Year : 2014 | Volume
: 1 | Issue : 4 | Page : 161--167
Approaches to tackling the menace of street begging by visually disabled persons in Northern Nigeria
Aliyu H Balarabe1, Abdulraheem O Mahmoud2,
1 Department of Ophthalmology, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria
2 Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
Aliyu H Balarabe
Department of Ophthalmology, Federal Medical Centre, Birnin Kebbi, P.M.B. 1126, Kebbi State
Street begging is a social challenge that is more rampant in Northern Nigeria than elsewhere in the country. Some poor individuals resort to street begging to sustain their families. Street begging is found more among people living with physical challenges, particularly the blind persons. We reviewed the literature on the causes of blindness and challenges to accessing curative and rehabilitation support services. This is with a view to draw the attention of policy formulators on the appropriate rehabilitation of the visually disabled persons in order to tackle the menace of street begging in Northern Nigeria. A review of the literature was done electronically as well as manually. For electronic search, various scientific journals and web-based search engines were used. The search terms were blind street beggars, visual disability among beggars, avoidable blindness, blindness in northern Nigeria, socioeconomic impact of blindness, psychosocial impact of blindness, challenges of rehabilitation in Nigeria, visual disability in Northern Nigeria, destitution in Nigeria. Cross references of relevant articles were also retrieved. Majority had blindness from avoidable causes (over 75%) and had difficulty in accessing curative and rehabilitation support services. In the light of the avoidable nature of the majority of the causes of blindness among blind beggars in Northern Nigeria, coupled with the existing inadequate modalities for rehabilitating incurably blind, it is recommended that, a comprehensive eye care program on preventive, curative and rehabilitative services with a strong public health education campaign on the avoidable causes of blindness and discouraging street begging should be put in place by relevant stakeholders.
|How to cite this article:|
Balarabe AH, Mahmoud AO. Approaches to tackling the menace of street begging by visually disabled persons in Northern Nigeria
.Sub-Saharan Afr J Med 2014;1:161-167
|How to cite this URL:|
Balarabe AH, Mahmoud AO. Approaches to tackling the menace of street begging by visually disabled persons in Northern Nigeria
. Sub-Saharan Afr J Med [serial online] 2014 [cited 2020 Apr 9 ];1:161-167
Available from: http://www.ssajm.org/text.asp?2014/1/4/161/144721
INTRODUCTION AND EPIDEMIOLOGICAL CONSIDERATIONS
Visual disability is a serious challenge to a developing country. Poverty as a consequence of visual disability may occasionally lead to destitution and street begging, especially in areas where rehabilitation services are scarce. Street beggars are individuals or group of persons who beg or make a living from the streets by asking people for money, food and clothes as gifts or charity.  Street begging is a social challenge and a menace that is rampant in Northern Nigeria.  Some poor individuals resort to street begging to sustain their families. This is more pronounced among people who are physically challenged particularly the blind persons. Poverty and blindness are linked in a cycle in developing countries, as poverty is not only a cause but also a consequence of visual disability. 
The VISION 2020: The right to sight, a global initiative for the elimination of avoidable blindness by the year 2020 was launched in 1999. , The Vision seeks to eliminate the main causes of avoidable blindness by the year 2020 in order to give all people in the world the Right to Sight.  This initiative can be achieved through comprehensive eye care program. To achieve a comprehensive eye care program in any community, there will be a need for advocacy that is a crucial component of VISION 2020; the Right to Sight. 
The global number of people with blindness is projected to increase from around 45 million in the year 2000 to over 75 million by 2020.  If the VISION 2020 initiative is implemented, the projection is less than 25 million in 2020. This would save 100 million people from going blind and an estimated 400 million years of blindness between now and the year 2020.
The VISION 2020 program consists of three elements: Disease control, human resource development and infrastructure development. The guiding principles for VISION 2020 program are an integrated, sustainable, equitable and excellent eye care services. The strategies to be employed include concerted teamwork, training, better management, monitoring and evaluation of eye care services.  These strategies should be a reflection of local needs, based on the assessment of what really needs to be done. The assessment should address not only what or how much to do, but also address the question of how an existing program can be done better. The Vision can be achieved through implementing national and district action plans, hence the need for planning at regional levels.
