunodeficiency virus in south India reveals major differences from sentinel surveillance-based estimates.

BACKGROUND: The human immunodeficiency virus (HIV) burden among adults in India is estimated officially by direct extrapolation of annual sentinel surveillance data from public-sector antenatal and sexually transmitted infection (STI) clinics and some high-risk groups. The validity of these extrapolations has not been systematically examined with a large sample population-based study. METHODS: We sampled 13838 people, 15-49 years old, from 66 rural and urban clusters using a stratified random method to represent adults in Guntur district in the south Indian state of Andhra Pradesh. We interviewed the sampled participants and obtained dried blood spots from them, and tested blood for HIV antibody, antigen and nucleic acid. We calculated the number of people with HIV in Guntur district based on these data, compared it with the estimate using the sentinel surveillance data and method, and analysed health services use data to understand the differences. RESULTS: In total, 12617 people (91.2% of the sampled group) gave a blood sample. Adjusted HIV prevalence was 1.72% (95% confidence interval 1.35-2.09%); men 1.74% (1.27-2.21%), women 1.70% (1.36-2.04%); rural 1.64% (1.10-2.18%), urban 1.89% (1.39-2.39%). HIV prevalence was 2.58% and 1.20% in people in the lower and upper halves of a standard of living index (SLI). Of women who had become pregnant during the past 2 years, 21.1% had used antenatal care in large public-sector hospitals participating in sentinel surveillance. There was an over-representation of the lowest SLI quartile (44.7%) in this group, and 3.61% HIV prevalence versus 1.08% in the remaining pregnant women. HIV prevalence was higher in that group even when women were matched for the same SLI half (lower half 4.39%, upper 2.63%) than in the latter (lower 1.06%, upper 1.05%), due to referral of HIV-positive/suspected women by private practitioners to public hospitals. The sentinel surveillance method (HIV prevalence: antenatal clinic 3%, STI clinic 22.8%, female sex workers 12.8%) led to an estimate of 112635 (4.38%) people with HIV, 15-49 years old, in Guntur district, which was 2.5 times the 45942 (1.79%) estimate based on our population-based study. CONCLUSION: The official method in India leads to a gross overestimation of the HIV burden in this district due to addition of substantial extra HIV estimates from STI clinics, the common practice of referral of HIV-positive/suspected people to public hospitals, and a preferential use of public hospitals by people in lower socioeconomic strata. India may be overestimating its HIV burden with the currently used official estimation method.

Adolescent↗

PubMed2006

Risky behavior of drivers of motorized two wheeled vehicles in India.

INTRODUCTION: Motorized two-wheeled vehicles (MTV) account for a large proportion of road traffic in India and the riders of these vehicles have a high risk of road traffic injuries. We report on the availability of drivers licenses, use of a helmet, driver behavior, and condition of vehicles for MTV drivers in Hyderabad, a city in India METHODS: Drivers of a MTV aged >16 years were interviewed at petrol filling stations RESULTS: There were 4,183 MTV drivers who participated in the study. Four hundred sixty one (11%; 95% CI 9.7-12.3%) drivers had not obtained a drivers license and 798 (21.4%) had obtained a license without taking the mandatory driving test. Two thousand nine hundred twenty (69.8%; 95% CI 67.9-71.7%) drivers reported no/very occasional use of a helmet, the significant predictors of which included that those driving borrowed a MTV (odds ratio 7.90; 95% CI 3.40-18.40) or driving moped/scooterette/scooter as compared with motorcycle (3.32; 2.76-3.98), lower education (3.10; 2.66-3.61), age >45 years (2.41; 1.63-3.57), and males (1.57; 1.16-2.13). Two thousand five hundred and eight (59.9%) drivers reported committing a traffic law violation at least once within the last 3 months. Overall, 1,222 (29.2%) drivers reported ever being caught by traffic police for a traffic law violation with data on violations available for 1,205 of these drivers, of whom 680 (56.4%) paid a fine, 310 (25.7%) paid by bribe, and 215 (17.8%) made no payment. The proportion of those who did not make payment for committed violation was significantly higher among females (46.8%) than males (16.3%). Two thousand fifty two (49%) of all MTVs had no rearview mirror CONCLUSIONS: These data suggest the need to enact and enforce policy interventions for improving the drivers license system, mandatory use of a helmet, effective traffic law enforcement, and ensuring good vehicle condition to reduce the risk factors that potentially contribute to mortality and morbidity in road traffic crashes in MTV drivers in Indian cities.

