Vision Loss in the Dongarias

Drs Debasmita Majhi, Suryasnata Rath and others add to the growing repository of the Tribal Odisha Eye Disease Study by describing the prevalence and causes of vision loss in the Dongaria tribe of Odisha. They also document malnutrition and alcohol abuse in the community. 

India is a large country with many small populations. This diversity spills across the country’s diverse geography, with many rural and tribal pockets remaining cut-off from key development milestones and health services. Tribal communities make up about 8% of the Indian population and are spread over 461 documented communities. About 75 tribal groups are further classified as ‘Particularly Vulnerable Tribal Groups’ (PVTG) by the government of India to mark their endangered status and their lack of access to modernity. The Southeastern state of Odisha is home to the third-largest tribal community in the country, where 13 PVTGs live across 14 districts.  

Indigenous, tribal communities develop in isolation from larger society, and this distance is key to the survival of their culture and lifestyle. However, this distance also places them at a high risk of disease, including vision loss, even when compared to other communities that live in their proximity. The L V Prasad Eye Institute had embarked on the Tribal Odisha Eye Disease Study (TOES) to document and assess the various eye health factors of Odisha’s tribal communities. TOES-PVTG is an extension of this study in collaboration between LVPEI, the Ministry of Tribal Affairs, Government of India, Odisha’s tribal welfare department, the district administration, and local NGOs. TOES-PVTG focuses on the Dongaria, an 11,000-strong PVTG that lives in the Rayagada district of Odisha. It aims to enumerate the prevalence of vision loss in this group and provide eye care at no cost to them. 

In a new paper in the Indian Journal of Ophthalmology, Drs Debasmita Majhi, Suryasnata Rath, Taraprasad Das and others from LVPEI Bhubaneshwar present the results from the TOES-PVTG project. Their community health worker-led door-to-door screening program covered 89% (9,872) of the Dongaria tribe of about 11,000 individuals living in 88 hamlets. In addition, height, weight, and mid‐upper arm circumference was also collected for children under 5. 55% of the population were female, with only 5.2% (522) over 61 years of age. The group had a basic literacy rate of 14% and two-thirds confirmed habitual intake of alcohol. Vision impairment in the population was about 12.4%, with blindness at about 2.5%. Cataract was the primary cause of both vision impairment (50%) and blindness (76%), while uncorrected refractive errors were the second-most cause of vision impairment. 

While 37% of the population were children under 16 years of age, about 20% of the children had Vitamin A deficiency. About 17% of the children had acute malnutrition and 18% were stunted. More women were associated with vision loss than men; and many of them were under-weight. About 0.2% of the Dongaria community wore spectacles before this intervention. About 243 people of the 690 who needed cataract visited LVPEI’s secondary centre and 55% of them received free cataract surgery. Nearly 1,500 people received spectacles for their near or distance vision.  

Dr Debasmita Majhi, the lead author, says, ‘TOES is the first population-based study of one large PVTG in Odisha. What is true for the  Dongaria  community could be true for other PVTGs in India. It helped us to understand the required policy changes to address better connectivity, education and livelihood opportunities, and proximity to health facilities, along with improvising health-seeking behaviour.’ 

‘The Dongarias, a PVTG community, are a sequestered lot. The TOES project helped us realize the bane and benefits of this sequestration,’ muses Dr Suryasnata Rath, Network Director of Operations, LVPEI and the corresponding author of this paper. ‘While access to healthcare, education and harmful alcohol consumption were of concern, we found very low prevalence of refractive errors among children thanks to adequate outdoor activity and limited penetration of urban devices. The Dongarias seemed content with their culture and habitat. With rapid urbanization and attempts to bring PVTG communities into the mainstream only time will tell whether the Dongarias gained or lost in the bargain.’ 

Majhi D, Das T, Padhy D, Marmamula S, Khanna RC, Ota AB, et al. Prevalence and causes of visual impairment in Dongaria indigenous (tribal) community. Tribal Odisha eye disease study # 12. Indian J Ophthalmol 2023; 71:2850-5.  

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