Quality of Life Related to Visual Impairment in Visually Impaired Learners at the Center for Social Promotion of the Blind in Parakou in 2022

Self-image

The overall mean score for the «self-image» dimension was 4.92±1.13 (82.0±18.33%). The mean score for visual impairment was 4.90±0.99 (81.7±16.5%) and for blindness was 4.93±1.16 (82.2±19.3%). Participants with a «Good» score were the most numerous, i.e. 70% of visually impaired participants and 74.5% of blind participants (Table 3).

Factors influencing the ‘self-image’ dimension after multivariate analysis After multivariate analysis, female participants were

Psych Dimension

The overall mean score for the «Psyche» dimension was 3.21±1.01 (80.3±25.3%). The mean score for the visually impaired was 3.70±0.67 (92.5±16.8%), and for the blind was 3.10±1.04 (77.5±26.0%).

Participants with a «Good» score were the most represented, i.e. 90% among the visually impaired and 74.5% among the blind, as shown in the following (Table 5).

After multivariate analysis, female participants were 6.17 times more likely to have a ‘Poor’ score on the ‘Psyche’ dimension (Table 6).

Table 6: Distribution of participants according to score on the ‘Psyche’ dimension, after multivariate analysis (CPSA, 2022). Daily Life Dimension The overall mean score for the «Daily life» dimension was 8.63±2.71 (53.9±16.9%). The mean score for the visually impaired was 11.10±2.02 (69.4±12.6%) and for the blind was 8.10±2.56 (50.6±16.0%).

Participants with a «Poor» score were the most represented, at 51.1% in the blind group. The score was «Good» in 50% of cases for the visually impaired (Table 7).

Factors influencing the ‘Daily life’ dimension after multivariate analysis.

Female participants were 5.76 times more likely to have a «Poor» score on the «Daily life» dimension (Table 8).

RP IC 95% RP p-value

Sex

Female 5,763 [1, 51] 0,015

Male 1 - - Table 8: Distribution of participants according to score on the ‘Daily life’ dimension after multivariate analysis (CPSA, 2022). Frustration/Anxiety Dimension The overall mean score for the «Frustration/ Worry» dimension was 17.49±5.68 (62.5±20.3%). The mean score for the visually impaired was 20.30±6.46 (72.5±23.1%), and for the blind was 16.89±5.39 (60.3±19.3%). Participants with a «Good» score were the most numerous, at 50.0% among the visually impaired. The score was «Average» in 46.8% of blind participants. This is shown in the following (Table 9).

Factors Influencing the ‘Frustration/ Worry’ Dimension after Multivariate Analysis

After multivariate analysis, female participants were 10.39 times more likely to have a «Poor» score-t-on the «Frustration/ Worry» dimension. Similarly, participants aged between 15 and 25 were 28.26 times more likely to have a ‘Poor’ score on the ‘Frustration/ Worry’ dimension (Table 10).

Table 10: Distribution of participants according to score on the ‘Frustration/anxiety’ dimension after multivariate analysis (CPSA, 2022). Social Dimension The overall mean score for the «Social» dimension was 9.88±2.35 (70.57±16.78%). The mean score for the visually impaired was 9.40±2.95 (67.1±21.1%), and for the blind was 10.0±2.22 (71.4±15.9%).

Participants with a «Good» score were the most represented, i.e. 40% among the visually impaired and 42.6% among the blind, as shown in the Table 11 below.

Factors influencing the ‘Social’ dimension after multivariate analysis Female participants were 33.15 times more likely to have a poor score (Table 12).

Socio-Demographic Data

Age: The mean age of the participants was 16.70 ± 4.55 years with extremes of 8 and 25 years. This result is similar to that of Monteiro, et al. [6] in Parakou at Benin, in 2017, with an average age of 16.07± 4.02 years and extremes of 8 and 25 years old. On the other hand, Guirou, et al. [4] in Bamako, Mali, in 2018 found a lower average age of 12 years, with extremes of 5 and 15 years. This difference could be explained by the variation in the age limits considered from one study to another. In contrast, Thapa, et al. [7] in Nepal, Asia in 2018 reported a higher mean age of 69.64 ± 64 years, with extremes of 60 and 95 years. This significant difference could be explained by the fact that their study was carried out on an elderly population.

Sex: In this study, the gender distribution 72% male to 28% female with a sex ratio of 2.56 showed a greater proportion of male subjects, which is observed in many studies [8, 9, 10, 11]. The higher proportion of men does not necessarily reflect greater blindness in male subjects. However, this predominance could be explained by the greater social importance given to the education of boys in Beninese society, hence the decision to place them in specialized centers for the blind. In contrast, Thapa, et al. [7] in Nepal, Asia, in 2018, and Mba Aki, et al. [12] in Bamako, Mali, in 2019, noted a female predominance of 55.86% and 64.5% respectively. These different results could also be justified by the socio-demographic disparities between the different study populations, the nature of the study and the sampling. In the present study, schoolchildren were in the majority (52.6%). This could be explained by the fact that parents prefer to keep younger children at home rather than enrol them in rehabilitation centers.

Clinical Data: Previous surgery, the type of which could not be specified, had been performed in 21.1% of the participants. Probable childhood eye infection was found in 14% of cases. A previous study [6] carried out in the same center in 2017 revealed that childhood measles was the cause of blindness in 18.92% of cases. According to Kello, et al. [13], measles is one of the main causes of blindness in children in Third World countries. Vaccination against measles can therefore reduce ocular complications. Thirteen (13) participants (22.8%) had a family history of visual impairment. The hereditary nature of certain pathologies causing visual impairment could justify this rate. In this study, eyes with a visual acuity of 1/50 to no light perception were more represented with a rate of 86% on the right and 80.7% on the left. Monteiro, et al. [6] in Parakou, Benin in 2014 reported a rate of 80.95% for eyes with no light perception. These rates reflect the severity of visual impairment in centers for the visually impaired. Visual impairment was discovered in most subjects at birth (36.8%). This rate is lower than that reported by Ntim- Amponsah, et al. [14] in Ghana and Alagaratnam, et al. [15] in England (42.8% and 45% respectively). The fact that the visual impairment has existed since birth suggests that the lesions responsible for it were precocious or even congenital.

Type of Visual Impairment: Blindness occurred in 82.5% of cases, compared with poor vision in 17.5%.This rate of blindness in the present study is comparable to that of Domngang, et al. [11] in Cameroon (87.5%), Mba Aki, et al. [13] in Mali (80%) and Asferaw, et al. [10] in Ethiopia (89.8%).The African studies found a higher proportion of blind people in the group of people with sight impairments visual. These results contrast with those of high-income countries, where treatment is earlier and more appropriate [12].

Affected Eye: The rate of binocular blindness was in the majority, with 52 cases (91.2%), compared with 5 cases (8.8%) of monocular blindness. This finding is similar to that of a study by Tchabi, et al. [16] in Cotonou at Benin in 2014 who found 100% binocular blindness. However, significantly lower rates of bilaterality have been reported by some authors. In the case of blindness, Balo, et al. [17] in Togo in 2000, Traore, et al. [18] in Mali in 2006, Al-Akily, et al. [19] in Yemen in 2010, and Eballe, et al. [20] in Cameroon in 2008, reported 2.47%, 5.8%, 7.9% and 34% respectively. This significant difference could be justified by the fact that the present study was carried out in a center specifically for amblyopes and blind people.

