Causes of Blindness and Low Vision Among Rural Dwellers in Mbaitoli Local Government Area of Imo State

Blindness and impaired vision are big problems for public health, especially in developing nations where people can't get to eye care facilities very easily. These illnesses have significant medical, social, and economic ramifications for those affected, particularly within rural communities. This study sought to ascertain the prevalence and primary aetiologies of blindness and visual impairment among rural inhabitants in the Mbaitoli Local Government Area (LGA) of Imo State, Nigeria. A prospective community-based study was executed involving 120 participants (50 males and 70 females) aged 18 to 60 years. Standard clinical methods were used to check visual acuity. The World Health Organization (WHO) classified blindness as having a visual acuity of less than 3/60 in the better eye and low vision as having a visual acuity of less than 6/18 even with the best feasible correction. Of the 120 people who were screened, 65 (23 men and 42 women) were found to be blind or have impaired vision. The 46-60-year age group had the most cases. More women than men were affected, with 11.4% of them being blind and 19.2% of them having impaired vision. Refractive error was the most common cause (27.69%), followed by cataract (16.92%) and glaucoma (12.31%). Blindness and impaired vision continue to be major health issues for people living in rural areas of Mbaitoli LGA. Most of the time, these disorders may be avoided or treated. To lessen the burden of visual impairment, it is highly advised to provide community-based eye health education, early screening, and better access to inexpensive eye care services.

The human eye is an important sensory organ that lets people see light and understand their surroundings. This makes vision one of the most crucial senses for everyday life. Good vision is important for learning, working, moving around, and having a good quality of life in general. Consequently, vision impairment has extensive medical, psychological, social, and economic ramifications for individuals and society as a whole [1].

A major global public health issue is blindness and low eyesight. They are linked to less freedom, less productivity, a higher risk of injury, and a lower quality of life. These diseases are especially common in low- and middle-income countries, where limited access to eye care facilities, poor health-seeking behaviour, poverty, and lack of awareness make the problem much worse [2].

There are different ways to define blindness and low vision, based on the clinical, legal, and functional points of view. The World Health Organization (WHO) says that blindness is when the best eye has a visual acuity of less than 3/60, even with the best possible correction. Low vision is when the best eye has a visual acuity of less than 6/18 but equal to or better than 3/60, even after the best treatment and refractive correction. From a functional perspective, low vision constitutes a degree of visual impairment that disrupts an individual's capacity to execute daily activities necessitating sight [3].

It is thought that more than 285 million individuals around the world have vision problems. About 39 million of these are blind, and 246 million have low vision. Around 90% of these people live in underdeveloped nations, and sub-Saharan Africa has a lot of them. The frequency of visual impairment escalates with advancing age, especially in those over 60 years, attributable to age-associated ocular conditions such as cataract, glaucoma, and age-related macular degeneration.

Cataract, uncorrected refractive errors, glaucoma, diabetic retinopathy, age-related macular degeneration, trachoma, corneal opacities, onchocerciasis, and ocular trauma are the main reasons why people go blind or have reduced vision around the world. Cataracts are still the most common cause of blindness in the world, causing about half of all cases. Glaucoma and untreated refractive problems come next. More than 80% of these causes can be avoided or treated with current medical and surgical procedures [5].

National surveys in Nigeria show that more than one million adults are blind and more than four million have impaired vision. The most common causes are the same as those around the world: cataracts, glaucoma, and untreated refractive problems. Rural populations are especially at risk because they don't have easy access to eye care services, they don't read or write well, they don't have good transportation systems, and they don't have enough money [6].

The Mbaitoli Local Government Area of Imo State has more than 200,000 people living there. Most of them live in rural areas and rely on farming for their income. Good eyesight is important for the economy and society, but there isn't much local information about how many people in this area have vision problems or what causes them [7].

Consequently, this study aimed to ascertain the prevalence and primary aetiologies of blindness and visual impairment among rural inhabitants in Mbaitoli LGA. The findings are anticipated to yield evidence-based data that can support public health initiatives, community eye health programs, and policy development focused on mitigating preventable blindness and enhancing visual health in rural Nigeria.

Study Design

The design of this research is that of prospective vision screening-based type of research. The subjects were screened to find out those visual conditions qualified for this particular research.

Description of Study Area

Mbaitoli local government area of Imo State was the locale conducted in Achi, Mbieri, item, Mbaitoli and Ohuhia Mbieri all in Mbaitoli Local Government Area, it was a method used to ascertain the causes of blindness and low vision among the rural dwellers having sort and obtained permission from the various community leaders to secure full and adequate co-operation of the indigenes and provision of a venue for the exercise.

Study Population

The population of Mbaitoli was 201,648 according to the 2006 census.

Sample Size

120 subjects were used, ages from 18-60 and above, gender 70 female,50 male.

Instruments for Data Collection

• Snellen visual acuity charts (for both far and near)
• Ophthalmoscope
• Pentorch
• Tonometer
• Proparacaine eye drop

Sampling Technique

Case History

An exhaustive case history was undertaken for each patient in order to establish the background and incidence leading to the visual problem. This was aided by the self- administered question whereby such as personal profile, like name, age, gender occupation, address, phone number etc. other information includes family ocular history, general health condition and chief complaint.

Visual Acuity Test

British standard Snellen charts for distance and reduced near visual acuity charts were used for the visual acuity test for each eye.

In some cases, the weaker eye was tested first to avoid the possibility of blind individuals and low vision patient by memorization of the letter on chart, of cause with proper occlusion of the  second eye, finally acuity is obtained for both eyes.

Ophthalmoscope

This was done with direct ophthmoscope in order to have to a view of the fundus and retina to detect any pathology present, examination of the anterior segment of the eye. This was done in   a semi- dark room and subject was looking at a fixation target high on the opposite wall. Then subjects were seated comfortably on a chair while the examiner examined the eye monocular at a very close range by shining a bright light into the eye giving the fundal colour of orange. The blood vessels were checked for any abnormalities of artery to vein ratio of 2:1, axial streaking on arteries and any pulsation size and shape of the disc were checked and the normal cup disc ratio of 0.3 fundus was observed for exudates or deposits and sharp macular reflex.

Pentorch

Using a penlight, the external adnexa of each patient was carefully inspected for defects.  In addition to external and physical examination was also carried out on the patient to ascertain if the patients have any other problem, besides visual impairment.

Tonometer

This was carried out using the perkins tonometer to determine the intraocular pressure (IOP) of the subjects.

Intraocular pressure (IOP) of 18-21mmHg was considered as the normal IOP. The subject was made to sit on a chair and was instructed about the process of tonometry.

An anesthetic was instilled into the eyes for loss of sensation to the eyes and after 5 mins, subjects was told to look ahead to maintain a steady open eye, the tonometer which had been sterilized and cross checked was used to determine the IOP of the eye. Increased intraocular pressure (IOP) is one of the predisposing factors.

Method of Data Collection

The World Health Organization (WHO) for the prevention of blindness record format and its definition of low vision was used. World Health Organization defined blindness as visual acuity of less than 3/60 in the better with best possible correction while low vision was defined as visual acuity of less than 6/18 but equal to or better than 3/60 better eye with best possible correction.

The source of data collection was from the visual screening organized in one town out of nine towns that made up the Mbaitoli LGA. Through advocacy to the village heads vision screening was organized and widely publicized. The villagers that came out for the exercise were subjected to detailed case history, visual acuity, external examination, ophthmoscopy and tonometer.

Validity/Reliability of Instruments

Snellen: It was performed in an illuminated environment. The validity was checked before use.

Direct Opthalmoscope: The opthalmoscope battery was fully charged and checked to make sure it was in good condition before use.

Pentorch: The equipment was checked to make sure it was in good condition before use.

Perkins Tonometer: The battery of the Perkins was fully charged in other to give a constant procedure. It is portable, it is valid just like the Goldman applanation tonometer

Statistical Analysis

The data presentation was solely based on the objective findings and subjective responses of the subject with blindness and low vision. Using percentage table and for the distribution of age, sex, causes and nature of blindness and low vision was analyzed. Chi- square was used to test for significance.

Table 1: Age Distribution of Participants.

Table 2: Gender Distribution of Participants.

Table 3: General distribution of blindness and low vision.

The above table shows that 25 people were blind (20.83%) of which 10 were male (9.4%) and 15 were female (11.4%). The table also shows that 40 were low vision (33.3%) of which 15 were male (14.1%) and 25 were female (19.2%).

Table 4: Prevalence of causes of blindness and low vision.

Table 5: Comparison of causes by gender.