The national blindness and visual impairment survey in Nigeria,  revealed the prevalence of blindness in those 50 years and above to be 5.5%. The prevalence of blindness in people of all ages  was estimated to be 0.78%. This detailed survey in Nigeria revealed a much higher prevalence of blindness than generally observed in Rapid Assessment of Avoidable Blindness in other African countries (2.5-3.7% in those 50 years and older). , It is also significantly higher than values in developed countries (0.15-0.9%). ,, The methodology employed in the Nigerian study  was similar to the studies conducted in other populous Asian countries. ,
Prior to the national survey in Nigeria, most data used for planning eye care services have been generated from hospital-based studies, , or special population groups,  or from small, focal surveys. ,,,,, These data showed regional variation in prevalence and causes of blindness. Results of a national survey in Nigeria  showed that participants living in the South-West geopolitical zone had the lowest prevalence of blindness (2.8%), while those in North-East geopolitical zone had the highest (6.1%).
The major causes of blindness in developing countries of Africa ,, and Asia , are largely due to avoidable causes such as cataract, trachoma, onchocerciasis and corneal scarring with cataract accounting for more than 40% of blindness in these regions. The predisposing factors include ignorance, poverty, illiteracy, culture and belief, self-medication and lack of eye care personnel.
Data obtained during the Nigerian national survey of blindness, and low vision,  showed that cataract accounted for 43% of blindness. Other causes included glaucoma 16%, corneal opacity 12%, optic atrophy 3%, refractive error 1%, while macular degeneration accounted for less than 1%, others constituted 18%. The neglected tropical diseases, onchocerciasis and trachoma, accounted for 1% and 4% of blindness, respectively. Trachoma and onchocerciasis are focal diseases and are responsible for a significant proportion of blindness in endemic areas. ,,,, However, the contributions of trachoma and onchocerciasis at national level were found to be low in Nigerian survey,  However, trachoma contributes about 12% of blindness among beggars in an urban community in Sokoto, North western Nigeria.  Regional variations need to be addressed so that priority attention is given to those regions with high magnitude of blindness but lack adequate surgical, optical and rehabilitative services within a system that delivers comprehensive eye care to populations.
To achieve a comprehensive eye care program in any community, there will be a need for advocacy that is a crucial component of VISION 2020; the Right to Sight.  A review of the literature for the current research was done electronically as well as manually. For electronic search, various scientific journals and web-based search engine were used. The search terms were blind street beggars (BSBs), irreversible blindness, visual disability, avoidable blindness, blindness in northern Nigeria, barriers to eye health services, socioeconomic impact of blindness, psychosocial impact of blindness, rehabilitation services, challenges of rehabilitation, visual disability in northern Nigeria; quality-of-life, blindness in Nigeria. Cross references of relevant articles were also retrieved.
CAUSES AND CONSEQUENCES OF BLINDNESS AMONG BEGGARS
In a study among BSB in a Local Government Area (LGA) in Sokoto State, Northwestern Nigeria in which 202 blind individuals were examined, the major causes of blindness were corneal opacities, cataract and complications from couching (60.8%, 5.4% And 4% respectively).  The main causes of blindness in that survey was comparable to other studies among blind beggars in North east and North central Nigeria, , with the major causes being corneal scarring (83%)  and cataract (48.3%).  Corneal scarring is a significant cause of blindness in developing countries. ,,,, The underlying causes of corneal scarring in these three major studies were measles, trauma and infective keratitis.
The proportion of individuals with cataract blindness among blind beggars was far less than what was reported from prevalence surveys in Northern Nigeria. , Since cataract blindness is treatable most people with cataract blindness would rather go for surgery than embark on street begging. Avoidable causes were responsible for more than 80% of blindness among beggars studied in Northern Nigeria. ,, These were mainly preventable causes such as corneal opacities, complications of cataract intervention and glaucoma in which early detection and prompt intervention would have prevented the blindness. Other causes were treatable, such as cataract and uncorrected aphakia.
The proportions of blindness due to avoidable causes obtained in these studies were similar to other studies carried out in Nigeria (80-94%). ,, These findings are typical of blindness in Sub-Saharan Africa and other parts of the developing world where 80-90% of all blindness is due to avoidable causes. The barriers to accessing curative services among blind beggars in Sokoto, North western Nigeria, were reported to be as a result of services not being available (50.3%) or blind persons not being taken to any of the available health facilities by their parents/relatives (25.2%). Other barriers were due to cost of treatment (12.9%) or lack of awareness of the available health facilities (11%). The barriers reported in that study have some similarities to factors observed in other barrier studies in Nigeria and elsewhere. ,,,,
In human term, the cost of blindness is incalculable. In social term, it is astonishing and in economic term, it is the most expensive of all the causes of serious disability.  The presence of a number of blind individuals in a community implies a significant loss of productivity.  Not only because the blind often cannot be productively engaged but also because others must care for them and generate the needed resources for their survival.