Main Causes of Blindness and Visual Impairment: The main causes of blindness, in descending order, were cataract (29.8%), corneal scarring (19.3%) and globe phthisis (15.8%), retinitis pigmentosa (8.8%), glaucoma (7.0%) and optic nerve atrophy (7.0%). These results are practically in line with those of the WHO, which states that childhood blindness is mainly linked to corneal opacities, cataracts, retinal diseases and uncorrected refractive disorders in countries with limited resources [21]. Many authors [3, 8, 22, 23] also confirm that the proportion of visual impairment attributable to cataract is higher in low- and middle-income countries than in high-income countries. Assavedo, et al. [24] in Parakou, Benin, in 2017 found that the main causes of blindness were cataracts (36.74%), glaucoma (19.70%), retinochoroiditis (10.23%) and corneal opacities (7.58%). According to the National Blindness Control Programme (PNLC) in Benin, cataracts (54%), glaucoma (15%) and corneal opacities (11%) were also the main ocular conditions responsible for blindness [25]. This difference in the proportion for glaucoma could be explained by the fact that our study population is a young population, whereas these authors conducted a «general population» study.

Categorisation of Causes: The causes of visual impairment were mainly infectious in 42.1% of cases and congenital in 35.1%. Satisfaction with treatment at the CPSA Parakou.

Overall, 50.9% of participants were satisfied, 42.1% were moderately satisfied and 7% were not very satisfied. For the latter, the reasons given were the poor quality of accommodation and food, the fact that products were sometimes not available in the infirmary for treatment when needed, and the lack of qualified teachers with a good command of Braille, especially at secondary level.

Analysis of Quality of Life Dimensions: The study of the quality of life of people with disabilities has become an increasing priority. However, research into the quality of life of blind and partially sighted people is rare and limited to clinical outcomes [26]. This study attempts to analyse the quality of life of blind and partially sighted people in a specific center. The quality of life of learners at the CPSA Parakou was assessed along 5 dimensions: self-image, psyche, daily life, frustration and social.

Self-Image Dimension: Both visually impaired and blind people maintained a good self-image, with mean scores (SM) of 81.7±16.5% and 82.2±19.3% respectively. Numerous studies have reported that disabled people can have a much more positive self-image than the healthy people around them [26]. Gender was significantly associated with self- image in both univariate and multivariate analyses, with P-values of 0.007 and 0.024 respectively. Female participants were 19 times more likely to have a poor score for the «Self- image» dimension.

Psyche Dimension: The visually impaired have a better psyche (SM=92.5±16.8%) than the blind (SM=77.5±26.0%). Nevertheless, the score is good in both cases. As associated factors, age at onset of visual impairment and gender were significantly associated with «Psychism», with P-values of 0.030 (univariate analysis) and 0.029 (multivariate analysis) respectively. Female participants were 6.17 times more likely to have a poor score. The earlier the onset of visual impairment, from an early age, the better the quality of life. People who are blind from birth, or who are blind for most of their lives, find it easier to overcome their problems. This finding has also been made by other authors in their studies: Vuletic, et al. [26] in Croatia in 2016, Amini, et al. [27] in Iran in 2010, and Pey, et al. [28] in the UK in 2012.Patients who become blind later in life go through a series of phases of acceptance and adaptation to the new situation. Whereas those blind from birth learn to accept their life and their disability from birth. Thus, the late onset of visual impairment is much more difficult to accept. Patients generally declare that they have had to go through a shock, wanting their lives to remain unchanged and resisting rehabilitation. The fact remains, however, that vision loss most certainly affects their lives. The stages they go through are affected by strong emotions (more profoundly by a sense of loss), and by the desire to regain their sight. Many never manage to adapt and lose their independence [29].

Daily Living Dimension: With regard to «Daily life», visually impaired people were satisfied with their daily life (SM=69.4±12.6)%, whereas blind people were moderately satisfied (SM=50.6±16.0%).In univariate analysis, gender (P-value=0.18) and the type of eye affected (P-value=0.39) were significantly associated with «Daily life». Subjects with unilateral involvement had a better daily life than those with bilateral involvement. This is normal and obvious since subjects with unilateral blindness see better. They have less difficulty taking charge of their lives and carrying out activities of daily living. Female subjects are 6 times more likely to have a «Poor» score on the «Daily life» dimension.

