i FACTORS CONTRIBUTING the BLINDNESS in MANHAL HOSPITAL HARGAISA, SOMALILAND ____________________ A proposal Presented to the School of health science New Generation University College Hargaisa, Somaliland __________________ By: Bashir Saleban Bashe IDNO: 4029/13 ________________ In Partial Fulfillment of the Requirements for the Bachelor Degree In public health office March 2016
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i
FACTORS CONTRIBUTING the BLINDNESS in MANHAL HOSPITAL
HARGAISA, SOMALILAND
____________________
A proposal
Presented to the School of health science
New Generation University College
Hargaisa, Somaliland
__________________
By:
Bashir Saleban Bashe
IDNO:
4029/13
________________
In Partial Fulfillment of the Requirements for the Bachelor Degree In
public health office
March 2016
ii
DECLARATION
"This dissertation is my original work and has not been presented for any
other academic award in any University or Institution of Learning".
Name and Signature of Candidate
Date
iii
APPROVAL SHEET
This dissertation entitled" factors contributes blindness at manhal hospital
prepared and submitted by new generation university college in partial
fulfillment of the requirements for the degree of public health department
of health officer
has been examined and approved by the panel on oral examination with a
grade of .
Name and Sig. of Chairman
Name and Sig of Supervisor Name and Sig. of Panelist
Name and Sig. of Panelist Name and Sig. of Panelist
Date of Comprehensive Examination: ____________________
Grade: ____________________
Name and Sign of Director of Department
Name and Sig of ASAO
iv
Dedication
This thesis is dedicated to my mother who taught me that the best kind of
knowledge to have it that which is learned for her own sake, I dedicated
to my advisor Dr abubakar Mohamed nuurfor his support, motivation and
untiring help during the course of my degree, I am also dedicated to my
sister who taught me that even the largest tats can be accomplished if she
is done one step at time, I dedicated my dissertation work to my family
and my friends.
v
Acknowledgement
First I am thanks to Allah most merciful gracious who allow me to write
my thesis secondly my sincere and deepest gratitude goes to my advisor
and instructor Dr. ABUBAKA MAOHAMED NUUR for his unreserved
assistance in giving me timely comments and relevant guidance
throughout the study. Moreover, I would also like to extend my thanks to
the New generation University college for giving me the chance and my
thesis work. I am grateful to my instructors, all other staffs of the NGUC,
supervisors, data collectors, study participants, my friends and my family
for their invaluable input to this thesis work. I would like to thank
MANHALHospital for their cooperation and assistance in the study.
Finally, I would like to forward my gratitude to teachers of Public Health
for their support
Contents
CHAPTER ONE ................................................................................ 1
vi
1.0 Background .............................................................................. 1
1.1 Problem Statement ............................................................... 3
1.2. Purpose of the study ............................................................ 5
1.3. Research objectives ............................................................. 5
1.3.1 Specific Objectives .......................................................... 5
1.3.2 Research Questions ...................................................... 5
1.4 Scope of study ....................................................................... 5
1.4.1 Geographical scope ......................................................... 5
1.4.2 Content scope ................................................................. 6
1.4.3 Time scope ...................................................................... 6
1.5 Significance of the study....................................................... 6
1.6 Operational Definitions of Key Terms ................................... 7
CHAPTER TWO................................................................................ 8
CHAPTER THEREE ......................................................................... 28
3.0 Introduction ........................................................................ 28
3.1. Research design ................................................................. 28
3.2. Target population............................................................... 29
3.3. Sample size ........................................................................ 29
3.4. Sampling technique ........................................................... 30
3.7. Data collection instrument ................................................ 30
3.8. Data analysis technique ..................................................... 30
3.10. Reliability ......................................................................... 31
3.11. Ethical considerations ...................................................... 31
3.12. Limitation of the study ..................................................... 31
CHAPTER FOUR ............................................................................ 32
CHAPTER FIVE .............................................................................. 55
vii
5.0 INTRODUCTION ......................................................................... 55
5.1 section (A) demographic characteristics of respondents ................ 55
5.2 SECTION B .............................................................................. 56
5.2.1 The role of factors contributing blindness .................................. 56
5.2.2 The magnitude of blindness ..................................................... 57
5.3 Conclusions................................................................................ 58
5.4 Recommendation ....................................................................... 58
List of figures.
Figure 4.1 ........................................................................................... 33
Figure 4. 2 .......................................................................................... 34
Figure 4. 3 .......................................................................................... 35
Figure 4. 4 .......................................................................................... 36
Figure 4. 5 .......................................................................................... 37
Figure 4. 6 .......................................................................................... 38
Figure 4. 7 .......................................................................................... 38
Figure 4. 8 .......................................................................................... 39
Figure 4. 9 .......................................................................................... 40
Figure 4. 10 ........................................................................................ 41
Figure 4. 11 ........................................................................................ 42
Figure 4. 12 ........................................................................................ 43
Figure 4. 13 ........................................................................................ 44
Figure 4. 14 ........................................................................................ 45
Figure 4. 15 ........................................................................................ 46
Figure 4. 16 ........................................................................................ 47
Figure 4. 17 ........................................................................................ 48
Figure 4. 18 ........................................................................................ 49
Figure 4. 19 ........................................................................................ 50
Figure 4. 20 ........................................................................................ 51
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Figure 4. 21 ........................................................................................ 52
Figure 4. 22 ........................................................................................ 53
Figure 4. 23 ........................................................................................ 54
1
CHAPTER ONE
1.0 Background History of blindness beginning in primitive times, the blindness was not
regarded as being of much value to the societies in which they lived. They
generally were not expected to be able to throw a spear accurately in
times of conflict, and it was also assumed that they could not hunt or fish
for food for basic sustenance. Add these assumptions to the natural "fear
of the dark," and it is easy to see how the destructive, negative social
attitudes about blindness developed and flourished. It is reported that in
many of the early great civilizations, blind babies were abandoned and left
to die, either from exposure to the elements or to be eaten by wild
animals. Later, some blind men were sold into galley slavery and some
blind women were sold into prostitution. Others were used for
amusement, but most lived their lives as beggars or were simply kept by
families.
The global level of blindness based on the population in each of the WHO
regions, we see the following: South East Asian 28%, Western Pacific
26%, African 16.6%, Eastern Mediterranean 10%, the American 9.6%,
and European 9.6%.The WHO estimates that in 2012 there were 285
million visually impaired people in the world, of which 246 million had low
vision and 39 million were blind. those who are blind 90% live in the
developing worldwide for each blind person, an average of 3.4 people
have low vision, with country and regional variation ranging from 2.4 to
2
5.5. In Africa, there are 5.88million blind individuals - shockingly, of
these, 80% of cases are preventable or are curable, if only effective and
accessible eye care services had been provided like so blindness is a major
health problem in Somalia the estimated blindness prevalence rate is
1.2% and more than 100 000 people suffer from visual impairment.
Cataract, trachoma and glaucoma are most factors contributing blindness
of for more than 70 % of the global blindness .Cataract history the earliest
documented case of cataract will reported to be in a museum in Cairo that
houses a small statue from the 5th dynasty. Globally cataracts are
responsible for 51% of world blindness, about 20 million people. Half the
blindness in Africa is due to cataract. The prevalence of blinding bilateral
cataract in Africa is estimated to be around 0.5% while in Somalia
cataract is one of the leading cause of blindness. Trachoma is the most
common infectious cause of blindness worldwide.
