Burden of eye disease and demand for care in the Bangladesh Rohingya displaced population and host community: A cohort study

Autoři: Munir Ahmed aff001;  Noelle Whitestone aff002;  Jennifer L. Patnaik aff003;  Mohammad Awlad Hossain aff001;  Lutful Husain aff001;  Mohammed Alauddin aff001;  Mushfiqur Rahaman aff005;  David Hunter Cherwek aff003;  Nathan Congdon aff003;  Danny Haddad aff003
Působiště autorů: Orbis Bangladesh, Dhaka, Bangladesh aff001;  Independent consultant, Orbis International, New York, New York, United States of America aff002;  Orbis International, New York, New York, United States of America aff003;  Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States of America aff004;  Cox’s Bazar Baitush Sharaf Hospital, Cox’s Bazar, Bangladesh aff005
Vyšlo v časopise: Burden of eye disease and demand for care in the Bangladesh Rohingya displaced population and host community: A cohort study. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003096
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003096



There is a growing awareness that addressing chronic as well as acute health conditions may contribute importantly to the well-being of displaced populations, but eye care service has generally not been prioritized in crisis situations. We describe a replicable model of eye care provision as delivered by Orbis International and local partners to the Rohingya and host population in Cox’s Bazar, Bangladesh, and characterize the burden of vision impairment and demand for sight-restoring services in this setting.

Methods and findings

Orbis International and local secondary facility Cox’s Bazar Baitush Sharaf Hospital (CBBSH) provide eye care support to the Rohingya population and the host community of all ages in Cox’s Bazar, Bangladesh, with fixed vision screening locations established in Camps 4 and 11 of the Kutupalong refugee settlement. Structured outreach targets these camps and four surrounding local subdistricts, with referrals made as needed for refraction (glasses measurement) and cataract surgery to CBBSH. Between February 2018 and March 2019, 48,105 displaced Rohingya (70.3%, among whom 71.6% were children and 46.5% women) and 20,357 local residents (29.7%, 88.5% children, 54.4% women) underwent vision screening. Displaced Rohingya sought services from a total of 12 surrounding camps, within which coverage was 17.3%, including 43.3% (27,027/62,424) of children aged 5–11 years and 60.0% (5,315/8,857) of adults ≥ 60 years old. The prevalence of blindness (presenting acuity < 3/60) among Rohingya patients exceeded that among local residents by 3- to 6-fold in each 10-year age group between 18 and 59 years (P < 0.001 comparing vision between the two groups in this age range), and the prevalence of cataract requiring surgery was also higher in Rohingya patients (18–29 years: 4.67% versus 1.80%, P = 0.0019; 30–39: 7.61% versus 2.39%, P < 0.001; and 40–49 years: 7.91% versus 3.77%, P = 0.0014). A limitation of the study is lack of data on population prevalence of eye disease.


The burden of untreated eye disease is very high among the Rohingya, particularly those in their peak working years who could contribute most to the resiliency of their community. Demand for eye care service is also great among children and adults in this population with many competing healthcare priorities. Research is needed, building on strong evidence of benefit in settled populations, to explore the specific impact of vision care on the well-being of displaced populations.

Klíčová slova:

Bangladesh – Cataract surgery – Cataracts – Eye diseases – Eyes – Vision – Visual acuity – Visual impairments


1. United Nations High Commissioner for Refugees. UNHCR Figures at a glance [Internet]. 2019 Jun [cited 2019 Sep 21]. Available from: https://www.unhcr.org/en-us/figures-at-a-glance.html

2. World Health Organization. Urgent health challenges for the next decade [Internet]. 2020 Jan [cited 2020 Jan 16]. Available from: https://www.who.int/news-room/photo-story/photo-story-detail/urgent-health-challenges-for-the-next-decade

3. United Nations High Commissioner for Refugees. Rohingya emergency [Internet]. 2019 Jul [cited 2019 Sep 21]. Available from: https://www.unhcr.org/en-us/rohingya-emergency.html

4. Morgan J. Disability–a neglected issue in Greece’s refugee camps. Lancet. 2017;389(3):896.

5. Hughes P, Hijazi Z, Saeed K. Improving access to mental healthcare for displaced Syrians: case studies from Syria, Iraq and Turkey. Br J Psychiatry. 2016;13(4):84–6.

