Causes of Childhood Blindness in North Ghana: Results From a School for the Blind in Wa, Upper West Region

Background: Because most developing countries lack sufficient resources and infrastructure to conduct population-based studies on childhood blindness, it can be difficult to obtain epidemiologically reliable data available for planning public health strategies to effectively address the major determinants of childhood blindness. The major etiologies of blindness can differ regionally and intra-regionally. The objective of this retrospective study was to determine (1) the major causes of childhood blindness (BL) and severe visual impairment (SVI) in students who attend Wa Methodist School for the Blind in Upper West Region, North Ghana, and (2) any potential temporal trends in the causes of blindness for this region.

Methods: In this retrospective study, demographic data and clinical information from an eye screening at Wa Methodist School for the Blind were coded according to the World Health Organization/Prevention of Blindness standardized reporting methodology. Causes of BL and SVI were categorized anatomically and etiologically. We determined the major causes of BL/SVI over time using information provided about the age at onset of visual loss for each student.

Results: The major anatomical causes of BL/SVI among the 190 students screened were corneal opacity and phthisis bulbi (n=28, 15%), optic atrophy (n=23, 13%), glaucoma (n=18, 9%), microphthalmos (n=18, 9%), and cataract (n=18, 9%). Within the first year of life, students became blind mainly due to whole globe causes (n=23, 26%), cataract (n=15, 17%), and optic atrophy (n=11, 13%). Those who became blind after age one year had whole globe causes (n=26, 26%), corneal opacity (n=24, 24%), and optic atrophy (n=13, 13%).

Conclusion: At the Wa Methodist School for the Blind, the major anatomical causes of BL/SVI were corneal opacity and phthisis bulbi. About half of all students became blind within the first year of life, and were disproportionately affected by cataract and retinal causes in comparison to the other students who became blind after age one year. While research in blind schools has a number of implicit disadvantages and limitations, considering the temporal trends and other epidemiological factors of blindness may increase the usefulness and/or implications of the data that come from blind school studies in order to improve screening methods for newborns in hospitals and primary care centers, and to help tailor preventative and treatment programs to reduce avoidable childhood blindness in neonates and schoolchildren.

Geographic Information Systems-Based Approaches to Study Congressional Redistricting in the United States

The ability for the citizens of a nation to determine their own representation has long been regarded as one of the most critical objectives of any electoral system. Without having the assurance of equality in representation, the fundamental nature and operation of the political system is severely undermined. Given the centuries of institutional reforms and population changes in the American system, Congressional Redistricting stands as an institution whereby this promise of effective representation can either be fulfilled or denied. The broad set of processes that encapsulate Congres- sional Redistricting have been discussed, experimented, and modified to achieve clear objectives and have long been understood to be important. Questions remain about how the dynamics which link all of these processes operate and what impact the real- ities of Congressional Redistricting hold for representation in the American system. This dissertation examines three aspects of how Congressional Redistricting in the Untied States operates in accordance with the principle of “One Person, One Vote.” By utilizing data and data analysis techniques of Geographic Information Systems (GIS), this dissertation seeks to address how Congressional Redistricting impacts the principle of one person, one vote from the standpoint of legislator accountability, redistricting institutions, and the promise of effective minority representation.