An ethnographic study of night blindness "ratauni" among women in the Terai of Nepal

Night blindness is the most common ocular condition representing moderate-to-severe vitamin A deficiency in children. Very little, however, is known about maternal night blindness, which has recently been reported to occur frequently during pregnancy in parts of south-east Asia. In Nepal, the prevalence of night blindness is reported to be 16%. We carried out an ethnographic study of night blindness during pregnancy in the south-eastern, rural plains of Nepal as preliminary research for a case-control study of the determinants of this condition. The purpose of the research was to identify local terms and concepts of night blindness and to examine women's perceptions of its causes, symptoms, severity, and consequences during pregnancy. Data collection involved in-depth interviews, case studies, unstructured observations and structured anthropologic methods, such as free listing and quick sort ranking. Women considered night blindness to be an important illness of pregnancy, ranking it second (to vaginal bleeding) in perceived severity from a list of 15 "women's illnesses". Local terms for night blindness were identified in three different languages from the region. Informants described a complex ethnomedical model of night blindness that included causes, symptomatology, and treatment alternatives. However, there was no perceived link between food intake and the occurrence of night blindness. The major causes of night blindness were attributed to pregnancy, weakness, or "hotness". Some women sought treatment for the condition but most women chose not to treat it since they believed that it was a transient condition of pregnancy. Interviews with women who had previously experienced night blindness and home-based observations of women exhibiting concurrent night blindness showed that it adversely affected their activity patterns, especially those related to child care and food preparation. Night blindness increased reliance on family members to perform various domestic chores and was also associated with personal injury and accidents. The findings of this study have relevance for women's reproductive health and nutrition throughout the Indian sub-continent. A simple history of night blindness may be a practical tool to identify women with nutritional and health risks. Maternal night blindness should be more routinely investigated in vitamin A deficient areas of the world, both to define the magnitude of the problem, and to develop programs/interventions that specifically target this population.