It afflicts some of the poorest regions of the globe, predominantly in
Africa and Asia. Trachoma is probably the third most common cause of
blindness worldwide, there are 8 million people who are blind or have
severe visual impairment from trachoma, 7.6 million not operated
trichiasis cases and 84 million with active trachoma. The highest
prevalence of trachoma is reported from Africa such as Ethiopia and
Sudan where the prevalence of active trachoma in children is often
greater than 50% in Somalia approximately 5.2 million people live in areas
known to be at risk for trachoma. About 10,000 have the advanced stage
of disease that can lead to permanent blindness.
3
Blindness: is strictly defined as the state of being totally sightless in both
eyes. A completely blind individual is unable to see at all.
Cataract: a scum or a film or a growth on the eye: right? Wrong! A
cataract is none of these. The word cataract simply means the
development of opacity in the crystalline lens inside the eye. We all have
such a lens sitting just behind the pupil.
1.1 Problem Statement
Blindness is one of the series diseases at Manhal hospital Hargeisa
Somaliland. It is one of the problems which cause disability in Somaliland.
Blindness is usually result multiple disease those effect many peoples of
our country. It is strictly defined as the state of being totally sightless in
both eyes. Cataract is one of the factors that influence the prevalence of
blindness. It is a dense, cloudy area that forms in the lens of the eye and
interferes with vision of the eyes.
There is an estimated 180 million people worldwide who are visually
disabled. Of these, between 40 and 45 million persons are blind and, by
definition, cannot walk about unaided. They are usually in need of
vocational and/or social support.
The loss of sight causes enormous human suffering for the affected
individuals and their families. It also represents a public health, social and
economic problem for countries, especially the developing ones, where 9
out of 10 of the world's blind live. In fact, around 60% of them reside in
sub-Saharan Africa, China and India.
4
Approximately 50% of the world's blind suffer from cataract. The majority
of the remaining persons are blind from conditions that include, among
others, glaucoma, trachoma, onchocerciasis (also known as river
blindness) and different conditions of childhood blindness. Despite a half
century of efforts, commencing with organized trachoma control activities,
the global burden of blindness is growing largely because of the
population growth and ageing.
Blindness have to deal with substantial debilitating consequences, Eye
Complications Diabetic retinopathy is indeed the most common eye
complication, causing nearly 24,000 cases of blindness in PWDs each year.
It's also in the same family of complications as kidney disease and
neuropathy, because it's a micro vascular complication, meaning that it's
caused by damage to your small blood vessels.
Most people are familiar with the "Big Bad" of diabetic eye disease:
diabetic retinopathy. It's the most well-known complication associated
with the eyes, but there are actually seven different conditions that can
affect a PWD's eyes: Cataracts; Glaucoma; Dry Eye Disease; Cranial Nerve
Palsy; Ischemic Optic Neuropathy; Retinal Vascular Occlusion and
Retinopathy
Cellulites of the Eyelid In some cases, the infection may spread to the eye
socket or the eye itself. This can lead to a serious condition called orbital
cellulites. You may have heard that diabetes causes eye problems and
may lead to blindness. People with diabetes do have a higher risk of
5
blindness than people without diabetes. But most people who have
diabetes have nothing more than minor eye disorders.
Blindness also impacts family and community members. Because
blindness imposes restrictions on the ability to move about and control
self and environment, a high proportion (75%) of visually impaired people
require assistance with everyday tasks. There are many causes of
blindness but the most common causes are Cataract, Glaucoma,
Trachoma and Diabetic retinopathy.
1.2. Purpose of the study
To asses factors contributing blindness in Manhal hospital Hargaisa,
Somaliland
1.3. Research objectives
1.3.1 Specific Objectives
I. To determine socio- economic factors contributing blindness
II. To assess the role of factors contributing blindness in Manhal
hospital
III. To examine the magnitude of blindness in Manhal hospital
1.3.2 Research Questions
I. What are the socio- economic factors contributing blindness
II. What is the role of factors contributing on blindness in Manhal hospital
III. What is the magnitude of blindness in Manhal hospital?
1.4 Scope of study
1.4.1 Geographical scope
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Manhal specialty and charity hospital locates in Mohamed Mooge district in
Hargeisa city Hargeisa, the hospital was opened in May 2006 to serve as
specialist hospital for the first time in Somaliland. Hospital harbors both
inpatient and outpatient treatment of eyes. Hargeisa is the largest city in
Somaliland located in the North West region. Hargeisa is the capital city of
Somaliland; it was the colonial capital of the Somaliland British
protectorate from 1941 to 1960, when it gained independence as the
state of Somaliland. The population of Hargeisa is estimated 1.5 million
people. This study will focus on Hargeisa city especially Man hospital.
1.4.2 Content scope
The content scope of this study factors contributing blindness.
1.4.3 Time scope
The study will carried out in manhal charity hospital for period starting
from Feb – May 2016.
1.5 Significance of the study
The study was help the researchers to gain knowledge on the topic under
study and at the same time contribute towards a degree of Public Health
at New Generation College University. This study will provided brief
information about factors contributing blindness at Manhal hospital to
know the level of Bindles rate caused by cataract of the hospital and also
government of Somaliland especially ministry of health (MOH, 2016) the
study also help millennium development goal number five which aims of
improving maternal health, of which factors contribtin is the first cause of.
The study also give enough information to the communities and Health
organizations who want to know the correlation between factors
7
conturbutin blindness and increase rate in Somaliland, and finally this
contributed educational bases for many upcoming researches.Correct
coping of provided recommendations reduce manhal hospital hargysa
1.6 Operational Definitions of Key Terms
For the purpose of this study, the following terms are defined as they are
used in the study:
Demographic characteristics of the respondents are attributes looked
for in this study in terms of gender, age, qualifications, number of years of
experience, job title.
Blindness is defined as a presenting VA of less than 3/60 in the better
eye. Low vision was defined as presenting VA of at least 3/60 but less
than 6/18 in the better eye. Monocular visual impairment, which is not a
WHO definition, was derived to represent participants who had normal or
near-normal vision in the better eye (VA of at least 6/18) and visual
impairment in the other eye (VA less than 6/18).
Trachoma is the commonest infectious cause of blindness. Recurrent
episodes of infection with servers A–C of Chlamydia trachomatis cause
conjunctiva inflammation in children who go on to develop scarring and
blindness as adults.
Cataract: a scum or a film or a growth on the eye: right? Wrong! A
cataract is none of these. The word cataract simply means the
development of opacity in the crystalline lens inside the eye. We all have
such a lens sitting just behind the pupil.
8
CHAPTER TWO
REVIEW OF RELATED LITERATURE
2.0 Introduction
This chapter presents the literature review about factors contributing
blindness. It also explores in highlights concepts, ideas and opinions from
the experts, theoretical perspective, and related studies.
Concepts, Ideas, Opinions from Authors/ Experts
Factors contributing blindness
2.1 Trachoma is the most common infectious cause of blindness
worldwide. It afflicts some of the poorest regions of the globe,
predominantly in Africa and Asia. The disease is initiated in early
childhood by repeated infection of the ocular surface by Chlamydia
trachomatis (WHO 2002) This triggers recurrent chronic inflammatory
episodes, leading to the development of conjunctival scarring. This scar
tissue contracts, distorting the eyelids (entropion) causing contact
between the eyelashes and the surface of the eye (trichiasis). This
compromises the cornea and blinding opacification often ensues.( Br. J.
