|Year : 2014 | Volume
| Issue : 2 | Page : 65-69
Ocular health survey among staff of benue state university teaching hospital, Nigeria
Keziah N Malu, Cecilia O Ojabo
Department of Ophthalmology, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
|Date of Submission||28-Jul-2013|
|Date of Acceptance||10-Feb-2014|
|Date of Web Publication||16-Jul-2014|
Keziah N Malu
Department of Ophthalmology, Benue State University Teaching Hospital, Makurdi, Benue State
Background: In developing countries, especially in Africa, most people with blinding eye conditions are not aware of their state and present with advanced disease. Objective: The main objective of the study was to determine common eye conditions and reasons for not seeking eye-care services among a teaching hospital staff. Materials and Methods: On World Sight Day 2012 staff of Benue State University Teaching Hospital (BSUTH) were invited to the eye clinic for the examination of their eyes. A questionnaire was filled for each and eyes examined and findings were analyzed. Results: There were 76 (48.1%) males and 82 (51.9%) females. The median age was 36.5 (range 19 to 65) years. The perceived cause of visual impairment (VI) and blindness was not significantly related to the level of education (P = 0.239). Reasons for not seeking eye-care services even when they had eye problems included finances 22 (13.9%), distance from eye-care center 4 (2.5%), lack of awareness 2 (1.3%), job situation 1 (0.6%) and fear 3 (1.9%). Of the 158 participants 30 (19%) had a close relative who had visual impairment (VI) or was blind. Most of the participants 151 (95.6%) had normal bilateral presenting visual acuity, 2 (1.3%) mild visual impairment and 5 (3.2%) moderate VI.The commonest ocular disorder was refractive error 39 (48.8%), followed by allergic conjunctivitis 14 (17.5%).Glaucoma 5 (6.3%) was the second potentially blinding ocular disorder, with 4 presenting with advanced disease. Cataract was seen in 4 (5.0%) and posterior segment disease in 2 (2.5%) participants. Conclusion: This study has shown that there is a lot of ignorance concerning causes of blindness and visual impairment among this group. There is therefore a need for awareness creation and eye health education and screening programs to detect ocular disorders.
Keywords: Awareness, blindness, hospital staff and glaucoma, visual impairment
|How to cite this article:|
Malu KN, Ojabo CO. Ocular health survey among staff of benue state university teaching hospital, Nigeria. Sub-Saharan Afr J Med 2014;1:65-9
|How to cite this URL:|
Malu KN, Ojabo CO. Ocular health survey among staff of benue state university teaching hospital, Nigeria. Sub-Saharan Afr J Med [serial online] 2014 [cited 2020 Mar 30];1:65-9. Available from: http://www.ssajm.org/text.asp?2014/1/2/65/136807
| Introduction|| |
About 285 million people live with visual impairment (VI) worldwide; 39 million of whom are blind and 246 million are with low vision.  The world's 90% visually impaired are said to reside in developing nations.  The World Health Organisation (WHO) enjoins all sub-regions where the prevalence of blindness for all ages is above 0.5%, to make concerted efforts in the fight against blindness so that its objective of "the right to sight" by 2020 is realised. 
In the middle and low-income countries cataract is the leading cause of blindness and visual impairment. Globally uncorrected refractive error (myopia, hyperopia or astigmatism) accounts for 43%, cataract 33%, and glaucoma 2% of those with visual impairment.  Studies have shown the role of cataract and glaucoma as principal causes of blindness in black populations, in contrast to the burden of visual loss due to age-related macular degeneration (AMD) in white populations. ,,,,
It has been observed that sometimes people have advanced eye diseases without realizing they have such conditions. Others have eye problems they know about but do not access eye care for various reasons. These people are helped through screening programs which bring eye care to their doorsteps and also detect eye conditions that some were not even aware of. ,,,,
The purpose of the study was to determine the common eye conditions and reasons for not seeking eye-care services among a teaching hospital staff and to offer them opportunity for treatment. To the best of our knowledge this type of study has not been undertaken in this part of the country before.
| Materials and methods|| |
This is a prospective study of the staff of Benue State University Teaching Hospital (BSUTH) as part of enlightenment campaign for "blindness awareness" World Sight Day 2012. Permission was sought and obtained from the management of the hospital to mount an enlightenment campaign and also offer free eye examinations to all the staff of the hospital.
Ethical approval for the study was granted by the Research and Ethics Committee of the Benue State University Teaching Hospital and the study was done in accordance to Helsinki Declaration on studies concerning human subjects. Individual oral consent was given by those who participated.