6. Ommeren M, Hanna F, Weissbecker I, Ventevogel P. Mental health and psychosocial support in humanitarian emergencies. East Mediterr Health J. 2015;21(7):498–502. doi: 10.26719/2015.21.7.498 26442890

7. Horton S, Gelband H, Jamison D, Levin C, Nugent R, Watkins D. Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness. PLoS ONE. 2017; 12(8): e0182951. doi: 10.1371/journal.pone.0182951 28797115

8. The World Health Organization. Universal eye health: a global action plan 2014–2019. 2013 [cited 2019 Sep 21]. Available from: https://www.who.int/blindness/actionplan/en/

9. Essue BM, Li Q, Hackett ML, Keay L, Iezzi B, Tran KD, et al. A multicenter prospective cohort study of quality of life and economic outcomes after cataract surgery in Vietnam: the VISIONARY study. Ophthalmology. 2014 Nov;121(11):2138–46. doi: 10.1016/j.ophtha.2014.05.014 25012931

10. Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, et al. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(9):e888–97 doi: 10.1016/S2214-109X(17)30293-0 28779882

11. Bal S, Duckles A, Buttenheim A. Visual health and visual healthcare access in refugees and displaced persons: a systematic review. J. Immigr Minor Health. 2019;21(1):161–174. doi: 10.1007/s10903-018-0766-x 29860671

12. Kaphle D, Gyawali R, Kandel H, Reading A, Msosa J. Vision impairment and ocular morbidity in a refugee population in Malawi. Optom Vis Sci. 2016;93(2):188–193. doi: 10.1097/OPX.0000000000000775 26636398

13. United Nations High Commissioner for Refugees. Refugee Response in Bangladesh Population Figures [Internet]. 2019 Aug [cited 2019 Sep 21]. Available from: https://data2.unhcr.org/en/situations/myanmar_refugees

14. National Eye Care Bangladesh. Standard cataract surgery protocols. 2nd ed. 2015.

15. Congdon N, Suburaman G-B, Ravilla T, Varga B, Resnikoff S, McLeod J, et al. Transforming research results into useful tools for global health: BOOST. Lancet Glob Health. 2016;4(2):e96. doi: 10.1016/S2214-109X(15)00267-3 26823227

16. Congdon N, Yan X, Lansingh V, Sisay A, Mueller A, Chan V, et al. Assessment of cataract surgical outcomes in settings where follow-up is poor: PRECOG, a multicentre observational study. Lancet Glob Health 2013;1:e37–45. doi: 10.1016/S2214-109X(13)70003-2 25103584

17. Bhatia A, Mahmud A, Fuller A, Shin R, Rahman A, Shatil T.A, et al, The Rohingya in Cox’s Bazar: when the stateless seek refuge. Health Hum Rights. 2018;20(2):105–122. 30568406

18. Khatun T. District-based measurement of human poverty in Bangladesh. The Bangladesh Development Studies. 2001;27(3):91–109.

19. Zhao LQ, Li LM, Zhu H, The Epidemiological Evidence-Based Eye Disease Study Research Group EY. The effect of multivitamin/mineral supplements on age-related cataracts: a systematic review and meta-analysis. Nutrients. 2014;6(3):931–49. doi: 10.3390/nu6030931 24590236

20. Lim HT, Yoon JS, Hwang SS, Lee SY. Prevalence and associated sociodemographic factors of myopia in Korean children: the 2005 third Korea national health and nutrition examination survey (KNHANES III). Jpn J Ophthalmol. 2012;56(1):76–81. doi: 10.1007/s10384-011-0090-7 21975827

21. Cousins S. Rohingya threatened by infectious diseases. Lancet Infectious Diseases. 2018;18(6):609–610. doi: 10.1016/S1473-3099(18)30304-9 31272735

22. Islam MM; Nuzhath T. Health risks of Rohingya refugee population in Bangladesh: a call for global attention. J Glob Health. 2018 Nov 9. doi: 10.7189/jogh.08.020309

23. Gelaw Y, Abateneh A. Ocular morbidity among refugees in southwest Ethiopia. Ethiop J Health Sci. 2014;24(3):227–234. doi: 10.4314/ejhs.v24i3.6 25183929

24. Kawuma M. Eye diseases and blindness in Adjumani refugee settlement camps, Uganda. East Afr Med J. 2000;77(11):580–2. doi: 10.4314/eamj.v77i11.46724 12862101

25. Zeidan Z, Hashim K, Muhit MA, Gilbert C. Prevalence and causes of childhood blindness in camps for displaced persons in Khartoum: results of a household survey. Eastern Mediterr Health J. 2007;13(3):580–5.

