Life history intervention tracking - a new dimension in child eye care

Bangladesh is home to over 48,000 blind children, based on the WHO's global estimate of the prevalence of childhood blindness, which is 0.75 per 1,000 children. Furthermore, 1.3 million children between the ages of 5 and 15 years have refractive error at an estimated prevalence of 4 percent. Vision development in children is a progressive process that starts at birth and continues through early childhood, with significant transformations occurring in the first few years. Newborns' vision is fuzzy at birth, and their best vision is at close range, such when they look at their parent's face. They are not born with all the visual abilities they need in life. They must learn to understand the world around them and respond to it appropriately by using the visual information that their eyes send to their brain. Over time, their vision improves and should reach adult levels by early teenage years. Because the refraction or ‘ability to see’ changes with age, refractive errors or blurry vision – myopia, hyperopia and astigmatism – if not corrected early and followed up properly, their consequences can be particularly harmful for children since vision is developed in the first few years of life. Any cause of poor vision in one or both eyes during childhood, as is the case with refractive errors or after pediatric cataract surgery, can lead to the condition known as “lazy eye” or Amblyopia which is difficult to treat. Precise optical rehabilitation and aggressive amblyopic treatment under close supervision and follow-up are critical to attaining good vision in refractive errors and after pediatric cataract surgery. It is very important to ensure that the family understands the prognosis and duration of treatment since they are going to be responsible for implementing most of it. Due to a lack of knowledge, financial constraints, and geographic inaccessibility, parents frequently neglect routine follow-up, especially in countries with limited resources.

The life history intervention tracking method is a comprehensive, rigorous, and reflexive process of collecting, interpreting, and presenting personal narratives. It provides a powerful means of illuminating the complexities of human experiences and the interplay between people’s lives and their societal context. Orbis International, Bangladesh, well-known in the country for its flagship program named Bangladesh National Childhood Blindness Reduction Program (NCBRP) since 2013, has provided refractive error service with spectacles to 85,288 children and carried out surgeries on 45,039 children through the program. It used life history intervention tracking methods to learn about the impact of eye health interventions on the lives of children who received spectacle or cataract surgical support, as well as how different events in their lives affected them in their childhood and adult lives. Life history intervention tracking is particularly important to know the ultimate visual status and the child’s social interaction. This method has been applied to several children in rural areas who received eye care through NCBRP.

These children shared stories that resonated deeply with themes of resilience, aspiration, and hope. Despite the challenges in their community that they face — limited access to quality healthcare and educational resources — their optimism shone through in every conversation. Many of these young voices told stories of overcoming obstacles that, for others, might seem insurmountable. Their lives, marked by hardship, were also rich with dreams, and the interventions provided by program had begun to create tangible change. Orbis’s commitment to improving eye health and access to care is more than just a medical initiative; it’s a vital investment in the children’s future. Several children described how receiving proper eye care had not only improved their vision but also opened up a world of learning that had previously been blurred by the challenges of undiagnosed visual impairments. These children spoke candidly about their dreams and the hurdles they face daily. For some, the struggle to access basic education was compounded by the lack of proper vision care — a barrier that Orbis is diligently working to dismantle. Their testimonies underscored how critical it is for support organizations to be present in these communities, providing not only medical assistance but also empowering children to envision a future beyond the limitations of their current circumstances. Hasan, Jannat, Nabid, Sabina, and Rafi are some of the kids who received Orbis’s support through surgical care and enabled them to continue their education and participate in daily activities, offering them a semblance of normalcy and hope. Similarly, Puja and Brishty benefited from Orbis's intervention with appropriate eyeglasses and medical treatment that alleviated their discomfort and helped to improve academic performance and overall quality of life.

In children, refractive status fluctuates until the early teens, and long-term vigorous follow-up is crucial to ensuring good vision, improving academic performance, and understanding their social interactions after refraction and cataract surgery, and all of this can be accomplished through periodical life history intervention tracking. The findings from the interviews highlighted the positive impact that comprehensive eye care interventions can have on the life of a child. The children’s story also demonstrated that additional support is necessary to enhance their overall well-being, and that eye care may not always be the only kind of care they require. These experiences underscored how focused healthcare, and educational efforts can elevate entire communities, transforming obstacles into opportunities for a more promising, inclusive future. The voices of these children underline that clear vision can indeed nurture their hope and transform lives.

- Moomtahina Noor is an independent consultant while Mirza Manbira Sultana is former Senior Monitoring and Evaluation Manager, Dr. Lutful Husain Director (Program Technology, Clinical Services & Research), and Dr. Munir Ahmed Country Director of Orbis International, Bangladesh