Accidents, Traffic↗

PubMed2006

Demography and sex work characteristics of female sex workers in India.

BACKGROUND: The majority of sex work in India is clandestine due to unfavorable legal environment and discrimination against female sex workers (FSWs). We report data on who these women are and when they get involved with sex work that could assist in increasing the reach of HIV prevention activities for them. METHODS: Detailed documentation of demography and various aspects of sex work was done through confidential interviews of 6648 FSWs in 13 districts in the Indian state of Andhra Pradesh. The demography of FSWs was compared with that of women in the general population. RESULTS: A total of 5010 (75.4%), 1499 (22.5%), and 139 (2.1%) street-, home-, and brothel-based FSWs, respectively, participated. Comparison with women of Andhra Pradesh revealed that the proportion of those aged 20-34 years (75.6%), belonging to scheduled caste (35.3%) and scheduled tribe (10.5%), illiterate (74.7%), and of those separated/divorced (30.7%) was higher among FSWs (p < 0.001). The FSWs engaged in sex work for >5 years were more likely to be non-street-based FSWs, illiterate, living in small urban towns, and to have started sex work between 12-15 years of age. The mean age at starting sex work (21.7 years) and gap between the first vaginal intercourse and the first sexual intercourse in exchange for money (6.6 years) was lower for FSWs in the rural areas as compared with those in large urban areas (23.9 years and 8.8 years, respectively). CONCLUSION: These data highlight that women struggling with illiteracy, lower social status, and less economic opportunities are especially vulnerable to being infected by HIV, as sex work may be one of the few options available to them to earn money. Recommendations for actions are made for long-term impact on reducing the numbers of women being infected by HIV in addition to the current HIV prevention efforts in India.

Journal Article↗

PubMed2006

What is the global burden of visual impairment?

BACKGROUND: A recent estimate by the World Health Organization (WHO) suggests that 161 million persons worldwide have visual impairment, including 37 million blind (best-corrected visual acuity less than 3/60 in the better eye) and 124 million with visual impairment less severe than blindness (best-corrected acuity less than 6/18 to 3/60 in the better eye). This estimate is quoted widely, but because it is based on definitions using best-corrected visual acuity, uncorrected refractive error as a cause of visual impairment is excluded. METHODS: We reviewed data from population-based surveys of visual impairment worldwide published 1996 onwards that included presenting visual acuity, and estimated the proportion of visual impairment caused by uncorrected refractive error in different sub-regions of the world. We then extrapolated these data to estimate the worldwide burden of visual impairment including that caused by uncorrected refractive error. RESULTS: The total number of persons with visual impairment worldwide, including that due to uncorrected refractive error, was estimated as 259 million, 61% higher than the commonly quoted WHO estimate. This includes 42 million persons with blindness defined as presenting visual acuity less than 3/60 in the better eye, and 217 million persons with less severe visual impairment level defined as presenting visual acuity less than 6/18 to 3/60 in the better eye, 14% and 75% higher, respectively, than the WHO estimates based on best-corrected visual acuity. Sensitivity analysis, taking into account the uncertainty of the proportion of visual impairment caused by refractive error, revealed that the number of persons in the world with visual impairment due to uncorrected refractive error could range from 82 to 117 million. CONCLUSION: The actual burden of visual impairment worldwide, including that caused by uncorrected refractive error, is substantially higher than the commonly quoted WHO estimate that is based on best-corrected visual acuity. We suggest that the indicative estimate of 259 million persons with visual impairment worldwide, which includes 42 million blind with visual acuity less than 3/60 in the better eye, be used for further planning of the VISION 2020 initiative instead of the often quoted 161 million estimate that includes 37 million blind.

Cost of Illness↗

PubMed2006

Revision of visual impairment definitions in the International Statistical Classification of Diseases.

