From visual function deficiency to handicap: measuring visual handicap in Mali.
OBJECTIVE
Blindness is a major public health problem in developing countries, even though most could be prevented by relatively simple hygienic and medical interventions. Relatively few patients use the quality health care services available, despite their low cost, due to problems of access or socio-cultural barriers. This health services research project stressed the need for measurement of subjective self-perceived health. The objectives of this study were twofold: a) To translate, adapt and integrate the cultural context found in Mali and validate two instruments for measuring, respectively, perceived vision and quality of life. b) To study the relationship between these variables and visual deficiencies by gender.


METHODS
The perceived vision and quality of life questionnaires were based on a translation of the Aravind questionnaire, adapted to Mali. The resulting perceived vision questionnaire comprises 13 questions, grouped according to five subscales (global vision, visual perception, sensory adaptation, visual field and depth perception). Furthermore, the 13 questions on quality of life were grouped into four subscales (personal care, mobility, social life and psychological). For both questionnaires, a global score could be computed. These two questionnaires were administered to a representative sample of 203 subjects with impaired vision, aged over 40, in a rural area in Mali.


RESULTS
The acceptability of the questionnaires was good (1% missing data). The convergent validity was adequate for all but one subscale (psychological). The discriminate validity is acceptable for three of the six subscales where measurement can be made (visual perception, personal care, mobility). The Cronbach alpha coefficients indicate good reliability for the global scores.


CONCLUSIONS
Analysis of mean results confirms the validity of the International Classification of Disease (ICD) definition of blindness (seeing less than 0.05 results in a steep decrease in quality of life). Moreover, blindness affects the quality of life of women more severely than that of men; this may be related to the availability of social support.
Schémann
Jean François
JF
IOTA (Institute of African Tropical Ophthalmology), Bamako, Mali. schemann@iotaccge.org
Leplège
Alain
A
Keita
Tahirou
T
Resnikoff
Serge
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008302:Mali / Q000453:epidemiology; D008875:Middle Aged; D011788:Quality of Life; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000175:diagnosis* / Q000453:epidemiology; D014787:Vision Tests / Q000379:methods; D019987:Persons with Visual Disabilities