Ophthalmol.,200).
9
The World Health Organization is leading a global effort to eliminate
Blinding Trachoma, through the implementation of the SAFE strategy. This
involves surgery for trichiasis, antibiotics for infection, facial cleanliness
(hygiene promotion) and environmental improvements to reduce
transmission of thenorganism. Where this programme has been fully
implemented, it has met with some success.(W.H.O). However, there are
significant gaps in the evidence base and optimal management remains
uncertain. Clinically, trachoma is sub-divided into active (early) and
cicatricial (late-stage) disease. (W.H.O., 2001).
Active disease is more commonly found in children and is characterized by
a chronic, recurrent follicular conjunctivitis, most prominently of the upper
tarsal conjunctiva. Follicles are collections of lymphoid tissue subjacent to
the tarsal conjunctival epithelium. Intense cases are characterized by the
presence of papillary hypertrophy—engorgement of small vessels with
surrounding oedema. In more severe cases, there is a pronounced
inflammatory thickening of the conjunctiva that obscures the normal deep
tarsal blood vessels.(NEGREL A.D.THYLEFORS)
During an episode of active disease, the cornea can be affected. There
may be minimal symptoms of ocular irritation and a slight watery
discharge. The scarring squeal of trachoma develops in later life, usually
from around the third decade, but can present earlier in regions with more
severe disease. Recurrent chronic conjunctival inflammation promotes
conjunctival scarring, which ranges from a few linear or stellate scars to
10
thick distorting bands of fibrosis with fornix shortening and symblepheron
(bands between eyelid and globe). (W.H.O., 2001)
The scar tissue contracts causing in-turning of the eyelids (entropion).
Contact between the eyelashes and the eye is called trichiasis. In
trachoma, trichiasis commonly results from entropion. However, trichiasis
may also arise from miss-direction of lashes in a normal position (aberrant
lashes) or lashes growing from abnormal positions (metaplastic lashes).
Ultimately, blinding corneal opacification can develop. Individuals with
entropion and trichiasis frequently experience pain as the lashes scratch
the cornea.(ROODHOOFT J.2000) The clinical features are usually
classified using the Simplified WHO Trachoma Grading System .This is
reliable and easy to use, yielding useful information on the prevalence of
active and cicatricial disease.(SAXENA S., JALALI S2000)
2.3. Cataract: a scum or a film or a growth on the eye: right? Wrong! A
cataract is none of these. The word cataract simply means the
development of opacity in the crystalline lens inside the eye. (STRATTON
I.M.2002) We all have such a lens sitting just behind the pupil. And this
lens does exactly the same job that the lens of a camera does: it focuses
light rays into a clear picture onto the "film" (retina) in the back of the
eye. If the crystalline lens becomes something other than perfectly clear
(cataract), a clear view of the world will no longer be possible. (TAYLOR
H.R. 2000)
11
And while there is no known effective medication to reverse cataract that
has already developed, there are things that may be effective at stopping
the development of cataract in the first place or at retarding the
progression of cataract once it has begun. For example, protection of the
eye from exposure to ultraviolet light may well provide some measure of
protection from developing cataract.(MEREDITH T.A. 2003)
The uses of antioxidants and of an aspirin once daily are other possible
factors that might provide some protection against cataract development.
Once cataract does develop, however, and is distracting or disabling to
the patient, the only effective known method of treatment is surgical
removal of the cataract. (HOLEKAMPN.M. .2000) of all the surgeries
known to man, this is without doubt the safest and the most effective
surgery. And while this is extremely gratifying, it should also be realized
that cataract surgery is not without potential risk of complication. The
likelihood of a complication, which results in loss of vision, is quite small.(
SCHEEN A.J.2001)
The risk of developing a complication, which makes the outcome of the
surgery less than perfect, is approximately 4%.(WHO 2003) This means
then, that approximately 96% of patients who undergo cataract surgery
are extremely pleased with the outcome, with improved vision and
comfort in doing and seeing the things that they need to do and see.
Having difficulty doing and seeing the things that one needs to do and
see, we believe is the primary indicator for proceeding to arrange for
cataract surgery. (WHO 2003)
12
The mere presence of a cataract is not in and of itself a sufficient reason
to arrange for surgery. Many patients are able to see and do virtually
everything that they need to see and do despite the presence of a small
cataract. But once the cataract becomes annoying, or even progresses to
the point of becoming disabling, it is appropriate for the patient to have a
discussion with his or her ophthalmologist about proceeding with surgical
removal of the cataract (STRATTON I.M 2002). Surgical removal of
cataract has undergone many developments over the past two decades (
KEEFFE J.E.2000).
A common misconception is that "laser" is generally used to "take off" the
cataract. This is virtually never the case, although we use lasers for many
different indications in ophthalmology, and we use very sophisticated
mechanical devices, which are sometimes confused with laser to perform
cataract surgery. The surgery itself is generally done on an outpatient
basis, and typically takes anywhere from 15 to 30 minutes to perform.(
THYLEFORS B.1998) A small incision is made for removal of the cataract
and, generally, an artificial lens (lens implant) is placed in the eye after
the cataract has been removed ( WITCHER J.P.2004).
The patient is typically asked to return for re-evaluation the following day
to make certain that everything is perfect, and to begin with the post-
operative medications (drops) that are typically prescribed following
cataract surgery (Freeman H.M.). The patient may see extremely well the
moment the patch is removed (the day after surgery); in some instances,
13
it may take several weeks for the patient to enjoy the full benefits of
improved vision following the surgery (WITCHER J.P.2004).
Restrictions in physical activity following surgery are generally minimal,
and are limited to restrictions on activities which could dramatically raise
the pressure in the eye (bending at the waist to lift something heavy),
activities that could result in exertion of pressure on the outside of the eye
(sleeping with the eye pressed against the hand or pillow), and extremely
vigorous jarring activity (for example jogging) (SRINIVASAN M 2000).
Medications are generally tapered and discontinued within a relatively
short period after surgery, and glasses for seeing the sharpest that the
eye can possibly see, both at distance and at near, are then prescribed,
unless the lens implant that has been chosen by the patient is one of the
so-called premium lenses developed by new technology and requiring out
of pocket premium payment by the patient, since insurers do not cover
the additional costs associated with the care of patients requesting these
special lenses, which are intended to enable patients to see well both at
distance and at near without glasses; approximately 85% of patients
choosing such lenses achieve this goal of good vision without glasses.