26. Shrestha JK, Pradhan YM, Snellingen T. Outcomes of extracapsular surgery in eye camps of eastern Nepal. Br J Ophthalmol. 2001;85(6):648–52. doi: 10.1136/bjo.85.6.648 11371480

27. Vincent JE. Simple spectacles for adult refugees on the Thailand-Burma border. Optom Vis Sci. 2006;83(11):803–10. doi: 10.1097/01.opx.0000239126.46172.80 17106407

28. Vincent JE, Netek S, Parry A, Mladenovich D, Thein NN, Amendola PR. Reported wearing compliance of ready-made spectacles at 6 and 12 months. Optom Vis Sci. 2010;87(12):958–65. doi: 10.1097/OPX.0b013e3181fef3a9 21076356

29. Anderson JDC, Bentley CC. Role of community health workers in trachoma control. Case study from a Somali refugee camp. Trop Doct. 1986;16(2):66–9. doi: 10.1177/004947558601600209 3765080

30. Matsumoto M, Wimer G, Sethi Aisha. Health needs of refugees: port of arrival versus permanent camp settings. East Mediterr Health J. 2019;25(5):306–314. doi: 10.26719/emhj.18.041 31364755

31. Doocy S, Sirois A, Tileva M, Storey JD, Burnham G. Chronic disease and disability among Iraqi populations displaced in Jordan and Syria. Int J Health Plann Manage. 2013;28(1):e1–e12. doi: 10.1002/hpm.2119 22685057

32. Amara AH, Aljunid SM. Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need. Global Health. 2014 Apr 3. doi: 10.1186/1744-8603-10-24

33. Doocy S, Lyles E, Roberton T, Akhu-Zaheya L, Oweis A, Burnham G. Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan. BMC Public Health. 2015 Oct 31. doi: 10.1186/s12889-015-2429-3

34. Shahin Y, Kapur A, Seita A. Diabetes care in refugee camps: the experience of UNRWA. Diabetes Res Clin Pract. 2015;108(1):1–6. doi: 10.1016/j.diabres.2015.01.035 25680680

35. Powe NR, Schein OD, Gieser SC, et al. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Arch Ophthalmol 1994; 112:239–52. doi: 10.1001/archopht.1994.01090140115033 8037792

36. Alexakis LC, Athanasiou M, Konstantinou A. Refugee camp health services utilisation by non-camp residents as an indicator of unaddressed health needs of surrounding populations: a perspective from Mae La refugee camp in Thailand during 2006 and 2007. Pan Afr Med J. 2019 Apr 17. doi: 10.11604/pamj.2019.32.188.16780

37. Ma X, Zhou Z, Yi H, Pang X, Shi Y, Chen Q, et al. Effect of providing free glasses on children's educational outcomes in China. Cluster-randomized controlled trial. BMJ. 2014;349:g5740. doi: 10.1136/bmj.g5740 25249453

38. Reddy PA, Congdon N, MacKenzie G, Gogate P, Wen Q, Jan C, et al. Effect of providing near glasses on productivity among rural Indian tea workers with presbyopia (PROSPER): a randomised trial. Lancet Glob Health. 2018;6:e1019–e1027. doi: 10.1016/S2214-109X(18)30329-2 30049615

39. Danquah L, Kuper H, Eusebio C, Rashid MA, Bowen L, Foster A, et al. The long term impact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines. PLoS ONE. 2014;9(4):e94140. doi: 10.1371/journal.pone.0094140 24747192

Článek vyšel v časopise

PLOS Medicine

2020 Číslo 3

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Zvyšte si kvalifikaci online z pohodlí domova

Antiseptika a prevence ve stomatologii
nový kurz
Autoři: MUDr. Ladislav Korábek, CSc., MBA

Citikolin v neuroprotekci a neuroregeneraci: od výzkumu do klinické praxe nejen očních lékařů
Autoři: MUDr. Petr Výborný, CSc., FEBO

Zánětlivá bolest zad a axiální spondylartritida – Diagnostika a referenční strategie
Autoři: MUDr. Monika Gregová, Ph.D., MUDr. Kristýna Bubová

Diagnostika a léčba deprese pro ambulantní praxi
Autoři: MUDr. Jan Hubeňák, Ph.D

Význam nemocničního alert systému v době SARS-CoV-2
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D., prim. MUDr. Václava Adámková

Všechny kurzy
Kurzy Doporučená témata Časopisy
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.


Nemáte účet?  Registrujte se