CHAPTER ONE

PROBLEM AND ITS SCOPE

1.1 Background of the study

Nutritional status: is defined as the intake of a diet sufficient to meet or exceed the
needs of the individual, that will keep the composition and function of the otherwise
healthy individuals within normal range.Poor nutritional status has been reported to
because by three main factors: decreased intake of nutrients, altered utilization, and
increased requirements (Jeejeebhoy et al.,1990).

Malnutrition: Is the condition that develops when the body does
not get the right amount of the vitamins minerals and other nutrients it needs to
healthy tissues and organ function determined by anthropometric measurements,
(WHO,2000).

Vision is the ability to see with a clear perception of detail, color and contrast and to
distinguish objects visually. Like any other sense, vision tends to deteriorate naturally
with age (Minot and Imran, 2004).

Visual impairment: The World Health Organization (WHO) defines visual impairment
(VI) as presenting visual acuity (PVA) that is worse than 6/18, but better and equal to
3/60 or a corresponding visual field (VF) loss of less than 20 degrees around the central
fixation in the better eye with presenting any optical correction.

Globally, it is estimated that approximately 1.3 billion people live with some form of
vision impairment. With regards to distance vision, 188.5 million people have mild vision
impairment, 217 million have moderate to severe vision impairment, and 36 million
people are blind .With regards to near vision, 826 million people live with a near vision
impairment.the leading causes of vision impairment in world wide are uncorrected
refractive errors and cataracts.Approximately 80% of all vision impairment globally is
considered avoidable.The majority of people with vision impairment are over the age of
50 year.(Bilyk et al., 2009).

Globally, ~50% of the causes of blindness in children are avoidable causes, mainly
cataract and vitamin A deficiency. The future life of visually impaired children is affected
by the problem so very vital point is childern are very vulnerable for blindness and
visual impairment because this stage is development preriod in anatomically and
physiologically .There fore, there is an urgency to treat the children because it cannot
be corrected in an adulthood stage of life. The main challenge of the treatment is the
need of special training and expertise in selecting the most appropriate treatment
approaches.

In Sub-Saharan African countries, including Ethiopia, low vision occurred on average in

70 million people. According to estimates from the World Health Organization (WHO)
Prevention of Blindness and Deafness Program, there are an estimated 285 million
visually impaired populations. Most cases of visual impairment and blindness are
preventable.(Montero, 2005).

In Africa A survey to determine the magnitude and etiology of visual and ocular
handicaps amongst Standard one primary school children in Nairobi, Kenya, found that
330 out of3,206 children had visual impairment.

Nutritional status is considered as an important determinant of successful ageing, and

perception of quality of life has been reported to be affected by poor nutritional,Recent
reports carried out in the United Kingdom suggest that the needs of visually impaired
people to maintain good nutritional status are not being met. A report, My Voice, stated
that 61%of the visually impaired, always or frequently, needed support to prepare
meals (Slade, 2015).

Many studies have reported the importance of the role of vision and visual cues when
eating Visual impairment was reported to be significantly linked with abnormal BMI.
Obesity school children was reported It was attributed to reduced physical activity in
some studies (Montero, 2005). There is a link between visual impairment and
nuritional status for teenage because VI have significance impact of nutritioanl status
or daily life of visual imapired people.(Musa, 1998).

In Somaliland Blindness remains a public health problem. It is estimated that about 140
000 people in the country are visually impaired, mainly due to cataract, corneal opacity,
refractive errors and glaucoma. However, 80% of these cases are avoidable,
preventable or curable through basic eye care and early treatment. The availability of
eye care services in Somaliland is very limited, and the cost of the basic eye care is
unaffordable to most people. Despite being integrated in the essential package for
health services, the implementation of the eye health programme in Somaliland remains
weak.

WHO works in partnership with national partners and the Somaliland health authorities
to build the capacity of health workers in eye care by facilitating training of
Somalilanddoctors. Five health care professionals in Hargeisa were also trained to
diagnose and treat common ophthalmic problems. The eye camp was very successful
despite the fragile security situation in Hargeisa. People came from all over the
Somaliland regions to be screened, treated and operated “More funding is needed to
scale up.These campaigns for the prevention of blindness in Somaliland.

1.2 Problem Statement

Visual impairment and blindness in childhood has implications in all aspects of the
child’s development. It possess educational, occupational and social challenges, with
affected children being at risk of behavioral, psychological and emotional difficulties,
impaired self-esteem and poor social integration. Moreover, visual problems are an
important contribution to poor nutritional status in a visual impaired people (MOPHS
and MOE, 2009).
Blind children have many years of blindness ahead of them: The number of “blind
years”
Resulting from blindness in children is more than half the number of “blind years”
caused by cataract in adults (Clare et al., 2003).

