Blindness, Vision Impairment and Disability in Northwest Ethiopia: a Rapid Assessment of Avoidable Blindness (RAAB) Survey

Background Ethiopia has one of the world’s highest prevalences of blindness. However, up-to-date population-based data are lacking. A Rapid Assessment of Avoidable Blindness (RAAB) survey was conducted in the West Gojam Zone and Bahir Dar City to estimate the prevalence and causes of blindness, vision impairment, and disability among adults aged ≥50 years to inform regional eye health planning. Methods A population-based cross-sectional survey using two stage cluster random sampling with probability proportional to size was conducted in 86 clusters, enrolling 50 individuals aged ≥50 years per cluster. Visual acuity was assessed uncorrected, with available correction and with pinhole; lens status and dilated fundus examination was performed (when indicated) by an ophthalmologist. Disability was assessed using the Washington Group Short Set questionnaire. Results A total of 4,078 participants were examined (response rate 94.8%). The prevalence of bilateral blindness was 3.0% (95% CI: 2.4%–3.5%), significantly higher among women (3.7%, 95% CI: 2.9%–4.5%) than men (2.1%, 95% CI: 1.4%–2.8%). The prevalence of bilateral vision impairment (VI) was 9.6%, with severe VI significantly higher among women (1.9%, 95% CI: 1.3%–2.6%) than men (0.8%, 95% CI: 0.4%–1.2%). Cataract (43.4%), glaucoma (14.8%), and age-related macular degeneration (13.9%) were the leading causes of blindness; and 82% of blindness was avoidable. Effective Cataract Surgical Coverage (eCSC, <6/12 surgical threshold) was 13.0% (95% CI, 9.5%–16.4%), and effective Refractive Error Coverage (eREC) was 5.3% (95% CI, 0.4%–10.1%). Only 41.6% of cataract surgeries achieved a ‘good’ visual outcome (≥6/12 post-operative presenting visual acuity), increasing to 45.5% with pinhole. Disability prevalence was 5.6% (95% CI, 4.6%–6.5%), vision related disability was 3.6% (95% CI, 2.9%–4.2%). Discussion Blindness and VI remain high suggesting eye health service are insufficient to meet needs. Strengthened and better-coordinated strategies are urgently needed to expand access to quality preventive, curative and rehabilitative eye care in Amhara.