Academic journal article Journal of Visual Impairment & Blindness

The Impact of War and Economic Sanction on the Incidence of Retinopathy of Prematurity in Serbia

Academic journal article Journal of Visual Impairment & Blindness

The Impact of War and Economic Sanction on the Incidence of Retinopathy of Prematurity in Serbia

Article excerpt

Abstract: This study compared the distribution of various types of visual impairments among Serbian children who were born prior to the imposed economic sanctions and wars of the 1990s in the former Yugoslavia to that of children who were born during the years of economic sanctions and active war.

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The tragic experience of economic sanctions and wars of the 1990s in the countries of the former Yugoslavia have left a legacy of severe physical and mental health problems among the civilians of the region, including children (Babic-Banaszak, Kovacic, Kovacevic, Vuletic, Mujkic, & Ebling, 2002). Many have suffered as refugees and displaced persons as their lives were disrupted, often brutally. During this period of conflict, internally displaced people had poorer health than did those who stayed in their homes, and, generally, all people who were living in areas that were directly affected by war had a lower health-related quality of life (Babic-Banaszak et al., 2002; Lopes Cardozo, Vergara, Agani, & Gotway, 2000). The impact of war on health inequalities among populations is well understood; changes in morbidity and mental health and poorer control of chronic diseases are common because people lack continual medical care and face poor adaptation to new environments (Cardozo et al., 2004; Kozaric-Kovacic, Kocijan-Hercigonja, & Jambrosic, 2002; Mollica, McInnes, Sarajlic, Lavelle, Sarajlic, & Massagli, 1999; Momartin, Silove, Manicavasagar, & Steel, 2003; Torinek, Katic, & Kern, 2005; Waldman, 2001). In 1995, the National Research Council of the Federal Republic of Yugoslavia (as it was known from 1992 to 2003) reported a notable increase in rates of abortion, child mortality, birth defects, and premature births in the countries of the former Yugoslavia.

Preterm delivery, or prematurity, is the most important risk factor for retinopathy of prematurity (ROP), a condition that leads to blindness that is related to the perinatal and neonatal periods (Darlow, Hutchinson, Henderson-Smart, Donoghue, Simpson, & Evans, 2005). Virtually all unit-based or population-based studies of risk factors for ROP have identified a measure of immaturity or the infant's size (low birth weight for gestational age) as having the greatest association with the risk of ROP (Flynn, 1987; McColm & Fleck, 2001), with ROP being strongly associated with smaller, immature, and sicker infants who were born prematurely (Lermann, Fortes Filho, & Procianoy, 2006; O'Connor, Stewart, Singh, & Fielder, 2006; Shah, Yeo, Ling, & Ho, 2005). ROP has also been examined in the context of socioeconomic circumstances and has been shown to be a major contributing cause of blindness in children in both middle-income countries and countries with a middle-level rank on the Human Development Index (HDI) as determined by the United Nations (Gilbert, Rahi, Eckstein, O'Sullivan, & Foster, 1997; Gilbert et al., 2005; Kocur & Resnikoff, 2002).

During the early years of war in the former Yugoslavia (1990-95), which were characterized by active conflict, migration of people, economic sanctions imposed on Yugoslavia, and a low standard of living, the number of births was greater than prior to the war (although there was a constant decrease from 1992 to 1995), and the rate of premature births increased; this pattern was noted in Serbia, Croatia, Slovenia, and Bosnia-Herzegovina (Fatusic, 2001; Nedic, Loncar, Ravic, & Komazec, 1999; Torinek et al., 2005). This increase in premature births has been linked to risk factors, such as elevated maternal stress and anxiety, and biomedical factors (Nedic et al., 1999). It has been recognized that the causes of premature births are multifactorial, and it has been speculated that environmental factors, such as stress, fear, exile, and inadequate prenatal maternal care, contribute to the rate of premature births (Hoffman & Hatch, 1996; Kuvacic, Skrablin, Hodzic, & Milkovic, 1996; McCormick et al. …

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