Guyana is situated on the northern coast of South America, east of Venezuela, west of Suriname, and north of Brazil. A tropical forest covers more than 80% of the country. The population of Guyana in 2006 was estimated 767,245 (growth rate: 0.3%) with 30% of the population under 15 years of age. The life expectance is 65.9 and literacy rate is estimated 99% in 2003. Guyana’s population is made up of five main ethnic groups–East Indian, African, Amerindian, Chinese, and Portuguese. Ninety percent of the inhabitants live on the narrow coastal plain, where population density is more than 115 persons per square kilometre (380 per sq. mi.). The population density for Guyana as a whole is low–less than four persons per square kilometer.
Educational services:
Although the government has provided free education from nursery school to the university level since 1975, it has not allocated sufficient funds to maintain the standards of what had been considered the best educational system in the region. Many school buildings are in poor condition, there is a shortage of text and exercise books, the number of teachers has declined, and fees are being charged at the university level for some courses of study for the first time. Education for the visually impaired children in Guyana is offered though an integrated education program based at two resource centres in Georgetown and Linden. A total of 26 children are enrolled in the two resource centres; eighteen in George Town and eight in Linden.
Estimated need for educational services for VI in Guyana
|
Population |
Childhood Pop. |
Children |
Bl/SVI |
Requiring Ed. Support Sighted Non-sighted |
|
|
767245 |
230174 |
276 |
138 |
97 |
23 |
Table 1: 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.
Coverage
|
Required Ed. Support Sighted |
Required Ed. Support Non-sighted |
Number of Children in the programme |
Number of Children assessed |
|
|
97 |
23 |
26 |
26 |
|
Table 2: Of the total number of 120 children with blindness and severe visual impairment who require additional educational support only 26 have been identified and enrolled in the program. This translates into coverage of 21.6%. This number does not include 276 children with low vision who may be enrolled in the schools but would be facing difficulties in accessing text and participation in the class work. This low enrollment could be partially understood in the context of low population density and scattered population. Also there is no active case finding mechanism for identification of VI children in place.
Distribution by Age:
|
Age groups (years) |
Frequency |
% |
|
1 – 5 |
2 |
7.7 |
|
6 -10 |
9 |
34.6 |
|
11 -15 |
11 |
42.3 |
|
16 – 20 |
4 |
15.4 |
|
21 – 25 |
0 |
0 |
|
Total |
26 |
100 |
Table 3: 77% of the children are in the age groups of 6-15, while 15.4% are older.
Distribution by Sex:
Fig. 1: There is a strong gender imbalance in the enrollment of girls with visual impairment and there are twice as many boys as girls in the programme.
Number of years spent in the programme:
|
No. of years in the programme |
Frequency |
% |
|
Less than 1 year |
8 |
30.8 |
|
1 – 3 years |
5 |
19.2 |
|
More than 3 years |
13 |
50 |
|
Total |
26 |
100 |
Table 4: Most of the children have been in the education program for more than three years. New enrollment is also reasonable as 30% of the children have been enrolled in the program in last one year.
Additional disability:
Fig. 2: A significant proportion of children (23%) had additional disabilities. Most frequently encountered other disability was learning disorder followed by hearing impairment.
Reading ability:
Fig. 3: Of the 26 children examined seven were Braille readers while the remaining were using large print.
Distribution by Diagnosis:
|
Diagnosis |
Frequency |
% |
|
Normal |
1 |
3.8 |
|
Refractive Error |
4 |
15.4 |
|
Corneal disease |
3 |
11.5 |
|
Lens related |
9 |
34.6 |
|
Retinal disease |
4 |
15.4 |
|
Albinism |
2 |
7.7 |
|
Others |
3 |
11.5 |
|
Glaucoma |
0 |
0 |
|
Total |
26 |
100 |
Table 5: The most common cause of visual impairment was lens related, mostly amblyopic followed by Aphakia but also posterior capsule opacification and other surgery related complication. A small number of children with refractive errors had also been wrongly enrolled in the programme when all they only require spectacles for the correction of their refractive errors.
Types of Refractive Errors:
|
Type of Refractive Error |
Frequency |
% |
|
Normal |
8 |
30.8 |
|
Myopia |
9 |
34.6 |
|
Hypermetropia |
4 |
15.4 |
|
Plain Astigmatism |
2 |
7.7 |
|
None |
3 |
11.5 |
|
Total |
26 |
100 |
Table 6: Of those children with significant refractive errors, myopia was the most common at 34%, followed by hypermetropia and astigmatism.
Presenting Distance Vision:
|
Presenting distance vision |
Frequency |
% |
|
Blind (HM or less) |
8 |
30.8 |
|
≥ 1.4 (Blind) |
2 |
7.7 |
|
≥ 1.1 – 1.3 (SVI) |
3 |
11.5 |
|
≥ 0.6 – 1.0 (LV) |
7 |
26.9 |
|
≤ 0.5 (Normally sighted) |
1 |
3.8 |
|
≤ 0.3 – 0.5 |
1 |
3.8 |
|
0.3 or better |
4 |
15.4 |
|
Total |
26 |
100 |
Table 7: On examination 38.5% of the children were found to be blind. 1.5% had severe visual impairment while a significant number (27%) had low vision.
Corrected Distance Vision:
|
Corrected Distance Vision |
Frequency |
% |
|
Normal |
8 |
30.8 |
|
≥ 1.4 (Blind) |
3 |
11.5 |
|
≥ 1.1 – 1.3 (SVI) |
3 |
11.5 |
|
≥ 0.6 – 1.0 (LV) |
7 |
26.9 |
|
≤ 0.5 (Normally sighted) |
5 |
19.2 |
|
Total |
26 |
100 |
Table 8: No classification shift was noted with prescription of best correction except a small increase in the number of normal sighted from low vision.