Prior notices were sent to departments informing them of the exercise. A banner was erected at the hospital gate and in the out-patient department where the screening took place on the world sight day. The Principal investigator and the department of ophthalmology drew up the questionnaire, agreed on the formant and mode of eye examination.
Previous training on the examination was undertaken in the eye department and the format standardized before the World Sight Day.
The questionnaire included staff demographic information such as age, sex, ethnic group, educational level, annual income, history of visual impairment (VI) and steps taken and participants' perception of the cause of VI and hindrances to accessing medical aid. History of glaucoma, cataract and refractive error either in self or family and siblings and also history of blindness and visual impairment and awareness of the cause were specifically asked for.
Blindness and VI awareness talk were delivered before commencing the exercise. Thereafter the staff was seen department by department so as not to stall the work going on in the hospital and also to prevent over-crowding.
The administrative and nursing staff of the eye department filled the questionnaire while the optometrists took the visual acuity and carried out the objective and subjective refraction where applicable. The distant presenting visual acuity (PVA) was determined using a Snellen lettered chart and a near vision chart for near. Where individuals wore corrective spectacles, the unaided and aided visual acuity (VA) was examined and recorded accordingly.
Individuals who could not read the chart at 6 meters were tested at 4 meters and at 1meter while those who could not read the letters even at 1m were tested for counting fingers, hand movements, and perception of light. Each eye was tested separately first and then with both eyes open and the vision recorded appropriately.
The ophthalmologists carried out a pen torch and direct ophthalmoscope for anterior and posterior segment examinations on all participants. Participants with significant eye conditions were referred to the eye clinic (BSUTH) where further treatment and follow up was given. The exercise was extended for one extra day in the departmental out-patient clinic to enable those who could not participate on the World Sight Day to come forward for the examination, if they so wished.
Statistical analyses were carried out using SPSS version 17.0 software (SPSS Inc., Chicago, IL, USA). Simple frequencies or cross-tabulations were used to present the data and chi-squared test was used to compare variables and a P-value less than 0.05 was considered statistically significant.
| Results|| |
At the time of World Sight Day Benue State University Teaching Hospital, being a new hospital had a total of 430 staff from all departments. One hundred and fifty-eight were present at the blindness awareness campaign and all presented for eye examination. There were 76 (48.1%) males and 82 (51.9%) females. The median age was 36.5 (range 19 to 65) years. The staff participants included 107 (67.7%) professionals and 51 (32.3%) artisans. Among them 108 (68.4%) had tertiary education, 46 (29.1%) secondary and 4 (2.5%) primary education only.
The highest group of participants 27 (17.1%) gave age as a perceived cause of VI/blindness followed by infection 26 (16.5%) with worms, "Apollo" and other infections acquired in childhood. Other causes included injury 3 1.9%), too much reading 2 (1.3%), profession 1 (0.6%), and witchcraft 1 (0.6%). The perceived cause of VI/blindness was not significantly related to the level of education (P = 0.239). [Table 1] shows the perceived causes of VI/blindness among the participants.
Various reasons were given by the participants for not seeking eye-care services even when they had eye problems. Most 120 (75.9%) had no reason for not seeking eye-care services. Some gave finances 22 (13.9%) as a reason for not seeking eye-care. Other reasons given included taking things for granted 6 (3.8%), living far away from eye care center (distance) 4 (2.5%), fear 3 (1.9%), lack of awareness of available eye services 2 (1.3%) and job situation 1 (0.6%) which could not allow them time off. [Table 2] shows various reasons given by the participants for not seeking eye-care services.
Of the 158 participants 30 (19%) had a close relative who had visual impairment or was blind. [Table 3] shows the distribution of VI/blind relative among the participants.
|Table 3: The distribution of visual impaired and blind relative among the participants|
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[Table 4] shows the cause of VI/blindness among the participant's relatives.
|Table 4: The cause of visual impairment and blindness among the participant's relatives|
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Most of the participants, 151 (95.6%) had normal bilateral presenting visual acuity. [Table 5] shows the presenting bilateral visual acuity amongthe participants. Of the 158 persons who presented for eye examinations 80 (50.6%) had ocular conditions. The commonest ocular disorder and visual impairing condition was refractive error 39 (48.8%). Most of the cataracts were immature representing only less or equal to stage 2 Mehra-Minassian central lens opacity grading system.  Posterior segment disease seen in two (2.5%) were in a case each of maculopathy and presumed ocular toxoplasmosis. [Figure 1] shows the distribution of various ocular disorders encountered during the examination of the staff.
Ocular diseases were significantly related to age (P = 0.001). The younger age groups presented with refractive errors more than those above 60 years. Cataract increased with age; glaucoma however presented more in the age group 31-50 years and the glaucoma suspects at a younger age of 31 to 40 years. Allergic conjunctivitis was seen in those less than 40 years and Pterygium in those between 30 to 40 years. The ocular diseases did not show any gender differences (P = 0.417) and professional relationship (P = 0.495) in the study population. [Table 6] shows age distribution of ocular disorder among the participants.
| Discussion|| |
From our study most people gave age as the perceived cause of visual impairment and blindness so one did not need to bother as visual impairment is expected with aging. This fallacy leads to the neglect of the elderly. Even though most of the causes of VI and blindness such as cataract, refractive errors, glaucoma in the elderly is correctable or controllable, older people in many societies are left to suffer from these conditions without apparent help. Their working-age relatives move to urban areas in order to look for jobs leaving them isolated and without help. , Studies have shown remarkable physical functioning and psychological well-being derived by the elderly as a result of improved vision after cataract surgeries. ,,
Some participants felt that visual impairment was as a result of worm infestation, ''Apollo'' (viral conjunctivitis) or childhood infection. This area used to be plagued by onchocerciasis so it is no wonder that many people attribute VI to ''worms'' (Onchocercal volvulus). This is seen in clinical practice whereby some patients make it a point of duty in taking ivermectin twice yearly without laboratory confirmation of onchocerciasis infestation. Other perceived causes included too much reading, profession and witchcraft. It is known that people take action in sourcing for treatment of their ailment depending on their perceived cause of the disease, and that may be why some consult with traditional herbal persons before ever looking for orthodox treatment. From our study the perceived cause of VI was not affected by the level of education; the person who thought witchcraft was his cause of VI had a tertiary education. This point highlights the importance of health education and blindness awareness campaigns at all levels irrespective of educational attainment.
Several reasons were given for not seeking eye care services. Reasons given included lack of finances, taking things for granted in hope they would get better, living far away from eye-care centres, fear that they may be made blind by hospital treatment, lack of awareness of available eye services; and job situation that could not allow them time out. Studies have shown these as recurrent reasons for not assessing eye-care in many societies ,,,,.
Among the participants 19% had a close relative who had visual impairment or was blind. This shows that visual impairment among the relatives is a problem in this community and that the major causes of VI namely cataract and glaucoma are the prevailing causes here.
About 4.6% of the participants were visually impaired (1.3% mild visual impairment and 3.2% moderate VI) though majority of them had normal visual acuity.
Ocular disorders were present in 50.6% of those who presented for eye examinations. This is rather high. May be they came in the first instance because they had ocular problems and so took opportunity of the free screening.
The commonest ocular problem and also visual impairing condition was refractive error. This was present in 48.8% of the participants. Allergic conjunctivitis 17.5% was the second commonest ocular disorder.
Glaucoma 6.3% was the second cause of the potentially blinding ocular disorder. Of the five individuals with glaucoma; four had advanced glaucoma. Three of the participants were diagnosed with glaucoma for the first time. A hospital audits in Dar es-Salaam  showed 29% of glaucoma patients and in Kano 53% of eyes  presented blind to the hospital. Seventy percent of glaucoma patients in Dar es-Salaam had cup/disc ratios of more than 0.8 in their better eye and in Kano 63% of the eyes had cup/disc ratios of 0.8 or more at presentation. In our study these three (60%) individuals were picked up during the awareness screening exercise with their cup/disc ratios greater than 0.8. Without this screening, they would more likely have presented blind at a later date. It is also worthy of note that these participants' visual acuities were still within normal range of better or equal to 6/12. This may suggest that we should not rely solely on visual acuity for screening subjects. Individuals presenting at screening centres who are above 30 years of age and the younger ones with family history of glaucoma should have fundoscopy done.
Glaucoma was detected at an earlier age in this population. The three subjects were in the age group 31-40 years. This may suggest that glaucoma presents early in this population.
There were 15% of subjects with fundus suspicious of glaucoma (glaucoma suspects) seen in this age group. Though glaucoma like cataract is age-related ocular disorder it was seen to present much earlier in this population. This trend is similar to studies in other West African countries where subjects were seen presenting with open angle glaucoma in their 30 s and 40 s as opposed to what attains among the Caucasians. ,,
Cataract in 2.5% was the third cause of potentially blinding ocular affectation. Most of the cataracts were immature.