Only one eye is generally operated upon at a time, though, assuming that
things go extremely well with the surgery, the other eye may
appropriately have surgery relatively soon after the first eye has been
successfully rehabilitated.( W.H.0. 1997,)
14
2.4. Glaucoma is caused by a number of different eye diseases that in
most cases produce increased pressure within the eye. This elevated
pressure is caused by a backup of fluid in the eye. Over time, it causes
damage to the optic nerve. Through early detection, diagnosis and
treatment, you and your doctor can help to preserve your vision.(W.H.0
2000)
There are a variety of different types of glaucoma. The most common
forms are: Primary Open-Angle Glaucoma (POAG) Approximately one
percent of all Americans have this form of glaucoma, making it the most
common form of glaucoma in our country. It occurs mainly in the over-50
age group. (RESNIKOFF S., 2001) There are no symptoms associated with
POAG. The pressure in the eye slowly rises and the cornea adapts without
swelling. If the cornea were to swell, which is usually a signal that
something is wrong, symptoms would be present. (SRINIVASAN M 2000)
2.4.1. Normal-tension glaucoma, also known as low-tension
glaucoma, is characterized by progressive optic nerve damage and visual
field loss with a statistically normal intraocular pressure. This form of
glaucoma, which is being increasingly recognized, may account for as
many as one-third of the cases of open-angle glaucoma in the United
States. Normal-tension glaucoma is thought to be related, at least in part,
to poor blood flow to the optic nerve, which leads to death of the cells
that carry impulses from the retina to the brain. (SRINIVASAN M 2000)
2.4.2. Angle-closure glaucoma affects nearly half a million people in
the United States. There is a tendency for this disease to be inherited, and
15
often several members of a family will be afflicted. It is most common in
people of Asian descent and people who are far-sighted. (TAYLOR H.R.
2000)
2.4.3. Acute Glaucoma unlike POAG, where the IOP increases slowly, in
acute angle-closure, it increases suddenly. This sudden rise in pressure
can occur within a matter of hours and become very painful. If the
pressure rises high enough, the pain may become so intense that it can
cause nausea and vomiting. The eye becomes red, the cornea swells and
clouds, and the patient may see haloes around lights and may experience
blurred vision. . (SAXENA S., JALALI S2000)
Pigmentation glaucoma is a type of inherited open-angle glaucoma that
develops more frequently in men than in women. It most often begins in
the twenties and thirties, which makes it particularly dangerous to a
lifetime of normal vision. (TAYLOR H.R. 2000)
Everyone should be concerned about glaucoma and its effects. It is
important for each of us, from infants to senior citizens, to have our eyes
checked regularly, because early detection and treatment of glaucoma are
the only way to prevent vision impairment and blindness. Your eye doctor
has a variety of diagnostic tools that aid in determining whether or not
you have glaucoma -- even before you have any symptoms. Let us
explore these tools and what they do. (KEENEY A.H.).
16
The Tonometer measures the pressure in the eye. If your doctor were to
use applanation tonometry, your eye would be anesthetized with drops.
Testing your visual field lets your doctor know if and how your field of
vision has been affected by glaucoma. Glaucoma can be treated with eye
drops, pills, laser surgery, eye operations, or a combination of
methods(W.H.0 2003). The whole purpose of treatment is to prevent
further loss of vision. This is imperative as loss of vision due to glaucoma
is irreversible (Freeman H.M.).
2.5. Childhood blindness
Childhood blindness is a priority area, considering the number of years the
visual handicap plays a role, the high frequency of developmental
anomalies and the fact that many of the conditions associated with
blindness in children are also causes of child mortality (Freeman
H.M.2002). Each year, an estimated half a million children go blind, mostly
in the poorest countries of Asia and Africa, of whom up to 60% die in
childhood. Seventy-five per cent of these children suffer from Vitamin A
deficiency, which causes night blindness, dry eye syndrome, an increased
susceptibility to ocular infections and a higher risk of dying from infections
due to an impaired immune system. Vitamin A deficiency is considered to
be the main cause of childhood blindness.( Freeman H.M.2000)
There are still 78 countries that have children with vitamin A deficiency.
(Freeman H.M.) Malnutrition is a contributing factor in half of all childhood
deaths (Br. J 2001). Vitamin A deficiency can be corrected by
supplementation of vitamins or by teaching the people to change their
17
diet. Another way of dealing with childhood blindness is to take care that
all children get the necessary vaccinations at the right time. The
combination of measles vaccination and vitamin A supplementation has
been one of the major success stories in reducing death from infectious
diseases. Worldwide, corneal scarring is the single most important cause
of avoidable paediatric blindness, followed by cataract and retinopathy of
prematurity (ROP). (WITCHER J.P.2004).
ROP occurs in babies who survive very low birth weight and is related to
the response of immature retinal vasculature to high oxygen exposure.
The creation of neonatology units in the western world but also in larger
cities of developing countries has increased dramatically the survival of
premature babies. However these children need careful ophthalmologic
monitoring in order to allow the early detection and treatment of ROP and
thus avoid its dramatic complications ( WITCHER J.P.2004).
2.6. Onchocerciasis (river blindness)
Onchocerciasis is caused by Onchocerca volvulus, a parasitic worm that
lives for up to years in the human body. Each adult female worm
produces millions of microfilaria that mi-21 grate throughout the body and
give rise to a variety of symptoms: serious visual impairment due to an
intense inflammatory reaction caused by the dead of the microfilaria in the
eye; lesions of the skin; lymphadenitis and general debilitation. There are
120 million people worldwide who are at risk of onchocerciasis. A total of
18 million people are infected of whom 99% are in Africa. Of those
infected, over 6.5 million suffer from dermatitis and 270 000 are blind.
18
Onchocerciasis is often called ’’river blindness’’ because this filarial disease
may cause blindness and because the black flies that transmit the disease
breed on rapid flowing streams (W.H.O 2005).
Onchocerciasis may start one year after a bite of the black fly.
Onchocerciasis constitutes a serious obstacle to the socio-economic
development, as many people do not want to live next to these rapid
flowing streams for fear of becoming blind because of infection. And these
rapid flowing streams turn the grounds in the vicinity into fertile areas. If
these fertile grounds are not used for agriculture that means that large
parts of these countries are not contributing to the economy and welfare
(W.H.O 2oo1).
The treatment of this disease is: by eliminating the black flies through
application of selected insecticides through aerial spraying of breeding
sites in fast-flowing rivers. by killing the larval worms with Ivermectin, a
safe and effective medication (one dose a year is distributed free of
charge to all those who need it) .The WHO hopes that this disease will
disappear before the year 2010 and that will happen at a cost of less than
US$ 1 per year for each protected person. The success of the control of
onchocerciasis in eleven West African countries proves that disease
control can be an economic investment with exceptionally high returns
(LIETMAN T., FRY A 1991).
2.7. Diabetes mellitus
19
Diabetes is a disease that in the long-term may lead to complications such
as blindness, kidney failure and limb amputation, as well as to heart
disease and stroke. After 15 years of diabetes, approximately 2% of
people become blind while about 10% develop severe visual handicap.
Loss of vision and blindness in persons with diabetes is the leading cause
of blindness and visual disability in adults in economically developed
societies, such as Belgium. India has the highest number of diabetics in
the world (MEREDITH T.A. 2002).
In Europe about 22.5 million adult people, 5% of the population, are
diabetic and worldwide an estimated 150 million people. The WHO
predicts a rise to 300 million by 2025 due to ageing, unhealthy diets, the
fact that unhealthy food is frequently cheaper, obesity and a sedentary
lifestyle. Most of the direct costs of diabetes result from its complications.
And, if the increase of diabetes and its complications occurs as predicted
by the WHO, the financial implications for the health services will be
disastrous. (W.H.O 2003).
Loss of vision due to diabetic retinopathy can often be prevented by
;[regular eye examinations and timely intervention with laser treatment or
surgery. Screening of people with diabetes is cost effective. A recent study
has demonstrated that diet, good metabolic control, assiduous treatment
of arterial hypertension, correction of hyperlipidemia and a less sedentary
life style can also delay the onset and progression of diabetic retinopathy
(W.H.0 2001).
20
In Belgium diabetic patients have access to all the necessary care to
prevent the complications of diabetic retinopathy. In developing countries
such care is inaccessible to the majority of the population.(W.H.O 2003)
2.8. Ocular injuries
Ocular trauma is a common cause of visual loss and is known to be the
most common cause of unilateral loss of vision. Each day eye injuries
occur that cause suffering, medical costs and one or more days of
restricted activity. In developing countries, the problem of injuries is more
severe as there is often a delay before these eye injuries are handled in
the proper way. Ocular trauma is the cause of bilateral blindness in more
than one million people. (LIETMAN T., FRY A 1991).
Ocular trauma can be prevented by risk appreciation and avoidance,
widespread wearing of high-performance spectacles or protective goggles,
appropriate occupational processing and shielding, extension of on-the-job
safety to the home environment and the application of modern principles
of surgical salvage( ROODHOOFT J.2000).
2.9. Blindness
The concept of blindness has been changing rapidly in the last decade of
the 20th Century (HOLEKAMP 1990).
Prior to that time, blindness was usually thought of as an absolute
condition. Lesser conditions were usually thought of in terms of poor
eyesight (with respect to resolution) or color blindness. (HOLEKAMP
1990).
21
The current understanding of blindness can be placed in a broader
framework with a stronger conceptual and theoretical foundation. Within
the framework of this overall work, blindness can be categorized into one
of three major types of visual inadequacy. The broadest historical type is
that of blindness due to non-neurological causes related to the
physiological optical system. Physiological blindness includes the effects of
cataract, glaucoma, retinal separations from its substrate and similar
physical problems of the ocular globe (LIETMAN T., FRY A 1991).
2.10. Losses to Psychological Security
Loss of physical integrity: Self-esteem is closely related to physical
competence and appearance. When individuals experience blindness, they
may feel ‘broken’ or no longer whole. When they were sighted, they may
have had negative stereotypes of blind people. They may now see
themselves as outsiders and different from those in the broader
community (W.H.O 2004)
Loss of confidence in the remaining senses: Vision is the dominant,
integrating sense. Without it, one must learn to trust the other senses.
However, this does not occur automatically. People often have the
mistaken belief that blind people have extraordinary senses of hearing and
touch. This has been shown not to be true. It is actually the result of
increased concentration and training. There is no magic compensation in
the remaining senses. Vision is such a dominant sense that the newly
blinded do not find it at all easy to gather environmental information from
the remaining senses (W.H.0 2004)
22
Loss of visual background: Sighted individuals have a far-reaching
experience with the environment. Sight gives them an instantaneous
sense of what is in the environment beyond their immediate task (W.H.O
20004) In the absence of vision, hearing can provide some information,
but only about people or objects emitting sound. Touch reaches only as
far as arm’s length. Also, peripheral vision can no longer be relied on as a
warning system. People and objects just suddenly appear and it’s
frightening. Newly blinded persons are in a visual vacuum, without a
palette of color and movement around them (W.H.O 2004)
Loss of light security It is a mistake to equate blindness with darkness.
The vast majority of people who are legally blind have functional vision,
and many others can perceive light. Equating blindness with darkness also
has broader psychological implications. Light is associated with goodness,
truth and, in general, positive characteristics. Darkness, on the other
hand, is associated with evil, despair, and ignorance. Light and darkness,
therefore, have emotional connotations for both sighted and blind people.
According to Carroll, this can result in barriers to full acceptance in the
broader society (W.H.O 2004)
Those who have been totally blind since birth—those relative few who
have never had light perception—must rely on the word of others who say
they live in darkness. Also, those who are experiencing a progressive loss
of vision often fear the final loss of sight as complete darkness (MATHEWS
D.R. 2001)
2.11. Loss in Basic Skills
23
Loss of mobility: Significant loss of vision results in a loss of independence
and in the ability to negotiate the environment. Newly blinded persons
may be afraid to move around their homes on their own. They are without
a sense of freedom, security, and control in their environment and feel
very dependent on others (SCHEEN A.J. 2000)
Loss of techniques of daily living: The performance of daily tasks leads to
repeated frustration. The result is that the individual is constantly
reminded that he or she is blind ((MATHEWS D.R. 2001)
2.12. Loss in Communication
Loss of ease of written communication: With the onset of blindness,
individuals lose their ease of access to reading and writing. They are no
longer able to deal with making lists, keeping track of appointments,
taking notes, or maintaining confidentiality in correspondence. They can
no longer see photographs and other graphic illustrations. Newspapers
and magazines become inaccessible; as do the books they may have
enjoyed reading to their children. The loss of written communication also
has detrimental effects on one’s profession ( WITCHER J.P.2004).
Loss of ease of spoken communication: Gestures and facial expressions
are important aspects of spoken communication and are lost with the
onset of blindness. It becomes harder to interrupt in a conversation, to
know who’s there, or to know when someone may have walked away.
Without visual cues, silences can be difficult. An individual may feel he or
24
she is expected to say something to fill the silence. Public speakers also
lose the ability to refer to their notes ( WITCHER J.P.2004).
Loss of informational progress: Fewer forms of information are readily and
naturally available. This makes it difficult to keep up with what’s going on
in the world at large, in the community, or among friends. It’s also more
difficult to keep up with current hair styles and fashion. Individuals may
find their world becoming smaller (LIETMAN T., FRY A 1991).
2.13. Losses in Appreciation
Loss of the visual perception of the pleasurable: Loss of vision means
losing the ability to access objects you found visually pleasing. This also
includes looking in the mirror or seeing how a new outfit looks. Does the
food “look good” to eat? Singles bars just aren’t the same! You can no
longer see the faces of your family ( N.M., KUMAR D.).
Loss of visual perception of the beautiful: This is a significant loss for
those who once enjoyed the visual arts—museums, art galleries or a
scenic walk in nature. It can be frustrating to try to imagine while
someone else tries to describe something beautiful.
2.14. Losses Concerning Occupation and Financial Status
Loss of recreation: whether physical or intellectual, is vital to stress
management. Perhaps the individual used to play basketball with friends
or took art classes. Even informal recreation activities like sitting down
25
with a good book or playing the piano using sheet music are gone.
(KEENEY A.H.)
Loss of career, vocational goal, job opportunity: Many who experience
blindness are seniors who have already retired. Others may have careers
they can return to with minor adjustments. For many working age adults,
however, this is an important loss. The reality is that personal identity is
very much tied to work. A favourite question at parties is “What kind of
work do you do?” This is an uncomfortable question for someone who has
recently experienced a loss of vision. At the same time, it is telling when
the question isn’t asked at all because of the lack of expectation often
associated with blindness (N.M., KUMAR D 1999)
Work also fills a lot of time in people’s lives. There is a large void of time,
intellectual stimulation, social contact and sense of accomplishment when
work is taken away (N.M., KUMAR D. 1999).
Loss of financial security: Having to quit work or leave for retraining
results in a loss of financial security. A major role in the family changes if
the person with vision loss is a caregiver or breadwinner.