Previous studies have explored the link between blindness and economics. , It has been estimated that, the economic gain of eliminating all avoidable blindness throughout the world by the year 2020 would be $102 billion as a result of increased productivity.  Another study undertaken in Gambia, showed that investing in eye care makes economic sense, as the investment yielded an internal rate of return of at least 10%.  Control of blindness can, therefore, alleviate poverty and contribute to the achievement of Millennium Development Goals. 
A study in Australia, on the economic impact and cost of vision loss,  estimated the cost of visual loss as a direct cost, the indirect cost and the cost of suffering and premature death. The direct cost included the cost of prevention and treatment of all vision disorders in the hospital, out of hospital and other health costs. The indirect costs include the cost to care givers, the lost productivity of the adult, the lost education of the blind child and the eventual lost productivity later during adulthood.  There was also a cost to the aids and the home modifications made to adjust to the blind persons. 
The indirect cost had been exemplified using the familiar scene of the young sighted child leading the blind around to beg on the street.  There was a lost income of a blind person just because of his disability as well as the lost education of the sighted child that escort the beggars. 
In a study in North central Nigeria on psychosocial characteristics of totally blind individuals, it was found that blind people were married (80%) and had children; they had longstanding blindness and no formal education or vocational training and therefore lived by street begging. They appeared to have a reasonable degree of social and family interaction and support; yet, there was a high rate of probable psychological dysfunction (51%). 
The key social challenges of blindness including mobility, occupation, and marriage are serious challenges not only for the blind and family but also for the society at large.  The society has a lot of roles to play in providing blind-friendly environment for those who are, unfortunately, afflicted.  This should be reflected in terms of special facilities on the roads, markets, well-founded schools, and rehabilitation centers for the blind. Adjustment to blindness is a holistic process (physical, social, and psychological), which enables the affected individual to live as normal a life as possible, comparable to people without disability in the community. The ophthalmologist is expected not only to play a major role in the physical care of the blind, but also in their social and psychological adjustment. The psychiatrists' involvement should be early enough to prevent, identify, and manage any psychological problems. Community health practitioners should advocate and evolve well-organized community health services to facilitate social adjustment in this group of people by identifying their social and health needs and how they can be met. 
The interrelationship between poverty and blindness has been well documented in a study among blind persons in Maiduguri, North eastern Nigeria.  Poverty has been conceptualized and measured in many different ways, it is not only adjudged in terms of income or consumptions, but also in terms of multidimensional deprivation considering basic needs such as health, education, access to clean water and other services, and capacities to participate in community life and influence decision-making. The role of poverty as a causative factor of blindness among the studied subjects could be inferred from the avoidable nature of the blindness.  The study also revealed a very low access to appropriate medical intervention at the early stages of the onset of eye problems possibly due to lack of funds and available facilities. Majority of the persons in that study roam the street begging to earn a living. 
PREVENTION AND CONTROL OF BLINDNESS INCLUDING REHABILITATION
Disease control should prioritize the major causes of blindness and low vision which includes cataract, trachoma, childhood blindness and uncorrected refractive errors and low vision. Majority of the BSBs were irreversibly blind and were in need of optimal rehabilitation support services.  Majority of the irreversibly blind subjects reported lack of adequate rehabilitation services.  Inadequacy of rehabilitation services in Nigeria has been reported. ,,,,
Rehabilitation of the blind involves provision of low vision services for those with some residual vision and formal education, especially to blind children.  It also includes the provision of vocational and functional training as well as social and legislative service support. 
Ophthalmologists are usually not the direct providers of formal rehabilitation or education for the irreversibly blind. Their role is to refer or advised the transfer of the irreversibly blind child or adult to a facility where self-care skill could be acquired. The Ophthalmologist could be involved in the initial counseling of the newly diagnosed blind, and in the prescription of low vision aids, particularly in places where relevant personnel (trained counselor and low vision aids specialist) are not available. 
Parents of irreversibly blind children may not be aware of the availability and/or entry requirements of schools for the blind. Counseling should include information about the available services in such facilities to encourage patients access them. Ophthalmologists in Nigeria also refer their patients to schools for the blind in order to have access to formal education. 
