International Ophthalmology

, Volume 38, Issue 6, pp 2313–2319 | Cite as

Environmental factors associated with ocular morbidity among children in three ecological regions of Nepal: a phase II Nepal Pediatric Ocular Diseases Study

  • Srijana AdhikariEmail author
  • Ujjowala Shrestha
  • Mohan K. Shrestha
  • Manish Paudyal
  • Bijaya Thapa
  • Murari Shrestha
Original Paper



The Nepal Pediatric Ocular Diseases Study (NPODS) was a 3-year (January 2012–December 2014) longitudinal study carried out in three ecological regions of Nepal to understand the magnitude of the problems of childhood ocular morbidity and blindness. Based on the results of this study, a second phase of NPODS was undertaken to understand the risk factors associated with childhood ocular diseases. This paper analyzes environmental factors.


This was a nested case–control study with study population selected from the same cohort of children included in the baseline survey of NPODS. The study areas were the same (three districts from three ecological regions: Sindhupalchowk from mountain, Makawanpur from hills, and Sarlahi from terai). After sample size calculation, cases and controls were taken in 1:4 ratio and matched for age, sex, and location.


A total of 830 children (166 cases, 664 controls) were selected with 5.4 % of cases and 2.7 % of control participants nonresponders. Among environmental factors, children who stayed with their mother during cooking, who had with fewer windows in their kitchen, and who used dusty roads to school had significant association with ocular morbidities. Similarly, children with cable TV in their house had higher chance of having refractive error.


Many of the environmental factors associated with ocular diseases in children are modifiable. Improving the household environment is likely to effectively decrease the burden of eye diseases. The association of refractive error with increased indoor and near activities is an important finding, reported herein for the first time in Nepalese children.


Nepal Pediatric Ocular morbidity Childhood blindness Environment 



The Fred Hollows Foundation Australia provided financial support in the form of research grant. The sponsor played no role in the design or conduct of this research.

Compliance with ethical standard

Conflict of interest

All authors (Dr. Srijana Adhikari MD, Dr. Ujjowala Shrestha, MD, Dr. Mohan Krishna Shrestha, MD, Mr. Manish Paudyal, Dr. Bijaya Thapa, MD, and Dr. Murari Man Shrestha MD) certify that they have no affiliation with or involvement in any organization, such as honoraria, educational grants, participation in speakers’ bureau, membership, employment, consultancies, stock ownership or other equity interest, and expert testimony or patent licensing arrangements (such as personal or professional relationship affiliations, knowledge or beliefs), in the subject matter or materials discussed in the manuscript.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki Declaration of 1964 and its later amendments or comparable ethical standard.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Srijana Adhikari
    • 1
    Email author
  • Ujjowala Shrestha
    • 1
  • Mohan K. Shrestha
    • 1
  • Manish Paudyal
    • 1
  • Bijaya Thapa
    • 2
  • Murari Shrestha
    • 3
  1. 1.Tilganga Institute of OphthalmologyGaushala, KathmanduNepal
  2. 2.Nobel Medical CollegeBiratnagarNepal
  3. 3.SAARC SecretariatKathmanduNepal

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