Fig. 4: On presentation, 10 children could not read N8 print (newspapers, books etc) while the remaining 8 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 |
8 |
30.8 |
|
Can read 20 or more at 1 meter |
9 |
34.6 |
|
Can read 10 – 20 at 1 meter |
3 |
11.5 |
|
Can read <10 at 1 meter |
6 |
23.1 |
|
Total |
26 |
100 |
Table 7: Contrast sensitivity helps an individual in mobility, recognition of faces, copying from the blackboard and reading fine print. 34.60% children require additional lighting and high contrast materials.
|
Colour vision:
|
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|
Table 8: Of those children with useful remaining vision majority had normal colour vision while 3.8% 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 |
8 |
30.8 |
|
Normal fields |
17 |
65.4 |
|
Constricted fields |
1 |
3.8 |
|
Total |
26 |
100 |
Table 9: One child had significant constriction in the visual fields and could benefit from orientation and mobility training.
Fig. 6: Nearly 16% of the children could benefit from the prescription of a telescope and achieve a normal or near-normal vision. 6X handheld monocular telescope was found to be most effective, followed by the 4X telescope.
Fig. 7: Nine children who couldn’t read small print all could read N8 with the aid of magnifiers. Two children who could read 1M without magnifiers were also prescribed 4X handheld magnifiers to facilitate their reading.
Cognitive Assessment
The methodology of cognitive assessment was same as done in Jamaica and Trinidad.
Table 1: What is your name? How do you spell that?
|
Name & spelling |
Frequency |
Percentage |
|
Does not comprehend |
2 |
7.7 |
|
Makes an attempt |
0 |
0 |
|
Needs time to answer |
2 |
7.7 |
|
Answers confidently |
1 |
3.8 |
|
Answers confidently & elaborate |
21 |
80.8 |
|
Total |
26 |
100 |
Table 1 shows 5 levels of response of children about their name and its spellings. 80.8% responded confidently and elaborated their reply while 3.8% answer confidently, followed by 7.7% who needed time to answer.
Table 2: How old are you? And which class do you attend?
|
Age & class |
Frequency |
Percentage |
|
Does not comprehend |
2 |
7.7 |
|
Makes an attempt |
0 |
0 |
|
Needs time to answer |
1 |
3.8 |
|
Answers confidently |
4 |
15.4 |
|
Answers confidently & elaborate |
19 |
73.1 |
|
Total |
26 |
100 |
Table 2 shows response of children when asked about their age and class. 88.5% answers confidently, while 7.7% could not comprehend the question.
Table 3: Where do you live and which school do you attend?
|
Town & school |
Frequency |
Percentage |
|
Does not comprehend |
2 |
7.7 |
|
Makes an attempt |
1 |
3.8 |
|
Needs time to answer |
4 |
15.4 |
|
Answers confidently |
3 |
11.5 |
|
Answers confidently & elaborate |
16 |
61.5 |
|
Total |
26 |
100 |
Table 3 shows response of children about their village and school. 15.4% needs time to answer, 3.8% made an attempt while 7.7% doesn’t comprehend the question.
Table 4: What is your favourite subject at school and why?
|
Favorite subject |
Frequency |
Percentage |
|
Does not comprehend |
5 |
19.2 |
|
Makes an attempt |
0 |
0 |
|
Needs time to answer |
2 |
7.7 |
|
Answers confidently |
4 |
15.4 |
|
Answers confidently & elaborate |
15 |
57.7 |
|
Total |
26 |
100 |
Table 4: 73.1% responds confidently while 19.2% 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 |
2 |
7.7 |
|
Makes an attempt |
1 |
3.8 |
|
Needs time to answer |
5 |
19.2 |
|
Answers confidently |
5 |
19.2 |
|
Answers confidently & elaborate |
13 |
50 |
|
Total |
26 |
100 |
Table 5: 50% answers confidently and elaborated, followed by 19.2% who answers confidently. 19.2% needs time to answer while 2 children could not comprehend the question.
Table 6: Which reading text has been given?
|
Reading text |
Frequency |
Percentage |
|
Level 1: Words |
9 |
34.6 |
|
Level 2: Sentences |
17 |
65.4 |
|
Total |
26 |
100 |
Table 6: The reading text was according to the intellectual and educational level of the children. 65.4% could read sentences while 34.6% couldn’t perform up-to the mark.
Table 7: Comprehension?
|
Comprehension |
Frequency |
Percentage |
|
Unable to make attempt |
3 |
11.5 |
|
Can read few words |
1 |
3.8 |
|
Can read text |
7 |
26.9 |
|
Can read without help |
6 |
23.1 |
|
Can read fluently with confidence |
9 |
34.6 |
|
Total |
26 |
100 |
Table 7: 11.5% of the sample was unable to read either through Braille or print while 3.8% could read a few words. However, 57.70% children could read fluently and without help.
Conclusion:
The above data shows the strengths and weaknesses of the cognitive profiles of the sample and factors which influence their performance. Most of the children actively participated in the assessment and it is clearly evident that lack of vision, in itself, does not inhibit learning, but lack of opportunity to function does and the less socially interaction there is, the less cognitive growth there will be. The sample is a good example of provision of many and varied concrete experiences i.e. “hands on” and “interactive” which help children with VI to achieve their cognitive potential.
Conclusion: