Jamaica is an island in the West Indies, 90 mi (145 km) south of Cuba and 100 mi (161 km) west of Haiti. The population of Jamaica in 2006 was estimated at 2,758,124 (growth rate 0.8%) with 31% of the population under 15 years of age. The life expectancy rate is 70.7 and according to the 2003 estimates the literacy rate in Jamaica is 87.9% (male: 84.1% and female: 91.6%).
Educational services:
The education services for the visually impaired have been delivered through Salvation Army School for the Blind. It is a residential facility primarily for children with visual impairment but also has a small number of children with multiple disabilities i.e. deaf-blind, multiple handicapped etc. The school has an enrolment of approximately 120 children. Of these, 20 children are studying in mainstream education supported by two itinerant teachers. All the children are referred by Ophthalmologists with a certificate of their visual status and diagnosis which is available in their case files. Some of the children have active pathologies and are receiving treatment. In many cases, the children have been prescribed with spectacles and a few children were using hand held magnifiers.
* Estimated Need for educational services for VI in Jamaica
|
Population |
Childhood Pop. |
Children |
Bl/SVI |
Requiring Ed. Support Sighted Non-sighted |
|
|
2758124 |
855018 |
1026 |
513 |
360 |
86 |
* The need is calculated using an estimated prevalence of Childhood Blindness of 0.6/1000 and twice this number as having low vision. The numbers are calculated using CBL/LV calculation tool. This indicates that there are at least 86 children in the country who would potentially require education with non-sighted techniques while there are another 360 children who have severe visual impairment and require educational support through sighted methods. In addition to the above, there are about 1000 children with LV who although could be attending mainstream education will be having difficulties in accessing text and coping with the class work and the chances of their dropping out of school are significantly higher than that of their sighted peers.
Coverage
|
Ed. Support required Sighted |
Ed. Support required Non-sighted |
Number of Children in the programme |
Number of Children assessed |
|
360 |
86 |
120 |
89 |
The main service provider for the education of children with VI in Jamaica is the Salvation Army School for the Blind. This is the special education facility which has around 120 children enrolled. Of these, we were able to assess 89 while the remaining were either absent or unavailable. Our data indicates that this programme is been providing services to 33.3% of the children with Bl/SVI in the country. Based on our discussions with key informants, there is no active case finding mechanism in place to identify children with VI. On the other hand, we couldn’t find any evidence of any other formal education support programme for children with VI in Jamaica. Considering the coverage rate in other countries, this coverage is reasonable however, still majority of children don’t have access to education.
Distribution by Age:
|
Age groups (years) |
Frequency |
% |
|
1 – 5 |
0 |
0 |
|
6 -10 |
23 |
25.8 |
|
11 -15 |
46 |
51.7 |
|
16 – 20 |
20 |
22.5 |
|
21 – 25 |
0 |
0 |
|
Total |
89 |
100 |
Table 1: Shows distribution of age in the sample. Majority of the children in programme are between the ages of 6-15 i.e. 77% which is the normal school going age of sighted children as well. Most of the children enrolled are studying in the grades appropriate to their age groups.
Distribution by Sex:
Fig. 1: Looking at the gender distribution of the sample, it is obvious that more male than female children are accessing educational services in the programme. There is no evidence to suggest that visual impairment in girls is less then boys and a concerted effort is needed to identify more female children.
Number of years spent in the programme:
|
No. of years in the programme |
Frequency |
% |
|
Less than 1 year |
4 |
4.5 |
|
1 – 3 years |
33 |
37.1 |
|
More than 3 years |
52 |
58.4 |
|
Total |
89 |
100 |
Table 2: Shows that 58.4% of the children have spent more than 3 years in the current programme, while 37.1% have spent 1-3 years. New enrollment seems to be low as only 4 children were identified who have joined the school this year.
Any other disability:
Fig. 2: A significant proportion of children had additional disabilities i.e. 17%. These included pre-dominantly children with hearing impairment, followed by intellectually challenged and a few with physical disabilities. There is a special facility in the school to cater to the needs of deaf-blind.
Reading ability:
Fig. 3: 55% of sample was using Braille as their learning medium while 45% were large print-readers. This corroborates well with the visual status of the children and in most cases only those needing Braille were its users and those with useful remaining vision were using print.
Distribution by Diagnosis:
|
Diagnosis |
Frequency |
% |
|
Normal |
8 |
9 |
|
Refractive Error |
2 |
2.25 |
|
Corneal disease |
6 |
6.74 |
|
Lens related |
20 |
22.47 |
|
Retinal disease |
26 |
29.21 |
|
Albinism |
0 |
0 |
|
Glaucoma |
23 |
25.84 |
|
Others |
4 |
4.5 |
|
Total |
89 |
100 |
Table 3: the distribution by diagnosis raises some alarms about the clinical services for children with VI. A significant proportion of children nearly 50% had visual impairment due to causes which were either preventable or treatable. Glaucoma features quite high on the list of causes of blindness/SVI. Optic Atrophy secondary to Meningitis was also observed. A few children had un-operated cataracts but this was due to their parents not giving consent for surgery. Majority of the lens related were either Aphakic or Psuedophakic and their VI was due to Amblyopia.