Expenses may also increase as a result of medical issues and those
associated with living with a disability. Taxi costs may increase, bargain-
hunting is much more difficult, and dry-cleaning bills may increase.
2.15. Resulting Losses to the Whole Personality
26
Loss of personal independence People in the general public may believe
the stereotype of the “helpless blind man” and reduce their expectations
of the person’s independence (KEEFFE J.E.. 2001).
The person with vision loss may struggle between the desire to remain
independent and hold onto the freedom it allows and the desire to remain
dependent in order to take advantage of the protection it provides
(KEEFFE J.E. 2001). A major part of independence is knowing when to ask
for help. People with “giving personalities” have a more difficult time
accepting help (KEEFFE J.E. 2001).
Loss of social adequacy: This loss tends to come from the lack of
expectation of others who are trying to be kind and sympathetic. In their
former sighted lives, people experiencing a loss of vision may have felt
pity for those who were blind. This perception can carry over into their
newly blind identity. Blindness may also result in a separation from society
at large. Either the individual is seen as helpless or as possessing
superpowers of hearing or memory. In either case, a feeling of social
inadequacy may result (KEEFFE J.E. 2001)
Loss of obscurity: This involves the feeling that you’re always “noticed” by
others. People who experience blindness lose their privacy. They are
noticed and may become public figures merely because of their blindness.
They may not want this attention but don’t always have a choice. They
become “the blind graduate”, “the blind lawyer” or “the blind dad of the
first grader” (KEEFFE J.E. 2001)
Loss of self-esteem: There are two aspects to self-esteem—the objective,
based upon a realistic sense of our accomplishments, talents and
27
contributions, and the subjective sense based on our feelings about
ourselves. When blindness occurs, it is no longer possible for one’s
“former self” to exist due to some or all of the losses above. People
experiencing vision loss may alter their expectations of making
contributions in the future and be affected by how they are perceived by
others (KEEFFE J.E. 2001).
Loss of total personality organization: A wide range of psychosocial
problems can manifest themselves as a result of vision loss (KEEFFE J.E.
2001)The individual’s total personality experiences an onslaught of blows.
How she or he reacts depends in part on personality and on individual
strengths and weaknesses. Inevitably there is a significant shock to the
system (KEEFFE J.E. 2001).
2.16. Research gap
2.17. CONCEPTUAL FRAMEWORK
Trachoma
Cataract
D.mellites
Glaucoma
Childhood blindness
F. contributing Blindness
Losses to
Psychological
Security
Losses to the Whole
Personality
Losses Concerning
Occupation and
Financial Status
Losses in Appreciation
Loss in
Communication
Losses to
Psychological
Blindness
28
FIGURE A
CHAPTER THEREE
Research methodology
3.0 Introduction
This chapter is about the methods that were used for collecting
information in the field. This chapter is mainly explaining how this study
will conducted. The applied method and technique in data collection and
the reason as to why they were used according to the research aims and
objectives of the study, this chapter presents a description of
methodology the researcher employed in collecting and processing about
the topic of study, including the research design, target population,
sample size, sampling strategies, research instrument , validity and
reliability of the instrument, data collection procedure, data analysis,
ethical consideration and limitation of the study.
3.1. Research design
The study adopted cross sectional research design with and quantitative
data collection approaches were employed. Quantitative approach are
used to generate ideas about factors contributing blindness, The design
Healthy aducation
Regular eyes diagnose
Self hygiene
Early treatment
29
will proposed because the study were carry out in a relatively short time,
the researcher prefers to conduct qualitative approach to understand,
practices and attitude to derive careful information of the this study.
3.2. Target population
This target population of this study will be (6o blind patients in Manhal
charity hospital. Ahmed Gabiley Feb 2016). The researcher selected this
target population because they are ones concerned and they had
convenient information.
3.3. Sample size
The sample size for the study will 53 respondents as per the calculation
below. This will be determined by the sample size calculating sloven’s
formula as below.
N = N
1+n (e2)
Where n = number of sample
N = the population size
E = the level of significance which is gives as (0.05) in social science
N = 53
30
1+60(0.05*2)
60
1+60(0.0025)
60
1+0.5
= 60
1.5
N = 53
3.4. Sampling technique
The study employed probability particularly simple random sampling under
this technique every individual, item or object or even of the population
unit is given has an equal chance of inclusion in the sample without bias
from the target.
3.7. Data collection instrument
The study was used a combination of data collection instruments which
include questionnaires schedule were developed in English following the
titling in the operational frame work and verbally translated in Somali for
more understanding. For obtaining primary data which will be the baseline
of our information, check list for observing, and interview guide for getting
secondary data.
3.8. Data analysis technique
31
All the interviewing schedules were checked on competences and
correctness, analyze data using software package for social sciences
(SPSS) the analyzed data was presented in tables in order to facilitate
easy interpretation, comparison and drawing of strong conclusion. Data
analysis determined the graphs and statistical tables were generated to
examine the relationship between outcome variable of death, injuries,
disabilities and mortality with exposure of multi factors in causation
3.10. Reliability
The research instrument yields consistent results after repeated trials. In
order to establish the reliability of the instrument that was used for this
study, the researcher used the pretest/ re test reliability. A pilot study was
conducted to improve the validity and reliability of the instrument; the
numbers of questions declared valid are 18 out of 23 indicating result of
0.78.
3.11. Ethical considerations
While conducting the research, the researcher was mindful of ethical and
data protection issues. All the individuals who were involved in the
research were remaining anonymous and information collected was used
purposely for the research. The researcher avoided using language or
mannerisms that can be harmful or offensive to the respondents or any
other person who involved in the research. In this study, the entire
respondent’s participation was voluntary, and the researcher takes and
complies with research consent form provided by the university.
3.12. Limitation of the study
32
During the research, the researcher encounter some constrains one such
problems the fact that the time for the data collection process was limited;
a longer duration of time was needed in order to have a deeper insight in
to theme under study. Another problem that there is no previous research
done this area, some respondent tried to hesitate to answer some
question asked them to them saying that they are fed up with question by
different people every time with no return, the researcher overcome this
by explaining the objectives of the study and assurance of confidentiality
of information given.
CHAPTER FOUR
PRSENTATION, ANALYSIS AND INTERPETATION OF DATA
This chapter presents the analysis of data gathered and
interpretation. It gives the demographic characteristics of the
respondent and variable used.
33
Figure 4.1
As figure 4.1 indicated the results showed that (34.6%) of the study
population were male and the rest (65.4%) were females and this
indicates most of the respondent were female.
Source: primary data
35%
65%
Gender
Male Female
34
Figure 4. 2
In the case of marital status figure 4.2 mentioned 40.4% were single
while 59.6% were married and this implies most respondents in this study
were married.
Source: primary data
41%
59%
Marital status
Single Marreid
35
Figure 4. 3
As figure 4.3 indicated age of the respondent in this study 35.5% were age 18-25 and 21.2% were age 26-40% while 40.4% were age 41-50 and this study showed that majority of the respondents were age the age between forty and fifty.
Source: primary data
39%
21%
40%
Age of the respondents
18-25 26-40 41-50
36
Figure 4. 4
In the case of Educational level attained figure 4.4 implies 26.9% were
university level and 25% were secondary school level while 3.8% were
primary school level and lastly 44.2% of the respondents never
attained school and this implies the most respondents of this study were
not attained school and they need to get basic educational level.
