Background: Night blindness (nyctalopia) is a vision impairment characterized by difficulty seeing in low light, often linked to vitamin A deficiency, retinal disorders, or genetic factors. Despite its preventable nature, awareness remains limited, particularly in underserved regions. This study assessed awareness, knowledge, and preventive practices regarding night blindness among residents of Himachal Pradesh, India. Materials and Methods: A descriptive cross-sectional study was conducted among 400 adults in Himachal Pradesh using a structured online questionnaire. The survey assessed socio-demographics, knowledge of night blindness causes, symptoms, and preventive practices. Data were analyzed using SPSS v26.0, with significance set at p<0.05. Results: While 82% correctly identified night blindness as difficulty seeing in low light, only 61.5% recognized vitamin A's preventive role. Awareness of symptoms like poor vision in dim light was limited (66.8%). Knowledge scores revealed 38.8% with “Very Good,” 38.5% with “Good,” 15.5% with “Fair,” and 7.3% with “Poor” understanding. Rural residents and individuals with limited education exhibited higher rates of low knowledge scores. Conclusion: Despite reasonable awareness in some areas, significant gaps remain in understanding key symptoms and preventive strategies. Targeted educational campaigns, improved nutritional awareness, and enhanced vision care in underserved areas are essential to address these gaps.
In an era marked by rapid technological advancement and increasing reliance on digital devices, ocular health concerns are becoming more prevalent. While conditions such as Digital Eye Strain (DES) have gained considerable attention, another vision-related condition often overlooked is night blindness, medically known as nyctalopia. Night blindness is characterized by impaired vision in low-light conditions, significantly impacting an individual's ability to navigate in dim environments. This condition, frequently linked to vitamin A deficiency, retinal disorders, or genetic factors, poses serious risks to safety and overall quality of life, particularly in regions with limited access to ophthalmic care [1-5].
Public awareness regarding night blindness remains insufficient, resulting in delayed diagnosis, ineffective management, and heightened vulnerability to accidents and injuries during nighttime activities. Despite its preventable nature in many cases, misconceptions about the condition and a lack of proactive eye care practices persist. Early identification of night blindness symptoms, combined with appropriate dietary interventions, vision screenings, and preventive strategies, can significantly reduce its impact [6-8].
India, a country with diverse socio-economic demographics, faces unique challenges in addressing night blindness awareness. In states like Himachal Pradesh, characterized by rural settlements and limited healthcare accessibility, individuals may remain unaware of critical risk factors and preventive measures. Vulnerable populations, particularly children, the elderly, and individuals with poor nutritional access, are disproportionately affected.
Given these concerns, this study aims to evaluate public awareness, knowledge, and preventive practices related to night blindness among residents of Himachal Pradesh, India. By assessing awareness levels across varying demographics, this research seeks to identify knowledge gaps and inform targeted educational initiatives. Findings from this study will provide valuable insights for healthcare professionals, policymakers, and educators to promote improved eye health practices and reduce the prevalence of night blindness in underserved communities.
Research Design
A descriptive cross-sectional study was conducted to evaluate public awareness, knowledge, and preventive practices regarding night blindness among residents of Himachal Pradesh, India. This study utilized a structured online questionnaire to ensure efficient data collection while reaching diverse demographic groups.
Study Area and Population
The study was conducted across various districts in Himachal Pradesh, a state with a diverse population distributed between urban and rural regions. The target population comprised adults aged 18 years and above from varying educational, occupational, and socio-economic backgrounds. Special attention was given to populations prone to nutritional deficiencies, limited healthcare access, and those engaged in nighttime activities such as farmers, drivers, and security personnel.
Sample Size and Sampling Technique
The sample size was determined based on a 95% confidence interval, a 50% estimated prevalence of night blindness awareness, and a 5% margin of error. Considering potential incomplete or erroneous responses, a sample of 400 participants was finalized. Convenience sampling and purposive sampling techniques were employed to ensure representation across diverse demographic groups. The questionnaire was disseminated through digital platforms such as WhatsApp, Facebook, and community groups to enhance participation.
Inclusion and Exclusion Criteria
Inclusion Criteria
Exclusion Criteria
Incomplete or ambiguous responses
Data Collection Instrument
A comprehensive and validated questionnaire was designed with the assistance of ophthalmologists, optometrists, and public health experts. The questionnaire was divided into four key sections:
The questionnaire was available in both Hindi and English to ensure accessibility and clarity.
Scoring and Knowledge Classification
Knowledge scores were assigned based on participants' responses to awareness-related questions. Scores were classified into four categories:
This classification system enabled the identification of key demographic groups requiring targeted educational interventions.
Data Collection Procedure
Data collection was conducted over three months (October to December 2024) using the Google Forms platform. The questionnaire link was distributed through social media platforms, local educational groups, and community forums to encourage participation. Before completing the survey, participants were informed about the study's purpose, the voluntary nature of participation, and the assurance of data confidentiality. Explicit informed consent was obtained from all respondents.
Data Analysis
Data were meticulously reviewed, cleaned, and organized using Microsoft Excel. Statistical analysis was performed using SPSS (version 26.0). Descriptive statistics were employed to summarize socio-demographic characteristics and knowledge scores.
Ethical Considerations
The study protocol was approved by the relevant institutional ethics committee. All participants were informed about the study's objectives, and participation was strictly voluntary. Data confidentiality and anonymity were maintained throughout the study. Participants were assured they could withdraw at any point without repercussions.
The socio-demographic profile of the 400 participants revealed a balanced gender distribution, with males constituting 51% and females 49%. Most respondents belonged to the economically active age groups, with 36.8% aged 26-35 years and 27.8% in the 36-45 years range. Educational backgrounds were diverse, with 34.5% holding undergraduate degrees and 34% having completed secondary education. Notably, 26% were homemakers, while office workers (23.3%) and teachers (17%) formed other prominent occupational groups. Rural participants constituted a significant majority (59.3%), emphasizing the need for improved awareness campaigns in non-urban settings (Table 1).
Table 1: Socio-Demographic Characteristics of Participants
Variable | Category | Frequency (n) | Percentage (%) |
Age Group (Years) | 18–25 | 86 | 21.5 |
26–35 | 147 | 36.8 | |
36–45 | 111 | 27.8 | |
46 and above | 56 | 14.0 | |
Gender | Male | 204 | 51.0 |
Female | 196 | 49.0 | |
Education Level | No formal education | 13 | 3.3 |
Primary school | 64 | 16.0 | |
Secondary school | 136 | 34.0 | |
Undergraduate degree | 138 | 34.5 | |
Postgraduate degree | 49 | 12.3 | |
Occupation | Homemaker | 104 | 26.0 |
Office Worker | 93 | 23.3 | |
Teacher | 68 | 17.0 | |
Healthcare Professional | 41 | 10.3 | |
Student | 53 | 13.3 | |
Other | 41 | 10.3 | |
Residential Setting | Urban | 163 | 40.8 |
Rural | 237 | 59.3 |
Regarding awareness and knowledge of night blindness, encouraging levels of understanding were observed across several key areas. A substantial 82% correctly identified night blindness as difficulty seeing in low light, while 70.3% recognized vitamin A deficiency as a common cause. Furthermore, 87% acknowledged that night blindness could indicate a serious condition, reflecting promising awareness of its potential risks. While 79.3% recommended consulting an eye specialist for night vision issues, gaps persisted in identifying specific dietary interventions, with only 61.5% correctly associating vitamin A with night blindness prevention. Additionally, only 66.8% identified poor vision in dim light as a key symptom, underscoring the need for targeted education on symptom recognition. Encouragingly, 80.8% acknowledged the benefits of consuming carrots and vitamin A-rich foods for improving night vision (Table 2).
