Integrating Geospatial Data and Measures of Disability and Wealth to Assess Inequalities in an Eye Health Survey: An Example from the Indian Sunderbans.

Soumya Mohanty,Rn Mohanty,Elena Schmidt,Sandeep Buttan,Emma Jolley

doi:10.3390/ijerph16234869

Abstract

The Sunderbans are a group of delta islands that straddle the border between India and Bangladesh. For people living on the Indian side, health services are scarce and the terrain makes access to what is available difficult. In 2018, the international non-governmental organisation Sightsavers and their partners conducted a population-based survey of visual impairment and coverage of cataract and spectacle services, supplemented with tools to measure equity in eye health by wealth, disability, and geographical location. Two-stage cluster sampling was undertaken to randomly select 3868 individuals aged 40+ years, of whom 3410 were examined. Results were calculated using standard statistical processes and geospatial approaches were used to visualise the data. The age–sex adjusted prevalence of blindness was 0.8%, with higher prevalence among women (1.1%). Cataract Surgical Coverage for eyes at visual acuity (VA) 3/60 was 86.3%. The study did not find any association between visual impairment and wealth, however there were significant differences by additional (non-visual) disabilities at all levels of visual impairment. Geospatial mapping highlighted blocks where higher prevalence of visual impairment was identified. Integrating additional tools in population-based surveys is critical for measuring eye health inequalities and identifying population groups and locations that are at risk of being left behind.

Highlights

Visual impairment is a global public health problem
These geographical challenges, vary across the blocks, with people living in the “remote” Sundarbans—the blocks that are adjacent to the forest area or the Bay of Bengal—facing much greater problems compared to those who live in the “peripheries” and closer to Kolkata
Data from the survey of visual impairment in the Sunderbans shows that the region is on track for achieving the goals of VISION 2020 for India

Summary

Introduction

Visual impairment is a global public health problem. Estimates from the World Health Organisation (WHO) suggest that 253 million people suffer from visual impairment globally, of whom 36 million are blind [1]. More than 75% of visual impairment is avoidable, which means it can be prevented or treated with access to good quality services, this access is far from universal. Around 89% of visually impaired people live in low- and middle-income countries (LMICs) and 55%. Are women, indicating inequalities in the availability and access to eye care. Cataract remains the leading cause of blindness and the second leading cause of severe and moderate visual impairment in LMICs [2]. The WHO’s Universal Eye Health Coverage: Global Action Plan (GAP) 2014–2019 calls for a 25%

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