BACKGROUND: The existing definitions of visual impairment in the International Statistical Classification of Diseases are based on recommendations made over 30 years ago. New data and knowledge related to visual impairment that have accumulated over this period suggest that these definitions need to be revised. DISCUSSION: Three major issues need to be addressed in the revision of these definitions. First, the existing definitions are based on best-corrected visual acuity, which exclude uncorrected refractive error as a cause of visual impairment, leading to substantial underestimation of the total visual impairment burden by about 38%. Second, the cut-off level of visual impairment to define blindness in the International Statistical Classification of Diseases is visual acuity less than 3/60 in the better eye, but with increasing human development the visual acuity requirements are also increasing, suggesting that a level less than 6/60 be used to define blindness. Third, the International Statistical Classification of Diseases uses the term 'low vision' for visual impairment level less than blindness, which causes confusion with the common use of this term for uncorrectable vision requiring aids or rehabilitation, suggesting that alternative terms such as moderate and mild visual impairment would be more appropriate for visual impairment less severe than blindness. We propose a revision of the definitions of visual impairment in the International Statistical Classification of Diseases that addresses these three issues. According to these revised definitions, the number of blind persons in the world defined as presenting visual acuity less than 6/60 in the better eye would be about 57 million as compared with the World Health Organization estimate of 37 million using the existing International Statistical Classification of Diseases definition of best-corrected visual acuity less than 3/60 in the better eye, and the number of persons in the world with moderate visual impairment defined as presenting visual acuity less than 6/18 to 6/60 in the better eye would be about 202 million as compared with the World Health Organization estimate of 124 million persons with low vision defined as best-corrected visual acuity less than 6/18 to 3/60 in the better eye. CONCLUSION: Our suggested revision of the visual impairment definitions in the International Statistical Classification of Diseases takes into account advances in the understanding of visual impairment. This revised classification seems more appropriate for estimating and tracking visual impairment in the countries and regions of the world than the existing classification in the International Statistical Classification of Diseases.

Biometry↗

PubMed2006

How much attention is needed towards men who sell sex to men for HIV prevention in India?

BACKGROUND: HIV prevention in India has mostly focussed on heterosexual transmission. Data on homosexual transmission are not readily available from India. We therefore assessed the probability of acquiring and transmitting HIV for men who sell sex to men and compared this with women who sell sex in India. METHODS: Sexual behaviour characteristics of 6661 men who have sex with men and 6648 women who sell sex were obtained in the Indian state of Andhra Pradesh through confidential interviews. These, along with estimates of HIV rates among them and risk of HIV transmission per unprotected sex act from other sources, were used to calculate their annual probability of acquiring and transmitting HIV. RESULTS: Of 6661 men who have sex with men in this sample, 1776 (26.7%) had sold sex to men. For every 1000 men who sell sex to men, annually 146 (95% confidence interval [CI] 116-179) would acquire HIV and HIV would be transmitted to 55 (95% CI 42-71) men who do not sell sex or women. These estimates were higher by 6.7 (95% CI 4.9-9.2) times for acquiring HIV and 2.5 (95% CI 2.0-3.2) times for transmitting HIV to sex partners outside their group, as compared with similar estimates for women who sell sex. In this sample, the average annual probability of acquiring HIV was higher among men who have sex with men but do not sell sex as compared with women who sell sex. CONCLUSION: These data indicate that men who sell sex to men are at much higher risk of acquiring and transmitting HIV than women who sell sex. Therefore, men who sell sex to men and their clients warrant substantial attention for comprehensive HIV prevention in India.

Adolescent↗

PubMed2005

HIV testing among female sex workers in Andhra Pradesh, India.

Of 6648 female sex workers (FSW) in 13 districts of Andhra Pradesh state in India, only 7.9% reported having undergone HIV testing, and three-quarters of the rest were unwilling to undergo HIV testing in the future. The risk of HIV infection as a result of the non-use of condoms was higher among FSW who reported not having been tested and were also unwilling to get tested, and they also held significantly more negative beliefs about HIV/AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed2005

High risk of HIV in non-brothel based female sex workers in India.

BACKGROUND: Heterosexual contact is the most common mode of HIV transmission in India that is largely linked to sex work. We assessed the non-use of condoms in sex work and with regular sex partners by female sex workers (FSWs), and identified its associations that could assist in planning HIV prevention programmes. METHODS: Detailed documentation of various aspects of sex work, and sexual behaviour with regular sex partners, was done through confidential interviews for 6,648 FSWs in 13 districts in the Indian state of Andhra Pradesh. Multivariate analysis was done to understand condom non-use with clients. RESULTS: 5,010 (75.4%), 1,499 (22.5%), and 139 (2.1%) FSWs were street-, home-, and brothel-based, respectively. Of the total 6,648 FSWs, 6,165 (92.7%) had penetrative vaginal/anal sex with at least one client in the last 15 days, and of these 2,907 (47.2%; 95% CI 41.2-53.2%) reported non-use of condom with at least one of her last three clients. Lack of knowledge that HIV could be prevented (odds ratio 5.01; 95% CI 4.38-5.73), no access to free condoms (odds ratio 3.45; 95% CI 2.99-3.98), being street-based as compared with brothel-based (odds ratio 3.36; 95% CI 1.87-6.04), and no participation in FSW support groups (odds ratio 2.02; 95% CI 1.50-2.70) were the most significant predictors of condom non-use with clients. Other associations included lower social support, lower income, age >24 years, illiteracy, and living in medium-size urban or rural areas. Of the 2582 who had penetrative sex with regular sex partner within the last 7 days, 2428 (94%; 95% CI 92.1-95.9%) had not used condom at last sex, and 1032 (41.8%) had neither used condom consistently with clients nor with regular sex partner. CONCLUSION: About half the FSWs do not use condom consistently with their clients in this Indian state putting them at high risk of HIV infection. Non-brothel-based FSWs, who form the majority of sex workers in India, were at a significantly higher risk of HIV infection as compared with brothel-based FSWs. With their high vulnerability, the success of expansion of HIV prevention efforts will depend on achieving and sustaining an environment that enables HIV prevention with the non-brothel based FSWs.

Adolescent↗

PubMed2005

Sex behaviour of men who have sex with men and risk of HIV in Andhra Pradesh, India.

OBJECTIVE: To obtain information on sex behaviour of a large sample of men who have sex with men (MSM) in India that would assist in planning HIV prevention. METHODS: Homosexual/bisexual behaviour of 6661 MSM at 62 urban-rural locations of various sizes in the Indian state of Andhra Pradesh was assessed through detailed interview. Multivariate analyses were performed to understand the associations with unprotected penetrative sex and barriers to condom use assessed. RESULTS: The average number of different male sex partners in past 4 weeks was six. In last three sex encounters with men, totalling 19 640, anal sex occurred in 16 769, at least once by 6121 (91.9%) MSM of which 3423 [55.9%; 95% confidence interval (CI), 51.7-60.1%] did not use condom at least once. A total of 2785 (41.8%) were currently married to women and 3354 (50.4%) had had vaginal/anal sex with women in the past 3 months, of which 2818 (84%; 95% CI, 81.1-86.9%) did not use a condom. Furthermore, 1585 (25.9%; 95% CI, 22.7-29.1%) had anal sex without a condom with men and also vaginal/anal sex without a condom with women. This was prevalent across urban-rural locations and its strongest association was with currently married MSM (odds ratio 15.1; 95% CI, 12.5-18.2). The predominant reason for not using a condom with women was 'do not use with regular partner' (68.4%). CONCLUSION: This high rate of unprotected penetrative sex by MSM with both men and women suggests that HIV prevention efforts in India should include a focus on MSM as well as their wives across many urban-rural locations and not only in large cities.

Adolescent↗

PubMed2005

Traffic law enforcement in Hyderabad, India.

The aim of the study was to understand traffic law enforcement (TLE) carried out by the police to reduce non-compliance with traffic laws on the roads of Hyderabad city in India for 2001-2003. The Traffic Police database of citations issued to drivers who violated traffic laws in Hyderabad was analysed for the years 2001-2003 to describe the TLE activities of the police, to describe and compare the TLE activities for the different types of vehicles and to compare the TLE activities for the 3 years. The violations were classified in five categories - those related to driving, parking, vehicle, document and others; and TLE into safety and other TLE. A total of 646 161 traffic-law violations were registered in 2001, 904 447 in 2002 and 964 275 in 2003 for Hyderabad. Driving and parking violations were the most common violations registered in all 3 years, with parking violations slightly higher in 2001 (43.5%) and driving violations slightly higher in 2002 (35%) and 2003 (36.4%). Auto-rickshaws (three-wheel commercial passenger vehicles) accounted for the highest violations registered in 2001 (41.4%) whereas motorized two-wheelers had the highest registered violations in 2002 (35.5%) and 2003 (33.2%). Safety TLE activity (detecting and registering driving violations) was only one-third of all the TLE activity performed by the police in the 3 years, and disobeying traffic signals was the most common violation registered under safety TLE. Indian rupees 50 (US$1.1) were collected by way of a fine in 87% of the cases registered. Age and gender of the violators were not recorded in the database. These data can be used for planning, monitoring and evaluating TLE in Hyderabad. These can help identify traffic control and human factors that could lead to traffic noncompliance, and help identify priorities for improving road safety. These data indicate a need to enhance the safety TLE activity of the police, to make TLE more visible in Hyderabad, and to assess the effectiveness of the current legal action as deterrence to improve road safety. Recommendations to enhance TLE within the given resources of the police are made. More effort is needed towards systematic collection and analysis of data on TLE in India to facilitate long-term improvements in TLE for safer roads.

Automobile Driving↗

PubMed2004

The lack of public health research output from India.

BACKGROUND: Systematic assessment of recent health research output from India, and its relation with the estimated disease burden, is not available. This information would help understand the areas in health research that need improvement in India to enhance the health of India's population. METHODS: The health research output from India during 2002, which was accessible in the public domain, was assessed by searching PubMed and other internet health literature databases, and was related to the disease burden suggested by the Global Burden of Disease Study. The main outcome measures were number of health papers with abstracts in basic, clinical and public health sciences; quality-adjusted research output based on the impact factors of journals in which the papers were published; classification of papers in disease/condition categories and comparison of research output with the estimated disease burden in each category. Comparison of the health papers from India during 2002 included in PubMed was done with those from Australia during one quarter of 2002. RESULTS: Of the 4876 health papers from India in 2002 in PubMed, 48.4%, 47.1% and 4.4% were in basic, clinical and public health sciences, respectively. Of the 4495 papers based on original research, only 3.3% were in public health. Quality-adjusted original research output was highest for non-communicable diseases (62% of total). Of the total quality-adjusted original research output, the proportions in injuries (0.7%), cardiovascular diseases (3.6%), respiratory infections (0.2%), diarrhoeal diseases (1.9%), perinatal conditions (0.4%), childhood cluster diseases (0.5%), unipolar major depression (0%), and HIV/AIDS (1.5%) were substantially lower than their proportional contribution to the disease burden in India. Human resources, health policy, health economics, and impact assessment of interventions were particularly poorly represented in public health research. The Australia-India ratio for quality-adjusted health research output per unit gross domestic product was 20 and for public health research output was 31. CONCLUSIONS: Good-quality public health research output from India is grossly inadequate, and strategic planning to improve it is necessary if substantial enhancement of population health were to be made possible. There is inordinately low relative research output in several diseases/conditions that cause major disease burden in India.

Academies and Institutes↗

PubMed2003

Outcome and number of cataract surgeries in India: policy issues for blindness control.

PURPOSE: To assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India. METHODS: In a population-based sample of 5268 persons in two rural areas in the state of Andhra Pradesh, India, data on the visual outcome of cataract surgery were obtained on 129 eyes of 106 persons operated previously. These were compared with the visual outcome of cataract surgery performed during 1999 in 2394 eyes of 2213 persons at two new rural eye centres set up in these areas that pay particular attention to the quality of eye care. Blindness in an eye was defined as presenting distance visual acuity less than 6/60, and in a person as this acuity level in the better eye. These data were extrapolated to India. RESULTS: In the population-based sample, of the 129 operated eyes, 51 (39.5%) were blind after surgery, which included 41 (31.8%) from cataract surgery-related causes. Of the 106 persons in the population sample who had had cataract surgery in one or both eyes, 26 (24.5%) were still blind. In contrast, for the cataract surgery at the two rural eye centres paying attention to quality, 3.1% of the eyes and 1.8% of the persons were blind soon after surgery, but these figures could increase 2.6 times over the lifetime of these persons. The 3.5 million cataract surgeries in India in 2000 are estimated to result in 0.32 million persons having blindness averted over their lifetime. To eliminate cataract blindness in India, an estimated 9 million good-quality cataract surgeries are needed every year during 2001-2005, increasing to over 14 million surgeries needed every year during 2016-2020 on persons most likely to go blind from cataract. CONCLUSIONS: The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract. If adequate attention is given to the quality of eye care, for the current number of cataract surgeries in India it should be possible to increase by threefold the number in whom blindness can be averted with cataract surgery. In addition to improving quality, the annual number of cataract surgeries has to be at least threefold the current number during 2006-2010 if cataract blindness in India is to be eliminated.

