Trinidad lies in the Caribbean Sea off the northeast coast of Venezuela. Trinidad, the larger at 1,864 sq mi (4,828 sq km), is mainly flat and rolling, with mountains in the north that reach a height of 3,085 ft (940 m) at Mount Aripo. The population of Trinidad and Tobago in 2006 was estimated at 1,065,842 (annual population growth rate 2%) with 20% of the population under 15 years of age. According to UN, life expectancy is 68 years (men) and 74 years (women) and according to the 2003 estimates the literacy rate in Trinidad is 99%.
Education Services:
In Trinidad, primarily the education services for the blind have been delivered through an inclusive education system supported by a special unit in the Ministry of Education. There are trained itinerant teachers who provide support to children with VI in mainstream schools. Trinidad also has a school for the blind with an enrolment of 20-22 children. 10 years ago, a national survey was undertaken to identify the children with visual impairment. Since then, there has been no survey to identify children with disabilities.
Estimated need for educational services for VI in Trinidad
|
Population |
Childhood Pop. |
Children |
Bl/SVI |
Requiring Ed. Support Sighted Non-sighted |
|
|
1065842 |
213168 |
256 |
128 |
90 |
21 |
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 21 children in the country who would potentially require education with non-sighted techniques while there are another 90 children who have severe visual impairment and require educational support through sighted methods. In addition to the above, there are about 250 children with LV who 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 due to unavailability of necessary support.
Coverage
|
Required Ed. Support Sighted |
Required Ed. Support Non-sighted |
Number of Children in the programme |
Number of Children assessed |
|
90 |
21 |
50 |
56 |
There are around 50 children enrolled in the programme and 6 children have been newly identified who weren’t assessed earlier. Our data indicates that this programme has been providing services to 62% of the children in need. Considering the coverage rate in other countries, this coverage is reasonable however, an active case finding mechanism can be helpful to identify the children with VI who are not accessing educational services.
Distribution by Age:
|
Age groups (years) |
Frequency |
% |
|
1 – 5 |
2 |
3.6 |
|
6 -10 |
15 |
26.8 |
|
11 -15 |
23 |
41.1 |
|
16 – 20 |
15 |
26.8 |
|
21 – 25 |
1 |
1.8 |
|
Total |
56 |
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. 68% 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 evident that more male than female children are accessing educational services in the programme. 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 |
8 |
14.3 |
|
1 – 3 years |
26 |
46.4 |
|
More than 3 years |
22 |
39.3 |
|
Total |
56 |
100 |
Table 2: The data shows that 46.4% of the children have spent more than 1-3 years in the programme, which also indicate the recent escalation of the programme. New enrollment again seems to be reasonable as 8 children were identified who have joined the school this year.
Any other disability:
Fig. 2: 12.5% of children had additional disabilities which include pre-dominantly children with hearing impairment, followed by learning disabilities.
Reading ability:
Fig. 3: 66% of sample was using large print as their learning medium while 34%% were Braille users. 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 |
9 |
16.1 |
|
Refractive Error |
2 |
3.6 |
|
Corneal disease |
7 |
12.5 |
|
Lens related |
10 |
17.9 |
|
Retinal disease |
19 |
33.9 |
|
Albinism |
1 |
1.8 |
|
Others |
5 |
8.9 |
|
Glaucoma |
3 |
5.4 |
|
Total |
56 |
100 |
Table 3: shows that nearly 24% children had visual impairment due to causes which were either preventable or treatable. Retinal diseases feature quite high on the list of causes of blindness/SVI. It is interesting to know that 16.1% of the sample falls within the normal category.
Types of Refractive Errors:
|
Type of Refractive Error |
Frequency |
% |
|
Blind |
17 |
30.4 |
|
Myopia |
17 |
30.4 |
|
Hypermetropia |
6 |
10.7 |
|
Plain Astigmatism |
5 |
8.9 |
|
None |
11 |
19.6 |
|
Total |
56 |
100 |
Table 4: Shows significant refractive errors where Myopia was the most common i.e. 30.4%, followed by hypermetropia 10.7%.
Presenting Distance Vision:
|
Presenting distance vision |
Frequency |
% |
|
≥HM (Blind) |
17 |
30.4 |
|
≥ 1.4 (Blind) |
5 |
8.9 |
|
≥ 1.1 – 1.3 (SVI) |
11 |
19.6 |
|
≥ 0.6 – 1.0 (LV) |
11 |
19.6 |
|
≤ 0.5 (Normally sighted) |
0 |
0 |
|
≤ 0.3 – 0.5 |
2 |
3.6 |
|
0.3 or better |
10 |
17.9 |
|
Total |
56 |
100 |
Table 5: This table shows that 58.90% were either blind or severe visual impaired, while 19.6% had low vision.
Corrected Distance Vision:
|
Corrected Distance Vision |
Frequency |
% |
|
≥HM (Blind) |
17 |
30.4 |
|
≥ 1.4 (Blind) |
3 |
5.4 |
|
≥ 1.1 – 1.3 (SVI) |
7 |
12.5 |
|
≥ 0.6 – 1.0 (LV) |
16 |
28.6 |
|
≤ 0.5 (Normally sighted) |
13 |
23.2 |
|
Total |
56 |
100 |
Table 6: A slight shift was noted in the categories after appropriate prescription of spectacles. The percentage of blind/SVI reduced from 58.90% to 48.30%, where those who improved with correction shifted from the previous to the low vision category which increased to 19.6% from 28.6%. The number of children with normal/near normal vision was increased from 12 to 13.