Table 6: Age Distribution of causes.

This research offers an extensive evaluation of the factors contributing to blindness and visual impairment among rural residents in the Mbaitoli Local Government Area (LGA) in Imo State. The study was prompted by the ongoing difficulties encountered by rural communities in obtaining excellent eye care services and the increasing prevalence of avoidable vision impairment in emerging nations. The results provide significant insights into the epidemiology of vision impairment in a rural Nigerian setting and underscore essential areas for public health intervention.

A review of current literature indicates that while the global prevalence of blindness and impaired vision is well recorded, there is a paucity of studies concentrating exclusively on rural people, especially at the community level [9]. Many national and international surveys frequently generalize findings across communities, sometimes neglecting the distinct socio-economic and environmental factors that define rural living. This study significantly enhances the literature by offering localized evidence that accurately represents the conditions of rural residents in Mbaitoli LGA, characterized by restricted healthcare access and typically low awareness of preventive eye care [10].

The methods utilized in this study facilitated a comprehensive assessment of visual impairment. Structured clinical evaluations enabled objective measurement of visual acuity, while participant interaction offered insights into the lived experiences of those affected by visual impairment. The sample size of 120 individuals was sufficient for community-based screening and facilitated significant analysis of prevalence trends across age and gender demographics. The integrated approach enhanced the validity of the results and provided a more thorough comprehension of both the clinical and social aspects of vision impairment [11].

The findings indicated that refractive errors, cataracts, and glaucoma were the predominant causes of blindness and visual impairment in Mbaitoli LGA. These results align with several national and international studies that indicate uncorrected refractive errors and cataracts as the predominant causes of visual impairment, especially in developing nations. The prevalence of refractive problems indicates insufficient access to fundamental optometric treatments, including vision screening and corrective eyewear, which are generally straightforward and economical remedies.

The high number of cataracts found in this study is due to the natural ageing process and the fact that people in rural areas have trouble getting surgery. Cataract is still one of the most common causes of blindness that may be avoided, but many people in rural areas still have vision problems because they don't know about them, can't afford them, or can't get to an eye surgery center [13]. Glaucoma also became a major cause of vision loss, which is worrying because it doesn't show any symptoms in the early stages and can't be reversed if not found early. The relatively large number of glaucoma patients shows how important it is to get regular eye exams and teach the public about the need of early diagnosis [14].

The age and gender differences seen in this study show even further how sociodemographic factors might affect eye health. The increased incidence of blindness and reduced vision in older adults aligns with global trends, as age-related visual disorders such cataract, glaucoma, and macular degeneration become more prevalent with advancing age. The greater burden on females may indicate extended life expectancy, diminished health-seeking behaviour, and socio-cultural obstacles that restrict women's access to healthcare facilities in rural areas [15].

The ramifications of these discoveries for public health are significant. Having trouble seeing makes people less productive, more dependent, and puts a lot of stress on families and communities in terms of money and social issues. In largely agrarian societies like Mbaitoli LGA, eyesight loss can significantly hinder an individual's capacity to participate in farming and other income-generating activities, hence increasing poverty and impeding overall community development.

This study has certain drawbacks, even though it has some strengths. The sample size, while sufficient for community screening, may restrict the applicability of the findings to other rural communities [19]. Moreover, the cross-sectional design precludes causal inference, and dependence on self-reported history may result in recall bias. Subsequent research utilizing larger samples and longitudinal methodologies would yield more substantial evidence regarding the course and drivers of vision impairment in rural contexts.

This study indeed contributes significant insights into the comprehension of blindness and impaired vision in rural Nigeria. By combining clinical data with real-life situations, it shows how important it is to provide focused, community-based eye care services [20,21]. The results support the global message that most causes of vision loss can be avoided or treated, and that putting money into primary eye care can greatly lower the number of blind people, improve their quality of life, and help socio-economic development in groups that don't have enough access to care [22].

This study found that refractive errors, cataracts, and glaucoma were the main reasons why people in the Mbaitoli Local Government Area of Imo State were blind or had limited vision. While differences were noted among age and gender cohorts, statistical analysis did not indicate a meaningful correlation between visual impairment and rural residency status alone. These results underscore the complex aspects of visual impairment and stress the necessity for thorough, context-specific healthcare approaches that prioritize early identification, treatment, and therapy of prevalent ocular disorders in rural areas.