Posterior segment disease in 1.3% was seen in a case each of maculopathy presumed ocular toxoplasmosis.
| Conclusion|| |
This study has shown that this population of hospital staff had significant potentially blinding ocular disorders. There is still a lot of ignorance concerning causes of blindness and visual impairment. There is a need for awareness creation, eye health education and population screening for early detection of these conditions even among the educated.
| References|| |
|1.||WHO Visual impairment and blindness Fact Sheet N°282June 2012 (Last accessed on 2012 Sept 22). |
|2.||Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, et al. Global data on visual impairment in the year 2002. Bull World Health Organ 2004;82:844-51. |
|3.||World Health Organization. Formulation and management of national programmes for the prevention of blindness. Geneva: WHO; 1990. WHO document PBL/90.18. |
|4.||Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br JOphthalmol2012; 96:614-618. |
|5.||Hyman L, Wu SY, Connell AM, Schachat A, Nemesure B, Hennis A, et al. Prevalence and causes of visual impairment in the Barbados Eye Study. Ophthalmology 2001;108:1751-6. |
|6.||Sommer A, Tielsch JM, Katz J, Quigley HA, Gottsch JD, Javitt J C, et al. Racial differences in the cause-specific prevalence of blindness in east Baltimore. N Engl J Med 1991;325:1412-7. |
|7.||Rahmani B, Tielsch JM, Katz J, Gottsch J, Quigley H, Javitt J, et al. The cause-specific prevalence of visual impairment in an urban population.The Baltimore Eye Survey. Ophthalmology 1996;103:1721-6. |
|8.||Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C, et al.; Nigeria National Blindness and Visual Impairment Study Group. Causes of blindness and visual impairment in Nigeria: The Nigeria national blindness and visual impairment survey. Invest Ophthalmol Vis Sci2009;50:4114-20. |
|9.||Olurin O. Causes of blindness in Nigeria-a study of 1,000 hospital patients. West AfrMed J Niger Med Dent Pract 1973;22:97-107. |
|10.||Hennis A, Wu SY, Nemesure B, Honkanen R, Leske MC; Barbados Eye Studies Group. Awareness of incident open-angle glaucoma in a population study: The Barbados eye studies. Ophthalmology 2007;114:1816-21. |
|11.||Mafwiri M, Bowman RJ, Wood M, Kabiru J. Primary open-angle glaucoma presentation at a tertiary unit in Africa: Intraocular pressure levels and visual status. Ophthalmic Epidemiol 2005; 12:299-302. |
|12.||Egbert PR. Glaucoma in West Africa: A neglected problem. Br J Ophthalmol 2002;86:131-2. |
|13.||Verrey JD, Foster A, Wormald R, Akuamoa C. Chronic glaucoma in northern Ghana - a retrospective study of 397 patients. Eye (Lond) 1990;4:115-20. |
|14.||Bowman RJ, Kirupananthan S. How to manage a patient with glaucoma in Africa. Community Eye Health 2006;19:38-9. |
|15.||Mehra V, Minassian DC. A rapid method of grading cataract in epidemiological studies and eye surveys. Br J Ophthalmol 1988;72:801-3. |
|16.||Evans J. Eye care for the older people. Community Eye Health 2008;21:21-3. |
|17.||Polack S. Restoring sight: How cataract surgery improves the lives of older adults. Community Eye Health 2008;21:24-5. |
|18.||Fletcher A, Vijaykumar V, Selvaraj S, Thulasiraj RD, Ellwein LB. The Madurai Intraocular Lens Study. III: Visual functioning and quality of life outcomes. Am J Ophthalmol 1998;125:26-35. |
|19.||McKee M, Whatling JM, Wilson JL, Vallance-Owen A. Comparing outcomes of cataract surgery: Challenges and opportunities. J Public Health (Oxf) 2005;27:348-52. |
|20.||ShahA. Barriers to the uptake of cataract surgery for women in urban Cape Town. Community Eye Health 2005;18:80. |
|21.||Cains S,Sophal S. Creating demand for cataract services: A Cambodian case study. Community Eye Health 2006;19:65-6. |
|22.||Saikumar S, Giridhar A, Mahesh G, Elias A, Bhat S. Awareness about eye diseases among diabetic patients: A survey in South India. Community Eye Health 2007;20:16-7. |
|23.||Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262-7. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]