Adult↗

PubMed2002

Planning low vision services in India : a population-based perspective.

OBJECTIVE: To assess the prevalence and causes of low vision in a population in southern India for planning low vision services. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 10,293 persons of all ages from 94 clusters representative of the population of the Indian state of Andhra Pradesh. METHODS: The participants underwent a detailed eye examination, including measurement of visual acuity with logarithm of the minimum angle of resolution charts, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, and stereoscopic dilated fundus evaluation. Automated threshold visual fields and slit-lamp and fundus photography were done when indicated using predefined criteria. MAIN OUTCOME MEASURES: Low vision was defined as permanent visual impairment that was not correctable with refractive error correction or surgical intervention. The participants with best-corrected distance visual acuity <6/18 to perception of light or central visual field <10 degrees because of an untreatable cause in both eyes were considered as having low vision. RESULTS: Low vision was present in 144 participants, an age, gender, and urban-rural distribution adjusted prevalence of 1.05% (95% confidence interval, 0.82%-1.28%). The most frequent causes of low vision included retinal diseases (35.2%), amblyopia (25.7%), optic atrophy (14.3%), glaucoma (11.4%), and corneal diseases (8.6%). Multivariate analysis showed that the prevalence of low vision was significantly higher with increasing age, and there was a trend for higher prevalence with decreasing socioeconomic status. Extrapolating these data to the estimated 1014 million population of India in the year 2000, 10.6 (95% confidence interval, 8.4-12.8) million people would have low vision. CONCLUSIONS: These data imply that there is a significant burden of low vision in this population, suggesting the need for low vision services.

Adolescent↗

PubMed2002

Population-based assessment of refractive error in India: the Andhra Pradesh eye disease study.

PURPOSE: To assess the prevalence, distribution, and demographic associations of refractive error in the population of the southern Indian state of Andhra Pradesh. METHODS: From 94 clusters in one urban and three rural areas of Andhra Pradesh, 11 786 persons of all ages were sampled using a stratified, random, cluster, systematic sampling strategy in the Andhra Pradesh Eye Disease Study, a population-based cross-sectional study. A total of 10 293 people underwent an interview and detailed dilated eye examination. Refraction was performed by ophthalmic personnel trained in the study procedures. Objective refraction under cycloplegia was assessed for participants < or = 15 years of age and subjective refraction for those > 15 years of age. Myopia was defined as spherical equivalent worse than -0.50 D and hyperopia as spherical equivalent worse than +0.50 D. RESULTS: In the participants < or = 15 years of age, the prevalence of myopia was 3.19% (95% confidence interval [CI] 2.24-4.13%) and of hyperopia was 62.62% (95% CI 57.10-68.13%). In this age group, myopia increased with increasing age and was more prevalent in the urban study area, and hyperopia prevalence was greater in the participants < 10 years of age. In participants > 15 years of age, the prevalence of myopia was 19.45% (95% CI 17.88-21.02%) and of hyperopia was 8.38% (95% CI 6.91-9.85%). Myopia and hyperopia increased with increasing age. Myopia was more common in males, those with education higher than class 12, those with nuclear cataract, and those living in rural study areas. Hyperopia was more common in females, those with any level of formal education, and those living in the urban area and in the well-off rural study area. CONCLUSIONS: There is significant refractive error in this population. These data on the distribution and associations of refractive error can be useful for the planning of refractive eye-care services.

Adolescent↗

PubMed2002

Refractive error in children in a rural population in India.