Types of Refractive Errors:
|
Type of Refractive Error |
Frequency |
% |
|
Blind |
38 |
42.7 |
|
Myopia |
17 |
19.1 |
|
Hypermetropia |
16 |
18.0 |
|
Plain Astigmatism |
2 |
2.2 |
|
None |
16 |
18.0 |
|
Total |
89 |
100 |
Table 4: 40% of the examined children had significant refractive errors where Myopia was the most common i.e. 19.1%, followed by hypermetropia 18% (some of this was actually Aphakia corrected with plus lenses).
Presenting Distance Vision:
|
Presenting distance vision |
Frequency |
% |
|
≥HM (Blind) |
38 |
42.7 |
|
≥ 1.4 (Blind) |
10 |
11.2 |
|
≥ 1.1 – 1.3 (SVI) |
12 |
13.5 |
|
≥ 0.6 – 1.0 (LV) |
15 |
16.9 |
|
≤ 0.5 (Normally sighted) |
0 |
0 |
|
≤ 0.3 – 0.5 |
2 |
2.2 |
|
0.3 or better |
12 |
13.5 |
|
Total |
89 |
100 |
Table 5: This table shows that 67.40% were either blind or severe visual impaired, while 16.9% had moderate low vision. Of those whose vision was either normal or near normal had either undergone surgery or had additional disabilities which was masking there actual visual status.
Corrected Distance Vision:
|
Corrected Distance Vision |
Frequency |
% |
|
≥HM (Blind) |
38 |
42.7 |
|
≥ 1.4 (Blind) |
6 |
6.7 |
|
≥ 1.1 – 1.3 (SVI) |
8 |
9.0 |
|
≥ 0.6 – 1.0 (LV) |
23 |
25.8 |
|
≤ 0.5 (Normally sighted) |
14 |
15.7 |
|
Total |
89 |
100 |
Table 6: A slight shift was noted in the categories after appropriate prescription of spectacles. The percentage of blind/SVI reduced from 67.40% to 58.40%,where those who improved with correction shifted from the previous to the low vision category which increased to 25.8% from 16.9%.There was no shift in the percentage of normal/near normal vision which remained the same.
Fig. 4: On presentation, 25 children could not read N8 print (newspapers, books etc) while the remaining 26 could read N8 print either unaided or with there existing spectacle. The remaining children did not have enough residual vision to access print and needed materials or non sighted.
Fig. 5: No significant change in the reading ability was noted with the prescription of new spectacles.
Contrast sensitivity:
|
Contrast sensitivity |
Frequency |
% |
|
Blind |
38 |
42.7 |
|
Can read 20 or more at 1 meter |
31 |
34.8 |
|
Can read 10 – 20 at 1 meter |
10 |
11.2 |
|
Can read <10 at 1 meter |
10 |
11.2 |
|
Total |
89 |
100 |
Table 7: Contrast sensitivity function is the ability of the eye to distinguish between various shades of luminance. It is an important visual function which helps an individual in mobility, recognition of faces, copying from the blackboard and reading fine print. 22.4% children require additional lighting and high contrast materials.
|
Colour vision:
|
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Table 8: Colour vision was not performed in detail and only functional colour vision assessment was carried out. Of those children with useful remaining vision majority had normal colour vision while 10.1% children had difficulty in recognizing basic colours. The teachers in the programme should be aware of the colour vision problems and need to develop teaching materials accordingly.
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Visual fields:
|
Visual fields |
Frequency |
% |
|
Blind |
38 |
42.7 |
|
Normal fields |
44 |
49.4 |
|
Constricted fields |
7 |
7.9 |
|
Total |
89 |
100 |
Table 9: Of the children with residual vision, 8% had significant constriction in their visual fields and could benefit from orientation and mobility training.
Fig. 6: Nearly 30% of the children could benefit from the prescription of a telescope and achieved a normal or near-normal vision. 6X handheld monocular telescope was found to be most effective, followed by the 4X telescope.
Fig. 7: Of the 24 children who couldn’t read small print 18 could read N8 with the aid of magnifiers. While the vision of the remaining 6 children didn’t improve substantially however, these children may still be able to read text with the help of close circuit televisions. Majority of the sighted children had never tried magnifiers before and were primarily relying on large print.