There are estimated 1.5million blind children worldwide, with an additional five million
who are visually impaired Among the blind and visually impaired children, 90% live in
the developing countries (Clare, 2001)In Nigeria.

The national Strategic Plan for Eye Care that is under review to pave way for the 2011-
2015planswillheavilybenefitfromtheseresults. Although several studies have been carried
out among general populations, there is little data on the prevalence, pattern and
causes of Viand blindness among primaries cool of visual loss children in Kenya(MOH,
2005).

Blindness is one of the series diseases at Manhal hospital Hargeisa Somaliland. It is one
of the problems which cause disability in Somaliland. Blindness is usually result multiple
disease those effect many peoples of our country. It is strictly defined as the state of
being totally sightless in both eyes. Cataract is one of the factors that influence the
prevalence of blindness. It is a dense, cloudy area that forms in the lens of the eye and
interferes with vision of the eyes.

Blindness also impacts family and community members. Because blindness imposes
restrictions on the ability to move about and control self and environment, a high
proportion (75%) of visually impaired people require assistance with everyday tasks.
There are many causes of blindness but the most common causes are Cataract,
Glaucoma, Trachoma and Diabetic retinopathy.

1.3 Purpose of the Study

The study was to find out the relationship between nutritional statusand visual
impairmentamong the teenage at Manual specialty Hospital Hargiesa, Somaliland.

1.4 Objectives of the Study

1.4.1 General Objectives

The overall the objective of this study is to examine the the relationship between
visual impairmentand nutritional status at Manhal hospital based study.

1.4.2 Specific objectives

I. To determine the demographic characteristics of respondents intermittent of
age and gender.
II. To explore or measure the level visual impairment at hospital based study
III. To exlprore or measure nutritional status at Manhal hospital based study

Research questions

I. How To determine the demographic characteristics of respondents

intermittent of age and gender?
II. How To explore or measure the level visual impairment at Manhal specialty
Hospital Hagias, Somaliland?
III. How To exlprore or measure nutritional status at Manhal specialty Hospital
Hagias, Somaliland ?
IV.
1.5 Scope of the problem
1.6 Time Scope:

The study under investigation was assigned to conduct March 2019 to May, 2019

1.6.2 Geographical scope

Manhal specialty and charity hospital locates in Mohamed Mooge district in Hargeisa city
Hargeisa, the hospital was opened in May 2006 to serve as specialist hospital for the
first time in Somaliland. Hospital harbors both inpatient and outpatient treatment of
eyes. Hargeisa is the largest city in Somaliland located in the North West region.
Hargeisa is the capital city of Somaliland; it was the colonial capital of the Somaliland
British protectorate from 1941 to 1960, when it gained independence as the state of
Somaliland. The population of Hargeisa is estimated 1.5 million people. This study was
focus on Hargeisa city especially Man hospital.

1.6.3 Content scope

The study was intended to examine the relationship between nuritional status and visual
impairment, Literature review of nutrition status and visual impairment is content scope of
this study. Demographic characteristics cause and effect relationship between the
independent variables and dependent variables.

1.6.4 theoretical scope

The study was examined by Hull’s theory of learning, (1983). It explains the
relationship between the two variables.

1.7 Significance of the Study

This study was benefited to the, Government, This study gives information about visual
impairment and nutritional staus of teenage. This study was inform the government
there is half of the children living with problems related to poor nutritional status,NOGs,
this study in form the humanitarian nongovernmental organization existence of in
Hargeisaa that there is a relationship between visual impairment and nutritional status.
Researchers, it has benefits for researchers to show and read this study to prove or
disprove and take as reference if they made other study.

Students, the students can read and understand the relationship between visual
impairment and nutritional status.
 It was beneficial for the students to use as a reference when they need to carry out
same research like this.

Operational Definitions of key Terms

Nutritional status: The condition of the body as influenced by the diet taken
and determined by anthropometric measurements.

Malnutrition: Is the condition that develops when the body does
not get the right amount of the vitamins, minerals, and other nutrients it needs to
maintain healthy tissues and organ function determined by anthropometric
measurements.

Visual impairment: Visual acuity <6/18 but equal to or better than 3/60 in the better
eye with best possible correction and visual field less than 10 degre in a widest part.

1.9Conceptual Frame Work

Independent variable IV Dependentvariable DV

Nutritional status
Visual imparment

Poor
Factors contribiting visual impairment and
nutritional
blindness.
status ,Loss
ability to shop
and daily live,

Visual Trachoma
impaired
Cataract
PEOPLE Do
not able D.mellites/Glaucoma
mobility and  Childhood blindness and
how to find Corneal opacity trauma
their food
Uncorrect refractive error