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Ocular Health Status of Primary School Children in Abagana -Njikoka Local Government Area of Anambra State Nigeria

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Ocular Health Status of Primary School Children in Abagana -Njikoka Local Government Area of Anambra State Nigeria OCULAR HEALTH STATUS OF PRIMARY SCHOOL CHILDREN IN ABAGANA-NJIKOKA LOCAL GOVERNMENT AREA OF ANAMBRA STATE, NIGERIA. BY OKOYE OBIEKWE (DR) 1 OCULAR HEALTH STATUS OF PRIMARY SCHOOL CHILDREN IN ABAGANA -NJIKOKA LOCAL GOVERNMENT AREA OF ANAMBRA STATE NIGERIA A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PART FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FINAL FELLOWSHIP OF THE MEDICAL COLLEGE IN OPHTHALMOLOGY, FMCOph BY OKOYE OBIEKWE NOVEMBER 2007 2 Declaration I hereby declare that this work is original unless otherwise acknowledged. It has not been presented to any other college for a fellowship nor has it been submitted elsewhere for publication in part or full. 3 Attestation This is to certify that study reported in this dissertation and the writing thereof were done by Dr. Okoye Obiekwe under our supervision. Name of Supervisor Professor R. E. Umeh Department of Ophthamology UNTH Enugu. Signature Date Name of Supervisor Professor U. F. Ezepue Department of Ophthamology UNTH Enugu. Signature Date 4 DEDICATION This work is dedicated to my darling wife Ngozi for her continual love and support; and our lovely children – Chiamaka and Chinemerem. 5 ACKNOWLEDGEMENT I am greatly indebted to my supervisors – Prof. R. E. Umeh and Prof. U. F. Ezepue for the personal interest and commitment, which they gave to this work. Their criticisms and corrections were most helpful. My profound appreciation also go to my teachers in the department of Ophthalmology, University of Nigeria Teaching Hospital Enugu namely Prof. E. N. Onwasigwe, Dr. N. O. Magulike, Dr. P. B. Nworah, Dr. C. M. Chuka-Okosa, Dr. B. I. Eze, Dr. F. C. Maduka-Okafor, Dr. A Aghaji, Dr. O. I. Okoye and Dr. L. Ubaka. They made the residency training worthwhile. I also thank Dr. C.N. Onwasigwe for her valuable assistance in the area of statistics. She was a great support despite her tight schedule. My sincere gratitude also goes to the administrative secretaries, headmistresses, headmasters and entire staff and pupil of the Primary Schools in Abagana – Njikoka Local Government Area. Their co-operation is deeply appreciated. I wish to thank all those who provided me with relevant literature – Prof. U. F. Ezepue, Prof. R. E. Umeh, and Dr. C. M. Chuka-Okosa. 6 I sincerely appreciate the various assistance recieved from my friends and colleagues: Dr. E. Achigbu, Dr. U. Agwu, Dr. N. Oguego and Dr. J. Azu-Okeke during the course of this study. I am grateful to Miss Ifesinachi and Mr Ikechukwu for their secretarial assistance. I am particulary greatly indebted to my lovely wife, Ngozi Okoye. She was solidly behind me throughout the study and in fact during the entire residency period. Finally my immeasurable thanks to the Almighty God whose unfailing love and mercy have been upon me and my family. His Fatherly eyes were continuously upon us throughout the duration of this study. 7 Table Of Contents Title page i Declaration ii Attestation iii Dedication iv Acknowledgement v List of Figures and Tables ix Summary CHAPTER 1 1.1 introductions 1 1.2 study area 7 1.3 objectives 11 CHAPTER 2 Literature review 12 CHAPTER 3 Materials and method 22 CHAPTER 4 Results 29 CHAPTER 5 Discussion 38 CHAPTER 6 6.1 conclusions 49 6.2 Recommendation 49 8 REFERENCES 52 APPENDIX i. Modified WHO/PBL Eye Examination form 58 ii. Consent form 60 iii. Ethical clearance approval 62 9 LIST OF FIGURES AND TABLES TABLES Table 1: Distribution of primary schools in Abagana - March 2006 Table 2: WHO Classification of Visual Impairment Table 3: Distribution of sample population by Visual Acuity in the better eye. Table 4: Causes of low vision amongst the study subjects Table 5: Distribution of ocular disorders amongst the study subject. Table 6: Distribution of the ocular disorders seen in the study subjects by age (n=2092). Table 7: Classification of ocular disorders in the affected eyes of the study subject into preventable and treatable disorders. Fig 1: Map of Njikoka local government area with inset map of Nigeria. Fig 2: Age and sex distribution of the study subjects. Fig 3: Anatomical site of ocular disorder in the affected eyes of the study subjects. 