The majority of the blind in a study in North central Nigeria realized the importance of education and that it could give them a better future.  Although many beggars earn some money from street begging or through social welfare support, they still reported a desire for a change of job, suggesting that begging was still objectionable to them. ,
The above finding calls for a holistic approach to combat the menace of street begging by the irreversibly blind persons in our communities. This will enable them to take their part in socioeconomic development of our dear nation, just as their counterparts do in the developed societies of the world. 
In the light of the avoidable nature of the majority of the causes of blindness among blind beggars in Northern Nigeria, coupled with the existing inadequate modalities for rehabilitating the incurably blind, the following recommendations are suggested.
STRENGTHENING OF PRIMARY EYE CARE SERVICES
An intensive public health education campaign on the avoidable causes of blindness should be conducted. The campaign should focus on discouraging the use of harmful traditional practices on the eye and stressing the importance of good nutrition and improved hygiene. The significance of taking patients to hospitals where qualitative eye care services are available should be emphasized. Couching as an alternative to cataract surgery should be discouraged. The significance of early presentation to hospital for treatment of infectious diseases in order to avert irreversible blindness should be encouraged. These can be achieved through radio messages, television jingles, posters and health talks at public places. Partnership between government, nongovernmental organizations (NGOs) and health workers will go a long way in achieving this objective. Government needs to improve on the existing health facilities available in the LGAs through funding and to integrate primary eye care into primary health care program. The Local government authorities and the National program on immunization should consolidate on the gains recorded so far on the immunization coverage in their respective areas. Strategies that should include public health campaigns should be adopted to ensure wider coverage and acceptance in order to achieve target levels on immunization and reduce the incidence of measles related corneal opacities in our communities.
STRENGTHENING THE REFERRAL SYSTEM AND PROVISION OF INFRASTRUCTURE AND TECHNOLOGY
State eye care programs where available should be faithfully implemented by making services more available and affordable for individuals to access. The local governments in Northern Nigeria should also be encouraged to set up district eye care program as envisaged in the VISION 2020 action plan. There is a need to strengthen the referral system from primary through secondary to tertiary eye center. Appropriate infrastructure and technology are required in all sectors of the eye care in Nigeria. There is a need to ensure an adequate supply of consumables.
HUMAN RESOURCE DEVELOPMENT
There is a need to adequately train enough human resource to deliver qualitative eye care services at all levels.
Strategies for the control of major blinding eye diseases need to be faithfully implemented as clearly articulated in the strategic plan for VISION 2020 in Nigeria.
PROVISION OF REHABILITATION SUPPORT SERVICES FOR THE IRREVERSIBLY BLIND
There is a need for rehabilitation and refurbishment of the existing rehabilitation facilities in the States and also increase funding for the education of the irreversibly blind children. Partnership by government, NGOs and parents should be encouraged to achieve this. The government should provide more vocational centers for training the irreversibly blind adults and subsequently provide funds for them to access with a view to establishing them in businesses, trade or farming. The community needs to be involved during the planning and implementation of rehabilitation support services, and community ownership should be encouraged.
Provision of community-based rehabilitation center within the LGAs to train irreversibly blind subjects to become self-reliant and productive should be encouraged. Legislative framework that will discourage discrimination on the ground of disability in certain field of activities to enable educated blind individuals to access jobs should be encouraged. This will encourage parents to allow their children/wards to access formal education.
The fact that even the sighted persons with or without disabilities resort to street begging as well, it is recommended that: Elements of cultural beliefs and practices that promote begging in the society be properly identified and discouraged by relevant stakeholders such as religious and traditional leaders. Provision of social amenities and poverty alleviation measures of more permanent nature such as meeting the Millenium Development Goals should be put in place by relevant stakeholders such as NGOs.
Majority of BSB had avoidable blindness that could either have been prevented or cured were the necessary ophthalmic resources made available and to their awareness as of the time they became blind. The subsequent irreversible status of their blindness makes them only amenable to social and rehabilitation support services. A comprehensive eye care programwith a strong health education component is required in Northern Nigeria. Emphasis should be on the need to utilize available eye health facilities and discourage harmful cultural beliefs and practices that could contribute to blindness and street begging. A comprehensive eye care program should include preventive, curative and rehabilitative services. The services will range from eye health promotion, through enhancement of residual vision, integrated education of the blind children and rehabilitation of the blind adults. These services should begin at the community through secondary to the tertiary levels. The services at each level will contribute to development and poverty reduction through prevention of disease and disability and by reducing the impact of disability through appropriate rehabilitation.
This approach when fully implemented will reduce the future population of blind beggars in Northern Nigeria.
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