Source: primary date
27%
25%
4%
44%
Educational level attained
University Secondary Primery Never attend school
37
Figure 4. 5
As the table 4.5 indicated in a side of occupation of the respondents 15.4
were private servant and 21.2% were house wife, while 21.2% were civil
servant and lastly 41.3% were un employed and this study showed that
majority of the respondent were jobless.
Source : primary data
16%
41% 21%
22%
Occupation
private servant House wife Civil servant Unemployed
38
Figure 4. 6
As table 4.6 shows the resident of respondent 19.2 % from Kood
buur and 11.5% From Ahmed dhagah while 17.3% from 26 June
and 44.2 from Gacan libax and lastly 7.7% from and this
implies that most of the respondent from Gacan libax district .
Source : primary data
Figure 4. 7
19%
12%
17%
44%
8%
Resident of respondent
Kood buur Ahmed dhagah 26 june Gacan libax Mohamoud Haibeh
58%
42%
0
5
10
15
20
25
30
35
Yes No
Do you have information about blindness?
Series1
39
As Fiigure 4.7 shows information about blindness 57.7% of respondent
were answered yes while 41.3% were answered No and this indicated
that majority of the respond known and the have information about
blindness
According the literature review which stated most blindness effected
they not information about what cause of blindness and the result of this
question its quietly different
Source : primary data
Figure 4. 8
Figure 4.8 indicated the respondent of this study get information 32.7%
from TV, and 42.3 from Radio while 7.7% from journal, and lastly 17.3%
of the respondents from community campaign and this study
showed that majority of the people got information of blindness
radio and TV.
33%
42%
8%
17%
0
5
10
15
20
25
TV Radio Journal Communitycampaign
If yes where you get this information?
Series1
40
Source : primary data
Figure 4. 9
As the Figure 4.9 mentioned information about trachoma 88.5% answered
Yes while 10.5 answered No and this showed that most of the
respondent have known trachoma and they have enough information
about trachoma.
According the literature review which stated most trachoma effected
patient they have not enough information about what cause of trachoma
and the result of this question its quietly different
Source : primary data
88%
12%
0
10
20
30
40
50
Yes No
Do you have any information about trachoma
Series1
41
Figure 4. 10
Table 4.10 indicated that trachoma is the most common infectious cause
of blindness and 36.5% of the respondent interviewed agree while
21.2 strongly agree and lastly 42.3 disagree and this implies that majority
of the respondent interviewed agree that trachoma is one of the most
causes of blindness in our country and even in globally as Richard’s
research (2006).
According the literature review which stated most many previous study
are showed that the trachoma is most common causetic agent blindness
and the most study respondent are agree previous.
Source : primary data
52%
19%
29%
0
5
10
15
20
25
30
Agree strongly agree Disagree
Trachoma is the most common infectious cause of blindness
Series1
42
Figure 4. 11
Figure 4.11 mentioned facial cleanness hygiene promotion and
environmental improvement can reduce transmission of trachoma and
67.3 of the respondent agree while 9.6 strongly agree and 21.2 disagree
and lastly 1.9 strongly disagrees. This study indicated that facial
cleanness and environmental improvement reduce or protect transmission
of trachoma.
According the literature review which stated most many previous study
are showed that the trachoma is most common promotion can reduce the
trasmtiomtion of trachoma and the most study respondent are agree
previous
Source : primary data
67%
10% 21%
2% 0
10
20
30
40
Agree Strongly Agree Disagree Strongly disagree
Facial cleanliness (hygiene promotion) and environmental improvements can
reduce transmission of trachoma
Series1
43
Figure 4. 12
Figure 4.12 showed cataract is common in children and 30.8% of the
respondent agrees while 28.8% strongly agree and 1.9% disagrees while
38.5 strongly disagree and this implies cataract is common in children as
this study showed.
According the literature review which stated most cataract effected
clients are old age patient and the result of this question its quietly
different
Source : primary data
31% 29%
2%
38%
0
5
10
15
20
25
Agree Strongly agree disagree strongly disagree
Cataract is common in children
Series1
44
Figure 4. 13
Figure 4.13 shows that symptoms of cataract 86.5 of the respondent
answered yes while 13.5 answered no and this indicated most of the
respondent in this study have known the symptoms of cataract.
According the literature review which stated most cataract effected
clients are showed that they have no idea about the symptoms of
cataract and the result of this question its quietly different and are
answered agree and know symtoms of cataract
Source: primary data
86%
14%
0
10
20
30
40
50
Yes No
Do you know symptoms of cataract
Series1
45
Figure 4. 14
Figure 4.14mentioned information about glaucoma and 75% of the
respondents answered yes while 25% answered no and this implies that
majority of the respondent have known glaucoma.
According the literature review which stated most glaucoma effected
client no information about glaucoma and the result of this question is
not matched previous.
Source: primary data
75%
25%
0
5
10
15
20
25
30
35
40
45
Yes No
Do you know information about glaucoma
Series1
46
Figure 4. 15
Table 4.15 mentioned Glaucoma can be treated with eye drops, pills,
laser, surgery and eye drops and 71.2% agree while 5.8% strongly agree
and 21.2% disagree while 1.9 % strongly disagree . This study implies
most of the respondent agrees that glaucoma can be treated.
Source : primary data
71%
3 11
1 0
5
10
15
20
25
30
35
40
Agree Srongly agree disagree strongly disagree
Glaucoma can be treated with eye drops, pills, laser surgery, and eye operations.
Series1
47
Figure 4. 16
Figure 4.16 indicated Vitamin A deficiency is considered to be the main
cause of childhood blindness and 42.3 % of the respondent agrees while
55.8% strongly agree and 1.9% disagrees and this study showed that
most of the respondent agrees vitamin a deficiency caused childhood
blindness.
Source : primary data
42%
56%
2% 0
5
10
15
20
25
30
35
Agree Srongly agree disagree
Vitamin A deficiency is considered to be the main cause of childhood blindness.
Series1
48
Figure 4. 17
Figure 4.17 mentioned diabetic can contribute blindness and 25% of the
respondents agree that diabetic can effective influence blindness while
(59.6%) strongly agree and lastly 15.4% disagree. This implies that
majority of the respondent agree diabetic can contribute blindness and
this study showed that diabetic mellitus is one of the main cause of
blindness. Other similar studies suggested that diabetes is the biggest
contributor of blindness.
25%
60%
15%
0
5
10
15
20
25
30
35
agree srongly agree disagree
diabetic can contribute blindness
Series1
49
Figure 4. 18
figure 4.18 mentioned number of people suffering blindness is increasing
and 96.2 of the respondent answered yes while 3.8 of the respondent
answered no and this study implies that number of blindness in the
country is increasing and this needs to make prevention.
Source: primary data
96%
4%
0
10
20
30
40
50
60
yes no
Number of people suffering blindness is increasing
Series1
50
Figure 4. 19
Table 4.19 mentioned possible reason of increasing blindness and 34.6%
of the respondent answered poor hygiene while 42.2% low socio
economic and lastly 23.1 of the respondent answered lack of knowledge
and this implies that poor hygiene and low socio economic most reasons
of increasing blindness .