Table 2: Awareness and Knowledge of Night Blindness Among the General Population
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | What is night blindness? | a) Ear sensitivity, b) Difficulty seeing in low light, c) Throat dryness, d) Skin rash | 328 | 82.0 |
2 | What is a common cause of night blindness? | a) Loud noise, b) Poor hygiene, c) Vitamin A deficiency, d) Cold weather | 281 | 70.3 |
3 | What part of the eye is most affected by night blindness? | a) Lens, b) Cornea, c) Retina, d) Optic nerve | 272 | 68.0 |
4 | Can night blindness be a symptom of a serious condition? | a) Yes, b) No, c) Only in children, d) Only temporarily | 348 | 87.0 |
5 | Which nutrient is essential to prevent night blindness? | a) Vitamin C, b) Vitamin A, c) Vitamin K, d) Iron | 246 | 61.5 |
6 | What should someone do if they struggle to see at night? | a) Ignore it, b) Consult an eye specialist, c) Use brighter lights, d) Wait a month | 317 | 79.3 |
7 | What is a common symptom of night blindness? | a) Hearing loss, b) Sore throat, c) Poor vision in dim light, d) Fever | 267 | 66.8 |
8 | Which symptom requires urgent medical attention? | a) Mild dryness, b) Sudden loss of night vision, c) Occasional blur, d) Tiredness | 302 | 75.5 |
9 | Can night blindness be inherited? | a) Yes, b) No, c) Only in the elderly, d) Only from injury | 278 | 69.5 |
10 | What condition is commonly linked to night blindness? | a) Ear infection, b) Retinitis pigmentosa, c) Sinusitis, d) Diabetes | 288 | 72.0 |
11 | What is a risk of untreated night blindness? | a) Increased accident risk, b) No risk, c) Hair loss, d) Joint pain | 257 | 64.3 |
12 | Can night blindness affect daytime vision? | a) Yes, b) No, c) Only if severe, d) Only at dusk | 312 | 78.0 |
13 | How does aging affect night blindness? | a) No effect, b) May worsen it, c) Improves vision, d) Causes ear pain | 273 | 68.3 |
14 | What dietary factor can prevent night blindness? | a) High sugar, b) Foods rich in Vitamin A, c) Low protein, d) Spicy food | 262 | 65.5 |
15 | Can night blindness be reversed in some cases? | a) Yes, b) No, c) Only with surgery, d) Only in youth | 268 | 67.0 |
16 | What habit may improve night vision health? | a) Rubbing eyes, b) Avoiding screens, c) Eating carrots, d) Using dim lights | 323 | 80.8 |
17 | What should you avoid if you suspect night blindness? | a) Drinking water, b) Driving at night, c) Resting, d) Bright lights | 307 | 76.8 |
18 | Which of these is NOT a cause of night blindness? | a) Vitamin A deficiency, b) Cataracts, c) Glaucoma, d) Ear wax | 248 | 62.0 |
19 | What is the first step if you notice night vision issues? | a) Increase screen time, b) Apply heat, c) See an eye doctor, d) Ignore it | 266 | 66.5 |
20 | What type of doctor diagnoses night blindness? | a) Cardiologist, b) Neurologist, c) Ophthalmologist, d) Dentist | 341 | 85.3 |
Knowledge score classification further highlighted significant trends. While 38.8% achieved “Very Good” scores (>80%) and 38.5% achieved “Good” scores (60%-79%), a noteworthy proportion still exhibited limited understanding. Approximately 15.5% scored within the “Fair” range (41%-59%), and 7.3% demonstrated “Poor” knowledge levels (<40%). These lower knowledge scores were more pronounced among participants with limited formal education and rural residents, emphasizing the importance of focused public health initiatives aimed at improving night blindness awareness in underserved communities.
Table 3: Knowledge Score Classification
Knowledge Category | Score Range | Frequency (n) | Percentage (%) |
Very Good | ≥80% | 155 | 38.8 |
Good | 60%–79% | 154 | 38.5 |
Fair | 41%–59% | 62 | 15.5 |
Poor | <40% | 29 | 7.3 |
The findings of this study provide comprehensive insights into the socio-demographic distribution, awareness levels, and knowledge gaps surrounding night blindness among residents of Himachal Pradesh. The results underscore both encouraging trends in awareness and concerning gaps that warrant targeted educational interventions to improve public understanding of night blindness and its preventive measures.
The balanced gender distribution among participants (51% males and 49% females) reflects an inclusive sampling approach, ensuring insights applicable to both genders. The dominance of respondents in the economically active age groups (26-35 years: 36.8%; 36-45 years: 27.8%) highlights the relevance of addressing night blindness awareness among working-age individuals, who are often engaged in daily activities that require good visual acuity, especially in low-light conditions.
The educational profile of participants reveals both strengths and gaps in health literacy. While 34.5% of respondents held undergraduate degrees and 34% had completed secondary education, there was a notable proportion of individuals with minimal formal education (19.3%). This demographic is particularly vulnerable to gaps in healthcare awareness and may lack access to reliable information about ocular health, underscoring the need for simplified educational campaigns designed to address their learning barriers.
Occupationally, homemakers (26%) and office workers (23.3%) comprised the largest groups, suggesting the need for diverse awareness campaigns targeting both home-based and workplace environments. Additionally, the rural-urban distribution revealed a significant rural majority (59.3%), reinforcing concerns that individuals in non-urban areas may face greater challenges in accessing vision care services. Given the limited healthcare infrastructure in rural regions, targeted outreach programs are essential to promote preventive strategies and timely treatment interventions.