PURPOSE: To assess the prevalence of refractive error and related visual impairment in school-aged children in the rural population of the Mahabubnagar district in the southern Indian state of Andhra Pradesh. METHODS: Random selection of village-based clusters was used to identify a sample of children 7 to 15 years of age. From April 2000 through February 2001, children in the 25 selected clusters were enumerated in a door-to-door survey and examined at a rural eye center in the district. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. Myopia was defined as spherical equivalent refractive error of at least -0.50 D and hyperopia as +2.00 D or more. Children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance in seven clusters. RESULTS: A total of 4414 children from 4876 households was enumerated, and 4074 (92.3%) were examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 2.7%, 2.6%, and 0.78%, respectively. Refractive error was the cause in 61% of eyes with vision impairment, amblyopia in 12%, other causes in 15%, and unexplained causes in the remaining 13%. A gradual shift toward less-positive values of refractive error occurred with increasing age in both boys and girls. Myopia in one or both eyes was present in 4.1% of the children. Myopia risk was associated with female gender and having a father with a higher level of schooling. Higher risk of myopia in children of older age was of borderline statistical significance (P = 0.069). Hyperopia in at least one eye was present in 0.8% of children, with no significant predictors. CONCLUSIONS: Refractive error was the main cause of visual impairment in children aged between 7 and 15 years in rural India. There was a benefit of spectacles in 70% of those who had visual acuity of 20/40 or worse in the better eye at baseline examination. Because visual impairment can have a significant impact on a child's life in terms of education and development, it is important that effective strategies be developed to eliminate this easily treated cause of visual impairment.

Adolescent↗

PubMed2002

Population-based study of spectacles use in southern India.

This study assessed the use of spectacles and its demographic associations in a sample representative of the population of the Indian state of Andhra Pradesh. A total of 11,786 subjects of all ages were sampled from 94 clusters in one urban and three rural study areas of Andhra Pradesh using stratified, random, cluster, systematic sampling. The eligible subjects underwent detailed interview and eye examination including dilated examination of the posterior segment. The data on the use of spectacles were analysed for subjects > 15 years of age. A total of 7,432 subjects > 15 years of age participated in the study of whom 1,030 (13.8%) had a refractive error of spherical equivalent +/- 3.00 Diopter or worse. The prevalence of current use of spectacles in those with spherical equivalent +/- 3.00 Diopter or worse, who were likely to be visually impaired without refractive correction, was 34.2% (95% confidence interval 30.3-38%) and of previous use of spectacles was 12.3% (95% confidence interval 10.3-14.3%). The odds of using spectacles currently were significantly higher for those with any level of education, those living in the urban area, and for those with aphakia or psuedophakia as compared with natural refractive error. Among those who had used spectacles previously, 43.8% had discontinued because they felt that either the prescription was incorrect or that the spectacles were uncomfortable, suggesting poor quality of refractive services, and another 19.6% had lost the pair and could not afford to buy another pair. These data suggest that the use of spectacles in this population by those with refractive error was not optimal. Two-thirds of those with spherical equivalent +/- 3.00 Diopter or worse were not using spectacles. Of those who had discontinued the use of spectacles, a significant proportion did so for reasons related to poor quality of refractive services. Strategies such as vision screening programmes and eye health promotion need to be implemented, the quality of refractive services monitored and the cost of spectacles regulated, if the substantial burden of visual impairment due to refractive error in this population is to be reduced.

Adolescent↗

PubMed2002

Fear of blindness and perceptions about blind people. The Andhra Pradesh Eye Disease Study.

This study assessed the fear of being affected by illness and disability including blindness, and perceptions of the population towards blind people in the Indian state of Andhra Pradesh. A total of 11,786 subjects of all ages were sampled from 94 clusters in one urban and three rural study areas of Andhra Pradesh using stratified, random, cluster, systematic sampling to represent the population of this state. A total of 10,293 subjects of all ages underwent a detailed interview and dilated ocular evaluation. Subjects > 15 years of age (7,432) were interviewed regarding fear of illness/disability and their perceptions of blind people. The fear of blindness was assessed in comparison to cancer, severe mental illness, heart attack, losing limbs, deafness, inability to speak, and paralysis. A majority of the study population feared all the illnesses and disabilities assessed. The prevalence of fear of blindness was 90.9% (95% confidence interval 89.1-92.8%) and 92.1% (95% confidence interval 90.6-93.6%) in urban and rural study areas respectively. With multiple logistic regression the fear of blindness was significantly higher for those with any level of education and for those living in the rural study areas. The proportion of those having positive feelings towards blind people was higher in the urban study area. A high prevalence of blindness, 1.84%, has been reported in this population previously. These data suggest that this population feared blindness, and yet there is a high rate of blindness. This reflects the need for increasing awareness about blindness in this population through eye health promotion strategies in order to reduce blindness, and awareness regarding the availability of rehabilitation services.

Adaptation, Psychological↗