Fig. 4: On presentation, 17 children could not read N8 print (newspapers, books etc) while the remaining 22 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 methods.
Fig. 5: A slight shift was noted in the categories after appropriate prescription of spectacles and the percentage of children who can’t see 1M reduced from 30.36% to 23.21%.
Contrast sensitivity:
|
Contrast sensitivity |
Frequency |
% |
|
Blind |
17 |
30.4 |
|
Can read 20 or more at 1 meter |
26 |
46.4 |
|
Can read 10 – 20 at 1 meter |
3 |
5.4 |
|
Can read <10 at 1 meter |
10 |
17.9 |
|
Total |
56 |
100 |
Table 7: Contrast sensitivity is an important visual function which helps an individual in mobility, recognition of faces, copying from the blackboard and reading fine print. 23.30% children require additional lighting and high contrast materials.
|
Colour vision:
|
Table 8: Of those children with useful remaining vision majority had normal colour vision.
Visual fields:
|
Visual fields |
Frequency |
% |
|
Blind |
17 |
30.4 |
|
Normal fields |
34 |
60.7 |
|
Constricted fields |
5 |
8.9 |
|
Total |
56 |
100 |
Table 9: Of the children with residual vision, 8.9% had significant constriction in their visual fields and could benefit from orientation and mobility training.
Fig. 6: 32% of the children could benefit from the prescription of a telescope and achieved a normal or near-normal vision. 4X handheld monocular telescope was found to be most effective, followed by the 6X telescope.
Fig. 7: 31% of the children could benefit from the use of magnifiers. 4X handheld magnifier were found to be most effective, followed by 7X magnifier.
Cognitive Assessment
Methodology:
The methodology of cognitive assessment was same as Jamaica.
Table 1: What is your name? How do you spell that?
|
Name & spelling |
Frequency |
Percentage |
|
Does not comprehend |
1 |
1.8 |
|
Makes an attempt |
0 |
0 |
|
Needs time to answer |
4 |
7.1 |
|
Answers confidently |
13 |
23.2 |
|
Answers confidently & elaborate |
18 |
67.9 |
|
Total |
56 |
100 |
Table 1 shows 5 levels of response of children about their name and its spellings. 67.9% responded confidently and elaborated their reply while 23.2% answer confidently. Only one child could not comprehend.
Table 2: How old are you? And which class do you attend?
|
Age & class |
Frequency |
Percentage |
|
Does not comprehend |
0 |
0 |
|
Makes an attempt |
1 |
1.8 |
|
Needs time to answer |
6 |
10.7 |
|
Answers confidently |
12 |
21.4 |
|
Answers confidently & elaborate |
37 |
66.1 |
|
Total |
56 |
100 |
Table 2 shows response of children when asked about their age and class. 87.5% answers confidently, followed by 10.7% who needed time to answer.
Table 3: Where do you live and which school do you attend?
|
Town & school |
Frequency |
Percentage |
|
Does not comprehend |
0 |
0 |
|
Makes an attempt |
1 |
1.8 |
|
Needs time to answer |
3 |
5.4 |
|
Answers confidently |
12 |
21.4 |
|
Answers confidently & elaborate |
40 |
71.4 |
|
Total |
56 |
100 |
Table 3 shows response of children about their village and school. 71.4% answers confidently and elaborated while 21.4% answer confidently.
Table 4: What is your favourite subject at school and why?
|
Favorite subject |
Frequency |
Percentage |
|
Does not comprehend |
1 |
1.8 |
|
Makes an attempt |
0 |
0 |
|
Needs time to answer |
6 |
10.7 |
|
Answers confidently |
19 |
33.9 |
|
Answers confidently & elaborate |
13 |
53.6 |
|
Total |
56 |
100 |
Table 4: 87.5% responds confidently followed by 10.7% who needs time to answer about their favorite subject at school while one child 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 |
1 |
1.8 |
|
Makes an attempt |
1 |
1.8 |
|
Needs time to answer |
3 |
5.4 |
|
Answers confidently |
21 |
37.5 |
|
Answers confidently & elaborate |
30 |
53.6 |
|
Total |
56 |
100 |
Table 5 shows 5 levels of responses of children about journey to the clinic. 53.6% answers confidently and elaborate their reply while 37.5% answers confidently.
Table 6: Which reading text has been given?
|
Reading text |
Frequency |
Percentage |
|
Level 1: Words |
10 |
17.9 |
|
Level 2: Sentences |
46 |
82.1 |
|
Total |
56 |
100 |
Table 6: The reading text was according to the intellectual and educational level of the children. 82.1% could read sentences while 17.9% were not fluent with sentences.
Table 7: Comprehension?
|
Comprehension |
Frequency |
Percentage |
|
Unable to make attempt |
7 |
12.5 |
|
Can read few words |
4 |
7.1 |
|
Can read text |
7 |
12.5 |
|
Can read without help |
12 |
21.4 |
|
Can read fluently with confidence |
26 |
46.4 |
|
Total |
56 |
100 |
Table 7: 12.5% of the sample was unable to read either through Braille or print while 7.1% could read a few words. However, 67.80% children could read fluently and without help.
Observations:
The above data shows that visual and cognitive developments are closely related. Most of the children actively participated in the assessment and patterns of difficulties noted in the assessment indicate that certain compensatory intervention strategies to facilitate learning and performance may be particularly helpful for children with VI.
GUYANA: