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Background: Chepang are the indigenous community inhabiting at mountain region of central Nepal sharing Mongolian features. Their literacy rate is below average and economic state is also miserable. Overall, this community is very backward and is the poorest of Nepal’s poor. The prevalence of ocular abnormalities in Chepang has rarely been reported. A very little is known about the ocular morbidity status among Chepang children.
Method: A cross-sectional study was carried out to find the prevalence of refractive error and other ocular morbidities among Chepang children. A complete eye examination was carried out in all children including slit lamp examination, fundus examination, retinoscopy and subjective refraction.
Result: Of 120 children, refractive error was present in 18 (15%) children. The prevalence of myopia (spherical equivalent, −0.50 D or more in either eye), astigmatism (≥0.75 D), and hyperopia (+0.50D or more) was 4.1%, 6.6%, and 4.1% respectively. Of 120 children, 2(1.67%) had amblyopia, 4(3.33%) had cataract, 1(0.83%) had nystagmus, 2(1.67%) had corneal opacity, 8(6.67%) had blepharitis, 4(3.33%) had conjunctivitis. The overall prevalence of any visual impairment was 32.5%.
Conclusion: Ocular morbidity is more prevalent among chepang children and is a public health concern among these indigenous populations.
Ocular morbidity is considered as one of most under diagnosed and undertreated public health problems in many developing nations especially in Asia [1-3]. The commonest ocular morbidity reported is refractive error. Refractive error is one of the most common causes of visual impairment around the world and the second leading cause of treatable blindness . 2.3 billion people are estimated to be living with this problem [4-6]. Uncorrected refractive errors are the most common cause of visual impairment in children in all regions, affecting an estimated 12.4 million children which has been documented in series of population-based, multi-country Refractive Error Study in Children (RESC) surveys in Nepal, China, Chile [7-9]. Incidence of myopia in children is multiplying globally is what now an ‘epidemic’ in East Asia, Europe and United States . An estimated 153 million people over 5 years of age are visually impaired as a result of uncorrected refractive errors, of which 8 million are blind. Approximately 12.4 million children in the age group 5-15 years are visually impaired from uncorrected or inadequately corrected refractive errors, estimating a global prevalence of 0.96 % [7-10]. Poor vision and
an inability to read material on the chalkboard due to refractive
error can profoundly affect a child’s participation and learning in the classroom .
In Nepal, an estimated 1,013,041 children less than 16 years of age (prevalence among under 16 age group assumed to be 10% based on different studies varying from 3-20%; 1,164,053 persons between 16-35 years of age have uncorrected refractive error for distance (estimated prevalence 15%) according to mid-term review of Nepal Blindness Survey 2010 [12-14] Apart from refractive error, anterior and posterior segment abnormalities have also been reported in abundant cases in many screening camps and school screenings.
Chepang are the indigenous community inhabiting at mountain region of central Nepal sharing Mongolian features [15,16]. They live in caves and thatched houses. Poverty, lack of education, poor infrastructure, the community are often in bad health. The health seeking practices among the chepang community is very poor which brings complication in the mother’s and child health. The children are deprived from good and balanced nutrient therefore they suffer from disease like pneumonia, diarrhea, typhoid and
many stillborn diseases which ultimately makes child mortality
high [15-17]. Overall, this community is very backward and is the
poorest of Nepal’s poor.
Kanda is located at Chitwan covering 12345sq km. The village
is situated at the top of the mountain that lacks access to roadways
and other infrastructures. One must walk at least for 9 hours
to reach Kanda village. Poverty and illiteracy are the identity of
chepang village located at Kanda. To the best of our knowledge not
much work is done in the Chepang school going children and very
little is known about the prevalence of refractive errors among
these indigenous population. Pokharel et al. in their study found
the prevalence of refractive error to be very little. Of 97 children,
7 had myopia and the commonest complaint observed was
watering followed by ocular pain and complaints of diminution of
vision for near . Our study will help in assessing the refractive
status of these children as well as increasing the awareness and
better planning of eye care services in these remote areas. Early
detection of reflective error and its timely and proper correction
saves permanent ocular morbidity.
A total of 120 children attending primary schools in Kanda
were included for eye examination. The school was contacted
in advance by local people who informed them about the eye
examination campaign. All parents were informed prior to the
date of examination about the eye screening activity and that all
children attending the school would be examined. The study was
cross-sectional, with the objective of ascertaining prevalence of
ocular morbidity especially, the prevalence of refractive errors.
The students underwent the following examinations:
a) Uncorrected, presenting and best corrected visual acuity
was assessed using Snellen vision chart at 6 meter distance.
b) Retinoscopy and subjective refraction were performed
in every child. Cycloplegic refraction was carried out in all cases
with 1% cyclopentolate administered every 10 minutes for 3
times. Wet retinoscopy was carried out after 1 hour of instillation
of 1st drop.
c) Anterior segment examination was carried out with the
help of a torch light and portable slit lamp biomicroscope.
d) Fundus evaluation was done with a direct
ophthalmoscope. Fundus evaluation with dilated pupil was
carried out in all required cases.
e) Extraocular movements and cover tests were performed
using torch light, and convergence was tested using RAF rule.
f) The following criteria were used to classify the refractive
h) If refractive error is of magnitude ≥+0.50 D. This
was further classified as low hypermetropia (>+0.50D to <+
3.0D), moderate hypermetropia (>+3.0 D to <+6.0D) and high
j) If refractive error is of magnitude ≥-0.50D. This was
further classified as low myopia (>-0.50D to <-3.0D), moderate
myopia (>-3.0D to <-6.0D) and high myopia (>6.0D).
l) Any cylindrical error ≥±0.5. Astigmatism was further
classified as simple myopic astigmatism, simple hyperopic
astigmatism, compound hypermetropic astigmatism, compound
myopic astigmatism and mixed astigmatism.
The study population consisted of 120 children between 6 to
14 years old of which 78 (65%) were male and 42 (35%) were
female. The most common ocular morbidity was refractive error
(15%) followed by blepharitis (6.67%). Of 120 children, 2(1.67%)
had amblyopia, 4(3.33%) had cataract, 1(0.83%) had nystagmus,
2(1.67%) had corneal opacity, 8(6.67%) had blepharitis, 4(3.33%)
had conjunctivitis. Figure 1 shows the specific ocular morbidities
present among chepang children. Myopia (spherical equivalent,
−0.50 diopters [D] or more in either eye) affected 4.1%. Hyperopia
(+0.50D or more) affected 4.1% in all age groups. Astigmatism
(≥0.75 D) was present in 6.6% of all children. Astigmatism was
found to be more prevalent among children. Refractive error was
equally prevalent on both male and female (7.5%). Table 1 shows
the prevalence of specific refractive error.
In the present study, the prevalence of ocular morbidities,
were similar to the study done on chepang . Refractive error
was the leading cause of visual impairment in the present study
population followed by blepharitis. In our study, the prevalence
of refractive error among chepang children was 15% which
was like Pokharel et al. . The prevalence of astigmatism was
6.6%% in our study. The high prevalence of astigmatism in our
study may be explained by the fact that astigmatism is correlated
with myopia, and myopia has a direct relationship with higher
education . In the Pokharel (2000) report, the prevalence of
refractive error was reported 4.8 % (hyperopia in 1.4 %, myopia
1.2 %, and astigmatism 2.2 %). The prevalence of refractive error
was found higher in our study compared to Pokharel et al. .
The prevalence of myopia was only 4.1%. These numbers are
staggering considering the rising epidemics of myopia all around
the world . Far from gadget could be the biggest reason among
Kaiti et al.  conducted a screening camp in rural area of
Nepal and found the prevalence of refractive error to be 48.41%.
The most prevalent was astigmatism followed by myopia. 43.8%
had cataract, 10.65% had conjunctivitis, 12.31% had pterygium,
0.79% had amblyopia, and 0.79% had chronic dacryocystitis
. These findings were found to be higher than our study. In a
study , cataract (35.8%) was most prevalent ocular morbidity
among chepang. 7.49% had glaucoma suspect, 7.16% had chronic
dacryocystitis. Of 97 children of age group 6 to 17 years, myopia
was only present on 7(7.21%) children. These finding were found
to be higher than our study. The prevalence of blepharitis was
(6.67%) in our study. Poor hygiene among Chepang children was
the attributing factor for blepharitis and conjunctivitis including
other ocular surface disorder.
Ocular morbidities are more prevalent among chepang
children. There should be accessibility of eye health service at
these remote areas and timely vision screening programs must be
conducted among these school going children. Since, uncorrected
refractive error and other ocular morbidities resulting in visual
impairment have negative impact visual performance and overall
quality of life, eye care should be made integral part of primary
health care and primary health care workers must be trained in
eye care so that appropriate management at local level can be