Source: primary data
35%
42%
23%
0
5
10
15
20
25
Poor hygiene Low socio economic lack of knowledge
If eyes what is the possible reason
Series1
51
Figure 4. 20
4.20 mentioned blindness can cause physical and physiolo impairment and
73.1 of the respondent agree while 25.% strongly agree and lastly 1.9%of
the respondent disagree and this implies that blindness can cause
negative consequence include physical and psychological impairment .
According the literate review the blindness can cause physical and
physiocoligla problem and result of of respondent are same
Source : primary data
73%
25%
2%
0
10
20
30
40
agree srongly agree disagree
Blindness can cause physical and physiological impairment
Series1
52
Figure 4. 21
Figure 4.21 mentioned prevention is the best way we can reduce the
problem of blindness and 34.6% of the respondent agree while 63.5%
strongly agree and lastly 1.9 of the respondent disagree and this study
showed prevention is the best we can reduce the problem of blindness as
majority of the respondent mentioned.
The result of this question similar to my literature and majority
respondent agree the previous research result
Source : primary data
35%
63%
2%
0
5
10
15
20
25
30
35
agree strongly agree disagree
Prevention is the best way we can reduce the problem of blindness
Series1
53
Figure 4. 22
Figure 4.22 revealed blindness can be treated 42.3 % of the respondent
answered by surgery while 42.3% answered medical and 1.9% answered
tradition and lastly 13.5% do not know treatment of blindness so this
study implies surgery and medical were best treatment of blindness .
The result of my liturture and the answer of respondent are aqual
the best way can treatment of blindness are surgery
Source: primary data
42% 42%
2%
14%
0
5
10
15
20
25
Surgery medical traditional do not know
Blindness can be treated by
Series1
54
Figure 4. 23
Figure 4.23 revealed the possible solution of blindness and 11.5% of the
respondent and answered health education while 21.1% answered prober
hygiene followed by 30.8% answered treat under line cause and lastly
36.5% answered medical intervention . This study implies that medical
intervention and treatment of under lining cause were possible solution of
blindness as this study showed.
According my litterer review the possible solution is medical intervtion
And the respondent people we are answered same result
Source: primary
13%
21%
31%
35%
0
2
4
6
8
10
12
14
16
18
20
Healtheducation
Proper hygiene Treat underlining cause
medicalintervention
The possible solution of blindness
Series1
55
CHAPTER FIVE DISSCUSSION OF FINDINGS CONCLUTION AND
RECOMMEDATION
5.0 INTRODUCTION
This study was intended to explore factors contributing blindness in
menhal charity Hospital, Somaliland it was based on three specific
objectives including
1. To determine socio- economic factors contributing blindness
2. To assess the role of factors contributing blindness in Manhal hospital
3. To examine the magnitude of blindness in Manhal hospital. This
presents the discussion of the study guided the study objectives the
discussion was research findings. The study was later concluded and
appropriate recommendation according from findings was made.
5.1 section (A) demographic characteristics of respondents
The findings of this study revealed that almost all 55 (65%) of the cases
were males, the influx denotes that males (gender) have higher chance of
blindness than females and the attributed reasons are mainly socio-
economic and demographic ones ,almost 40% % of them were between
41- 50 years , an indication that age main contributing factor for the
blindness. These results are in agreement with most of the studies done
where the majorty of respondent where single account for 59%. The
findings of the study suggested strongly case have no skills and education
as 44% never attend school. Only 5% have reached beyond primary
schools. This is also what is quality and clarity that is educationally big
influence personal and community healthy status. The study finds out
56
that all most all of respondents were house wife accounted for 41%, also
the district highest prevalence gacan libah were 44%.
5.2 SECTION B
57.7% respondent have information about factors contributing the
blindness, also 42% have get the information radio,88% of respondent
they know trachoma ,52% of respondent were common cause are
trachoma,67% of respondent promotion of trachoma is hygiene , 38% of
respondent disagree cataract are most common in children,85% of
respondent are answered agree the symptoms of catterct,78%of
glaucoma,56% of respondent are vitamin a deficiency are cause the child
hood blindness,60% of respondent are answered diabetic are cause the
blindness,96%of respond are show the number of blindness are
incerse,42% are respondent shows the possible cause are law of social
economic 75% are respondent are answer blindness are cause physical
physiology problem,35% are respondent are show the best way
privation medical prevtion,42% are respondent are blindness treatment
surgery
5.2.1 The role of factors contributing blindness
The study revealed the role of factors contributing blindness Include
trachoma , cataract and glaucoma .the study indicated trachoma is most
cost common cause in Somaliland especially in hargaisa and trachoma is
still one of the leading common cause of blindness as globally and
regional.
The World Health Organization is leading a global effort to eliminate
Blinding Trachoma, through the implementation of the SAFE strategy. This
57
involves surgery for trichiasi . antibiotics for infection, facial cleanliness
(hygiene promotion) and environmental improvements to reduce
transmission of thenorganism. Where this programme has been fully
implemented, it has met with some success. According to glaucoma was
one of the factors contributing blindness as this study indicated. Everyone
should be concerned about glaucoma and its effects. (WHO)
It is important for each of us, from infants to senior citizens, to have our
eyes checked regularly, because early detection and treatment of
glaucoma are the only way to prevent vision impairment and blindness.
Your eye doctor has a variety of diagnostic tools that aid in determining
whether or not you have glaucoma -- even before you have any
symptoms. Let us explore these tools and what they do.
Vitamin A deficiency is considered to be the main cause of childhood
blindness.
5.2.2 The magnitude of blindness
Visual impairment and blindness due to ocular disease is a significant
public health problem in the many parts of the world including Somaliland.
An estimated 180 million people worldwide are visually disabled, of whom
nearly 45 million are blind, four out of five of them living in developing
countries. As far as the South-East Asia Region is concerned, one-third of
the world's blind people (about 15 million) and 50% of the world's blind
children (approximately 0.7 million) live in this Region and 90% of 2this
blindness in the Region is avoidable. Blindness is one of the most
significant social problems in India. According to this study the prevalence
of blindness in population 50 years and above was 8.5% and 3estimated
58
prevalence in general population was 1.1%. Over 90% of the 12 million
blind people in Somaliland are living in the rural areas, most of whom are
most likely to unsaved as other research mentioned and 4unreached by
healthcare services. The concept of avoidable blindness (i.e. preventable
and curable) has gained increasing recognition in recent years. Avoidable
blindness is defined as blindness (visual acuity less than 3/60) which could
be either treated or prevented by known and cost congenital cataracts
etc.
5.3 Conclusions
This study identified a higher number of patients who were suffering
blindness in tertiary hospital impairment in Population. Senile cataract
trachoma and was the most comprehensive eye survey. The baseline
study about magnitude, causes and management of avoidable blindness
will help to develop and implemental appropriate programs to prevent
blindness. Large-scale studies should be conducted in Somaliland to
identify the magnitude of the avoidable blindness and implement effective
programs to make 'Vision successfully.
5.4 Recommendation
Health promotion: improvement health services such as the
strengthening patient education and increased accessibility and
acceptability and advocacy for improved political support for blindness
prevention
Preventing blindness: millions of people are still going needlessly in the
developing world from preventable disease such as trachoma, river
blindness and in children, vitamin A deficiency poverty lack of service and
59
resource as well as dire shortage of medical staff across sub Saharan
Africa are the main reasons why people continue to go blind from
preventable disease
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