10 Summary A cross sectional survey of the ocular status of primary school children in Abagana - a rural community in Njikoka Local Government Area of Anambra state of Nigeria, was undertaken. The available children in all the 8 primary schools aged 6 to less than 16 years were interviewed and examined with snellens chart, pen torch, head loupe and direct ophthalmoscope. Findings were recorded using the modified World Health Organization/Programme for Prevention of Blindness (WHO/PBL) eye examination form. More males 1081 (57.7%) than females 1011 (48.3%) constituted the sample population giving a male/female ratio of 1.07 to 1, (p= 0.0013). There were 20 different types of ocular disorders found in 127 out of 2092 children examined giving a prevalence of 6.1%. The most common ocular disorder was vernal conjunctivitis (48.1%) followed by refractive error (11.0%). The highest number of ocular disorder 61(48.0%) occurred in the age group 10 to 13 years. The number of school children with a visual acuity <6/18 in the better eye was 6 (0.3%). Of these, 4 (0.2%) were due to 11 preventable ocular disorders while 2 (0.1%) were neither preventable nor curable. Of the 4 (0.2%) cases of monocular blindness, 3 (0.14%) were preventable. The findings in this study indicate that most of the causes of visual impairment in the school children surveyed were avoidable and appropriate application of preventive and promotive primary eye care would go a long way in improving the ocular health status of primary school children in this locality. 12 CHAPTER 1 1.1 Introduction Background and Justification The prevalence of blindness in children (the proportion of the child population who are blind at a specific point in time) varies from approximately 0.3/1,000 children in wealthy regions of the world, to 1.2/1,000 in the poorer countries/regions.1 Blindness among children is more common in the poor region of the world for three main reasons2: first, there are diseases which can lead to blindness from causes which are not prevalent in industrialized countries, example, measles, vitamin A deficiency, and ophthalmia neonatorum. Second, there are fewer well equipped facilities and personnel trained in managing treatable causes of blindness. Third, is the contribution of ignorance, poverty and superstition in the rural areas. Incidence data are very difficult to obtain, but it has been estimated that there are 8 new blind children for every 100,000 children each year in industrialized countries.2 In the developing countries, approximately 13 500,000 children become blind every year – one every minute and about half of them die within one or two years of becoming blind. 3 The high number of blind years resulting from blindness during childhood is one of the reasons why the control of childhood blindness is a priority of the World Health Organization/International Agency for Prevention of Blindness (WHO/IAPB) Vision 2020: The Right to Sight Programme.4 Children who are blind have to overcome a lifetime of emotional, social and economic difficulties, which affect the child, the family and the society.5 Loss of vision in children influences their education, employment and social life.5 Childhood blindness is second only to adult cataract as a cause of blind-person years. Approximately 70 million blind-person years are caused by childhood blindness worldwide.6 Vision plays an essential role in development and visual deficit constitutes a risk factor not only for visio-sensory development, but also for overall development.7 Timely screening for the early detection of eye and vision problems in children is vital to avoid lifelong visual impairment. Early detection provides the best opportunity for effective treatment.8 14 In all regions of the world there are causes, which are amenable to primary, secondary and tertiary prevention, but the proportions vary from region to region. In the vision 2020 programme, the following conditions are priorities for control 9: Corneal scarring, due to measles, vitamin A deficiency, harmful traditional eye medicines, and ophthalmia neonatorum, constitute priorities in poor and very poor regions. Cataract and glaucoma: Important treatable causes in all regions. Retinopathy of prematurity - a condition important in middle- income countries, and in urban centers in developing countries. Refractive errors which is a treatable cause in all regions. Low vision: Services need to be expanded and developed in all regions. Amongst others the following targets have been agreed for disease control9: Reduce the global prevalence of childhood blindness from 0.75/1000 children to 0.4/1000 children. Elimination of corneal scarring caused by vitamin A deficiency, measles, or ophthalmia neonatorum. 15 All school children to receive a simple vision screening examination, with glasses provided for all those with significant refractive error. This should be integrated into the school health programme. School-age children (6 –15 years) represent 20 – 30% of the total population of most third world countries10. For Nigeria this translates to an estimated 20 – 30 million children. In some states in southern Nigeria, 80% of the children are in school and can best be reached there for any health care program11. Even assuming a case scenario of a school drop out rate of 50%, there will still be 10-15 million school age children 11. Therefore, school children form an important large target group, which must be screened adequately for early detection of eye diseases and prevention of blindness.12.
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