Frustration/Anxiety Dimension: Visually impaired participants were the most satisfied (SM=72.5%±23.1) with their quality of life in relation to the «Frustration/Worry» dimension, whereas blind participants were moderately satisfied (SM=60.3%±19.3). After multivariate analysis, gender and age were significantly associated with this dimension, with P-values of 0.004 and 0.018 respectively. Female participants were 10 times more likely to have a ‘Poor’ score on the ‘Frustration/Worry’ dimension. Participants aged between 15 and 25 were 28 times more likely to have a ‘Poor’ score on the ‘Frustration/ Worry’ dimension. So the older you get, the poorer your quality of life, because children are ignorant and not yet fully aware of their situation. The older you get, the more aware you become of life situations, the more concerned you are about your life and the more worried you are about your future security. A study by Vuletic, et al. [26] in Croatia in 2016 on the quality of life of visually impaired and blind people noted that both visually impaired and blind people were less satisfied with their future safety.

Social Dimension: Both blind and partially sighted people have a good social relationship, with mean scores of 67.1±21.1% and 71.4±15.9% respectively. The blind seem to be more satisfied with their social relationships than the partially sighted. Vuletic, et al. [26] also found that blind people were the most satisfied with their «close relationships» (SM = 85.78±16.98) with those around them. Chen-Wei, et al. [30] in China in 2018, in their study, found that blind and partially sighted people had a mean score of 71.33±19.57 on the «social functioning» dimension. Gender was significantly associated with the «Social» dimension (P-value = 0.001). Female participants were 33 times more likely to have a poor score.

The results of the study showed a statistically significant difference in the mean scores for all the dimensions of the PedEyeQ according to the type of visual impairment, and that the quality of life of visually impaired people was better than that of blind people. Other authors such as Vuletic, et al. [26], Pey, et al. [28] and Crewe, et al. [31] have also found similar results .Blind people find it harder to take charge of their lives than visually impaired people. Visually impaired people also have less difficulty moving around, recognizing objects and reading better than blind people. It was also noted that gender was significantly associated with quality of life on all the dimensions of the study scale. Men have an easier time adapting to and overcoming their disability than women. Women are more likely to have a poor quality of life.

The overall average score on the quality of life assessment scale of the respondents was 69.85%, within the theoretically expected world norm of between 60 and 80% according to Cummins [32]. Vuletic, et al. [26], At the end of their study of the quality of life of blind and partially sighted people in Croatia in 2016, also found a result (68.19%) within the normative range. Albrecht, et al. [33] in Chicago in 1999 found from their quality of life study that 54.3% of people with a severe disability reported an excellent or good quality of life, despite their severe disability. These individuals strive to gather sufficient resources to cope with the problems they encounter. Ultimately, they find the meaning, values and motivation to manage the disability. In this particular context, what could justify these results is the fact that the subjects surveyed are cared for in a rehabilitation center that provides them with education, accommodation and nutrition. In this way, the subjects surveyed live in an environment where everyone is disabled visual impairment apart from the supervisors. In addition to the hospitality offered by the center, the residents are entitled to a school for the blind using the Braille writing system. Blind and sighted students attend the same secondary school outside the center. This being the case, they receive the same training programs as at the sighted school, the only difference being that there is a system for transcribing lessons into Braille and vice versa. The only difference is that there is a system for transcribing lessons into Braille and vice versa, to ensure that results are consistent and unanimous in national examinations. Belonging to a community where all the members suffer from the same disability inevitably has a positive effect on the quality of life of those concerned. People are less socially isolated and more involved in their community. This is why the quality of life of blind and partially sighted people is within the normative range theoretically expected. One of the recommendations for future studies is to compare the quality of life of blind and partially sighted people living in the general population with that of those enrolled in CPSAs. This could provide some interesting results. During the course of this research, it was noted that children are sometimes sent to the CPSA without having been consulted by an ophthalmologist; this would explain the presence of children who do not belong in the center for the blind.