Encouragingly, the study revealed positive awareness levels in several key aspects of night blindness. An impressive 82% correctly identified night blindness as difficulty seeing in low light, reflecting a foundational understanding of the condition. Moreover, 70.3% of participants recognized vitamin A deficiency as a common cause, indicating basic awareness of nutritional risks. Furthermore, 87% correctly identified that night blindness could be a symptom of a serious medical condition, which is crucial for encouraging timely medical intervention.
However, substantial gaps remain in recognizing critical preventive strategies and subtle symptoms. Only 61.5% of participants correctly identified vitamin A as an essential nutrient for night blindness prevention, reflecting inadequate awareness of the role of diet in promoting ocular health. Given that vitamin A deficiency is one of the most preventable causes of night blindness, this gap is particularly concerning. Nutritional interventions, including the promotion of vitamin A-rich foods such as carrots, spinach, and dairy products, should be emphasized in public health campaigns. Additionally, the finding that only 66.8% identified poor vision in dim light as a primary symptom highlights the need for greater emphasis on symptom recognition to facilitate early diagnosis and intervention.
Preventive practices also require reinforcement. While 79.3% of participants acknowledged the importance of consulting an eye specialist for night vision issues, fewer individuals recognized dietary adjustments as a key preventive strategy. Additionally, while 80.8% correctly identified carrots and vitamin A-rich foods as beneficial for night vision, this awareness must be translated into actionable behaviors, particularly in rural areas where nutritional deficiencies are often more prevalent. Encouraging dietary changes through awareness campaigns, school-based nutrition programs, and collaborations with community healthcare providers could significantly improve preventive practices.
Knowledge score classification revealed a notable division between well-informed participants and those with substantial knowledge gaps. While 38.8% demonstrated "Very Good" knowledge and 38.5% scored within the "Good" range, a concerning 15.5% and 7.3% fell into the "Fair" and "Poor" categories, respectively. Participants with limited formal education and those residing in rural areas were disproportionately represented in the lower knowledge categories. These findings underscore the impact of educational disparities on health literacy and highlight the urgent need for customized awareness programs targeting these vulnerable populations.
The lower awareness levels observed in rural communities may be attributed to multiple factors, including limited access to healthcare facilities, inadequate exposure to health promotion campaigns, and social determinants such as economic constraints. To address these challenges, public health interventions must employ culturally appropriate educational materials designed to engage rural populations effectively. Community outreach programs utilizing local languages, visual aids, and interactive workshops can bridge existing knowledge gaps and encourage proactive eye care practices [9,10].
Implications for Public Health and Future Interventions
The study's findings emphasize the importance of integrating night blindness awareness into broader ocular health initiatives. Public awareness campaigns should prioritize highlighting night blindness symptoms, dietary interventions, and the importance of early medical intervention. Special focus should be placed on dispelling misconceptions and emphasizing the preventable nature of vitamin A deficiency-related night blindness. Additionally, promoting routine eye examinations, particularly among high-risk groups such as children, the elderly, and individuals with nutritional deficiencies, will be essential for improving early detection rates [11,12].
Educational institutions can play a critical role in promoting awareness by integrating ocular health topics into school curricula. Emphasizing the importance of vitamin A-rich diets, eye protection strategies, and early symptom recognition will empower younger populations with essential preventive knowledge. Furthermore, workplace wellness programs should focus on enhancing awareness among working professionals, particularly those engaged in nighttime occupations such as drivers, security personnel, and healthcare staff [12,13].
Healthcare providers should be equipped to deliver effective counseling on night blindness prevention during routine consultations. Encouraging optometrists and ophthalmologists to conduct community-based screening camps in underserved regions can enhance access to vision care and improve public awareness. Collaborative efforts involving government health departments, non-profit organizations, and local communities will be crucial to ensuring the widespread dissemination of accurate information [14,15].
The study highlights encouraging awareness trends regarding night blindness in Himachal Pradesh but reveals critical gaps in symptom recognition, dietary awareness, and preventive practices. The disproportionate knowledge deficits observed among rural and less-educated populations underline the urgent need for targeted educational campaigns tailored to these groups. By implementing comprehensive public health strategies, promoting nutritional education, and expanding vision care outreach programs, healthcare authorities can effectively reduce the burden of night blindness and improve ocular health outcomes across the region. Future research should evaluate the long-term impact of awareness interventions and explore additional strategies for enhancing community engagement and behavior change.
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