Participatory Rural Appraisal to Detect Childhood Blindness in Community

Public health in developing countries is a strange paradox. Because majority of health resources are located in urban area where less population lives whereas less health resources are located in rural area where more of the population lives. Due to absence of quality primary healthcare and low awareness among poor on availing such care, they are availing care from dubious sources or foregoing care leading to rise in morbidity and mortality in the rural community. Participatory Rural Appraisal (PRA) is an interactive approach in research that emphasizes local participation, which enables local people to contribute in their own appraisal, analysis and plans. PRA aims to facilitate information sharing among stakeholders. The objective of PRA is to enable development workers, government officials, and local people to work together to plan appropriate programs. PRA in not new in development process. It has evolved from Rapid Rural Appraisal (RRA) and has been implemented in several development projects.1 However, its uses in community ophthalmology as an alternative methodology is limited. As we are aware of the fact that about 1.4 million blind children in the world2. Every minute, somewhere in the world, a child goes blind and nearly half a million children develop blindness each year. Ninety per cent of blind children die before reaching adulthood usually from malnutrition. It also has been estimated that nearly a third of the global economic cost of blindness is due to childhood blindness. However, positive aspect of childhood blindness is about 45 percent of blindness in these children could have been prevented or treated. Present existing approaches are very effective to diagnosing childhood blindness from the community. However, impact of these approaches in the society is debatable. Despite implementation of several approaches in the rural community, it has been observed that prevalence of childhood blindness is not significantly decreasing. This is the vicious circle of poverty and poor health and it does exist in rural areas of developing countries like India. Presently all community approaches ABSTRACT Introduction: To evaluate the role of participatory rural appraisal (PRA) in community based rehabilitation (CBR) to detect and manage childhood blindness from rural community. Methods: Fifteen rural project areas with pre-existing CBR project were shortlisted. Main criteria of this selection were pre-existing CBR project with significant number of children with visual impairment. We have adopted PRA methodology to reach the rural community whilst aiming to detect childhood blindness. PRA approaches were also utilized to achieve immunization, spacing between child birth, proper maternal and child health and overall improvement of lifestyle. Information about the villages was collected from villagers by social mapping performed by the villagers themselves. Student’s t test was used to analyze the result. Results: 128 children (CBR program) with visual disability were identified out of which 77.14% were blind and 22.86% had SVI. After adopting PRA approach 84 new cases (p<0.05%) were detected of which 71.43% were blind and 28.57% had SVI. Main causes of blindness were cornea related (31.28%), lens related (21.72%) and buphthalmos (17%). Immunization of child improved from 11% to 81% (p=0.011) over a period of one year. Common practices including food habit, spacing between child births improved. 41% children are mobilized to blind school for rehabilitation. Conclusion: PRA methodology is a new approach in community ophthalmology and is very promising to detect and rehabilitate visually impaired children. PRA is very useful to improve knowledge, to plan rehabilitation as well to treat underlining causes of childhood blindness.