Cognitive Assessment
Methodology:
The cognitive assessment was done by administering a structured questionnaire to each child, participated in the assessment. The child was asked simple questions like what is your name, which class do you attend; how old are you and where do you live etc. Besides, a short reading text in large print and Braille given to the low vision and blind children respectively, duly prepared by the Itinerant teachers. Accordingly a circle in 1-5 point scale was given to mark out of five on the basis of the answer of the child and the reading test. It was also taken care that no adults/parents and concerned IE teacher interfered or answered on behalf of the child as instructed earlier.
Table 1: What is your name? How do you spell that?
|
Name & spelling |
Frequency |
Percentage |
|
Does not comprehend |
7 |
7.9 |
|
Makes an attempt |
2 |
2.2 |
|
Needs time to answer |
16 |
18.0 |
|
Answers confidently |
39 |
43.8 |
|
Answers confidently & elaborate |
25 |
28.1 |
|
Total |
89 |
100 |
Table 1 shows 5 levels of response of children about their name and its spellings. 28.1% responded confidently and elaborated their reply while 43.8% answer confidently, followed by 18% who needed time to answer.
Table 2: How old are you? And which class do you attend?
|
Age & class |
Frequency |
Percentage |
|
Does not comprehend |
8 |
9 |
|
Makes an attempt |
1 |
0.11 |
|
Needs time to answer |
11 |
12.4 |
|
Answers confidently |
44 |
49.4 |
|
Answers confidently & elaborate |
25 |
28.1 |
|
Total |
89 |
100 |
Table 2 shows response of children when asked about their age and class. 77.5% answers confidently, followed by 12.4% who needed time to answer.
Table 3: Where do you live and which school do you attend?
|
Town & school |
Frequency |
Percentage |
|
Does not comprehend |
9 |
10.1 |
|
Makes an attempt |
3 |
3.4 |
|
Needs time to answer |
15 |
16.9 |
|
Answers confidently |
34 |
38.2 |
|
Answers confidently & elaborate |
28 |
31.5 |
|
Total |
89 |
100 |
Table 3 shows response of children about their village and school. 16.9% needs time to answer, 3.4% made an attempt while 10.1% doesn’t comprehend the question.
Table 4: What is your favourite subject at school and why?
|
Favorite subject |
Frequency |
Percentage |
|
Does not comprehend |
20 |
22.5 |
|
Makes an attempt |
11 |
12.4 |
|
Needs time to answer |
20 |
22.5 |
|
Answers confidently |
23 |
25.8 |
|
Answers confidently & elaborate |
15 |
16.9 |
|
Total |
89 |
100 |
Table 4: 25.8% responds confidently followed by 22.5% who needs time to answer about their favorite subject at school while 22.5% does not comprehend the question.
Table 5: Can you tell us about your journey to this clinic today?
|
Journey to clinic |
Frequency |
Percentage |
|
Does not comprehend |
60 |
67.4 |
|
Makes an attempt |
10 |
11.2 |
|
Needs time to answer |
11 |
12.4 |
|
Answers confidently |
5 |
5.6 |
|
Answers confidently & elaborate |
3 |
3.4 |
|
Total |
89 |
100 |
Table 5 shows 5 levels of responses of children about journey to the clinic. 67.4% does not comprehend the question followed by 12.4% who needs time to answer while 11.2% makes an attempt. 3.4% answers confidently and elaborate their reply while 5.6% answers confidently.
Table 6: Which reading text has been given?
|
Reading text |
Frequency |
Percentage |
|
Level 1: Words |
15 |
16.9 |
|
Level 2: Sentences |
74 |
83.1 |
|
Total |
89 |
100 |
Table 6: The reading text was according to the intellectual and educational level of the children. 83.1% could read sentences while 16.9% couldn’t perform up-to the mark.
Table 8: Comprehension?
|
Comprehension |
Frequency |
Percentage |
|
Unable to make attempt |
26 |
29.2 |
|
Can read few words |
15 |
16.9 |
|
Can read text |
10 |
11.2 |
|
Can read without help |
18 |
20.2 |
|
Can read fluently with confidence |
20 |
22.5 |
|
Total |
89 |
100 |
Table 8: 29.2% of the sample was unable to read either through Braille or print while 16.9% could read a few words. However, 42.7% children could read fluently and without help.
Observations:
It is important to see the child with visual impairment first as a child (with all of the growing-up problems of other children), and secondarily as a child with a visual impairment. One aspect of social skills is often overlooked – that is of conversation. It was noticed that children sometimes have difficulty initiating, maintaining, and bringing closure to conversations. Some of these difficulties are due to the inability to observe facial expressions and body language, but the child’s lack of experiences and egocentricity may also have contributed to the problem. Specific attention may need to be given to conversational skills (e.g., talking about events, people, objects, and encouraging the child to talk about them as well; reading a story and asking the child to fill in details or even retell the story). If these skills are practiced in early childhood, they may be less trouble-some later, in school and in life.
Trinidad: