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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 138-142

Assessment of ocular health status of pupils in public and private primary schools in Sabon Gari, Zaria, Kaduna State


Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria

Date of Submission10-May-2019
Date of Decision29-Oct-2019
Date of Acceptance30-Dec-2019
Date of Web Publication5-Feb-2020

Correspondence Address:
Orugun AJ
Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State
Nigeria
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DOI: 10.4103/ssajm.ssajm_13_19

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  Abstract 


Background: Routine eye screening of pupils in schools as a matter of health policy is not obligatory in Nigeria. The administrative setting, organization, environment and social background of pupils in public and private schools are often different. Objectives: To determine the ocular health status of pupils in private and public primary schools in Sabon-Gari, Zaria, Kaduna state, Nigeria, and ascertain whether there are differences. Materials and Methods: This was a descriptive cross-sectional study. A multistage sampling technique was used to select the pupils. Visual acuity assessment using Snellen’s chart was done while anterior segment examination was carried out with a pen torch and loupe. Posterior segment was examined using a direct ophthalmoscope (Heine Beta 200). Results: A total of 540 pupils were selected from six primary schools, comprising 270 from three private schools and an equal number from 3 public schools. The ages of the pupils ranged from 3 to 16 years with a mean of 8.42 (SD ± 2.16). Females were 272 (50.4%) and males 268 (49.6%) (F:M = 1.01:1). The prevalence of ocular morbidities from the study was 22.8%. It was 24.4% in public and 21.1% in private schools respectively. Ametropia was the commonest ocular disorder seen in private schools pupils, 17 (6.3%), while vernal conjunctivitis, 23 (8.5%), was the most frequent findings in the public schools. Conclusion: Though ametropia was the commonest ocular morbidity seen among private school pupils and allergic conjunctivitis among those in public schools, these were not statistically significant (P > 0.05).


How to cite this article:
AJ O, KK O, Samaila E, Pam V. Assessment of ocular health status of pupils in public and private primary schools in Sabon Gari, Zaria, Kaduna State. Sub-Saharan Afr J Med 2019;6:138-42

How to cite this URL:
AJ O, KK O, Samaila E, Pam V. Assessment of ocular health status of pupils in public and private primary schools in Sabon Gari, Zaria, Kaduna State. Sub-Saharan Afr J Med [serial online] 2019 [cited 2020 Nov 25];6:138-42. Available from: https://www.ssajm.org/text.asp?2019/6/3/138/277785




  Introduction Top


Children require prompt attention for health-related issues generally and for ocular health specifically. Children very often are not able to articulate their visual complaints like adults.[1] The ultimate molding of a person’s personality and potential rests with his nature, and quality of eye sight. The early school years are formative for children in determining their physical and behavioral development. Poor vision in childhood affects performance in school and has a negative influence on their development and maturity.[2]

In Nigeria, pre-school enrolment ocular examination is not done by obligation since there is no such policy.

Many children therefore do not have access to eye examination except for occasional eye screening carried out in the schools.

Nigeria has experienced a population explosion in the last 50 years. The proportion of children below the age of 15 years in 2010 was 44.0%.[3]

The World Health Organization (WHO) states that there is a paucity of data on the prevalence and causes of blindness and visual impairment in African countries.[4],[5]

In 2010 it was estimated that 1.4 million children were blind in the world. An additional 7 million suffer from low vision and a further 10 million children had correctable refractive error causing visual impairment. A study by Grover et al.,[6] reported corneal and lenticular conditions were predominant causes of blindness. Amongst children outside schools for the blind, refractive errors were important causes of visual impairment and blindness.

Less attention has been given to eye care in children compared to adults. The importance of good vision cannot be over emphasized in education, behavioral, social and economic development. The school is a convenient place for eye examination of a large number of children who can be followed up. Although there is no obligatory national policy on pre-school enrolment ocular examination, some private schools still require that prospective pupils have some forms of general health examination conducted on them as part of the requirements for admission. This is usually not the case with public schools. Private schools are better organized in terms of funding, infrastructure and active parent teachers’ association (PTA) which take and act on important decisions on issues affecting the welfare of the pupils.

Thus, the pupils in public and private schools have varying social, economic and health-enabling environments. The possibility of differences in health in general and ocular health specifically therefore could exist.

This study aims to determine the ocular health status of pupils in private and public primary schools in Sabon-Gari, Zaria, Kaduna State, Nigeria, and ascertain whether there are differences.


  Materials and methods Top


This was a descriptive cross-sectional study conducted in Sabon-Gari-LGA, Zaria, Kaduna State, between November 2015 and November 2016. There were 26 private and 62 public registered primary schools with pupil populations of 6,108 and 46,685 respectively in Sabon-Gari, Zaria.

The sample size was determined using a standard formula n = Z2xpq/d2. Where n = desired minimum sample size, Z = standard normal deviate, 95% CI (1.96), P = prevalence taken as 19.9% from a previous study,[8] q = 1−P and d = desired level of precision taken as 5% (0.05). A total of 540 pupils were selected, 270 each from the private and public section. A multi stage sampling technique was used to select the pupils from three registered private and public primary schools each as follows.

Stage 1: Identification of all registered and approved schools in the study area was done for each group of schools, that is public and private schools.

Stage 2: Random selection of three primary schools from the approved lists above was made using the Microsoft Excel 2010 Analysis ToolPak random sample generator for each group.

Private schools selected

School A: Therbow Schools. Nos 74 River road GRA Sabon-Gari, Zaria.

School B: Ar-rayyan Islamic nursery and primary school, Nos 21/22 Army Rd, Sabon-Gari, Zaria.

School C: Judy Schools, Nos 20 King’s Road, Sabon-Gari Zaria.

Public schools selected

School A: Dogon Bauchi Model Primary L.E.A school, Sabon-Gari, Zaria.

School B: Army Children Primary School Sabon-Gari, Zaria.

School C: Ungwan–Fulani L.E.A primary school, Sabon-Gari, Zaria.

Stage 3: Determination of the population size to each school was by proportional allocation based on the number of pupils per school divided by the total population of the three schools in each group.

Stage 4: Selection of sample size for each class was by proportional allocation based on the number of pupils per class divided by the sum of population of the classes screened in the school.

Stage 5: Selection of pupils by systematic random sampling choosing every third pupil in a class was done for each class.

Study definition

Ametropia: Improvement in visual acuity of two lines or more with pin-hole for vision worse than 6/12 was considered to be a refractive error

Vernal conjunctivitis: Redness and/or pigmentation with presence of conjunctival papillae on the upper tarsal conjunctiva and/or limbal infiltration/papillae with/without secretions.

Infective/Microbial conjunctivitis: conjunctival hyperemia, lacrimation, irritation, and discharge.

Glaucoma suspect: Glaucoma suspect was defined as fundus findings of vertical cup disc ratio of ≥ 0.50 or asymmetry of ≥0.2 between the two eyes with direct ophthalmoscopy.

Pupils who consented participated in the study (consent was sought and obtained from the various heads of schools, proprietors/headmasters being the legal custodians of the children, and then assent from the pupils). Ethical approvals were obtained from the Health Research Ethics Committee (HREC) of Ahmadu Bello University Teaching Hospital Shika-Zaria and the Ethics Committee of the Kaduna State Ministry of Education. The study was conducted in accordance with the tenets of the Helsinki declaration.


  Procedure Top


Visual acuity assessment (distant)

A 6-meter distance was measured with the aid of a meter rule in a lit environment from which the Snellen’s/tumbling E-charts were hung. Starting with the right eye, with the left eye occluded, unaided visual acuity was assessed. Pupils who could not read the 6/6 line of the visual acuity chart repeated the test with a pin hole in place.

Pupils who use glasses were also tested with their glasses, additionally. The above sequence of visual acuity assessment unaided, with pin hole and with glasses if used by the pupil was repeated for the left eye. The anterior segment examination (which included the eyelid/lashes, orbits, adnexae, the extra-ocular motility, the conjunctiva, cornea, anterior chambers, iris, pupils, lens) was done with a pen torch light and examination loupe. Posterior segment (vitreous, retina, optic nerves, macula) examination was done by the researcher using the direct ophthalmoscope (HeineR Beta 200, Germany). Ocular findings were noted.

A proforma designed by the researchers was used for data collection. The data were coded and analyzed with the Statistical Package for Social Sciences version 20.0 (IBM SPSS Statistics, Chicago, Illinois, USA).


  Results Top


A total of 540 pupils were selected from six primary schools, comprising 270 from three private schools and an equal number from three public schools. The ages of the pupils ranged from 3 to 16 years with a mean of 8.42 (SD ± 2.16). Females were 272 (50.4%) and males 268 (49.6%) with F:M ratio of 1.01:1. Overall, almost 67% (66.5%) of the pupils were Hausas. In the public primary schools 80% of the pupils were Hausas and 7.8% Fulanis. In the private schools however, the ethnic distribution was more heterogeneous: Hausas were 53.0%, Yoruba 17.4%, Fulani, 10.4% and other tribes were 11.5%. The overall prevalence of ocular morbidities from the study was 22.8%. The prevalence of ocular morbidities in private and public schools were 21.1% and 24.4% respectively. Ametropia was the commonest ocular disorder reported in private schools 17 (6.3%) while vernal conjunctivitis was the most common reported morbidity in public schools 23 (8.5%). However, the pattern of refractive error varied between private and public schools. A higher number of pupils with ametropia (17) accounted for 6.29% of ocular morbidities in the private schools compared to 7 (2.6%) with refractive error in public schools. The age range of the pupils with ametropia was 6–9 years. More girls (n = 14, 58.3%) had ametropia than boys.

In each category of private and public schools an equal number of glaucoma suspects were reported-16 (5.9%) (P = 1.00). A higher proportion of pupils who had microbial conjunctivitis were in the public schools 5 (1.9%) as against a single case observed in the private schools (0.4%). The two cases of sub-conjunctival hemorrhages recorded were in the public schools (0.74%).


  Discussion Top


Due to the absence of an established school eye health program in the country, conducting school screening programs may be the means by which pupils could get access to eye care. Worldwide, screening people for diseases is receiving greater attention now as the benefits of early detection and treatment have been shown to be better.[9]

Abah et al. reported ocular morbidity prevalence of 22.6% in Zaria children school in 2011.[1] This is similar to our findings even though the studies were five years apart. The similar demographics of the study areas as well as the environment may account for the relatively unchanged prevalence recorded in both studies. A lower prevalence of 19.9% was reported by Ayanniyi et al in Ilorin.[8] In another study[10] in the United State of America, ocular morbidity prevalence was 21.5 %. Variation in prevalence of ocular morbidities may be due to the population size, the age range of children studied, besides ethnic, tribal and geographical differences.

Overall, a total number of 24 (4.45%) pupils had ametropia in both public and private schools. This percentage was higher than the prevalence recorded in the state capital, Kaduna (1.7%)[7] probably because of better access to ocular health services for pupils. However, it was lower than those recorded in Ilorin (6.9%) and in Ghana (71.7%)[8],[12] probably due to geographic, tribal and socioeconomic differences.[13],[14] In a comparative study of refractive errors of pupils in public and private schools in Ghana,[13] the prevalence was found to be 13.3%.

From this study a total of 32 pupils (16 each from private and public schools) which accounted for 5.9% for each of the groups were glaucoma suspects. In the study by Abah et al.,[1] 12% of the studied pupils were glaucoma cases/glaucoma suspects. The higher prevalence recorded in that study may not be unconnected to the fact that both glaucoma cases/glaucoma suspects were classified together. However, Ayanniyi et al.[15] recorded a far lower prevalence of 0.8 % of glaucoma suspects.

Vernal conjunctivitis was recorded in both private and public schools: It was the highest ocular morbidity recorded in the public schools. Twenty-three pupils (8.5%) in public schools and 14(5.2%) in private schools giving a combined prevalence of 6.9% (n = 37). Whereas vernal conjunctivitis is related to atopy and has genetic susceptibility, environmental factors are also associated triggers in the causation of the allergic disease.[11],[16] This may explain the relatively higher number of pupils in public schools with vernal conjunctivitis. The general environmental sanitation in public schools is not as good as what is obtainable in private schools. One of the public schools studied had a community refuse dumping site located within the premises. However, a lower prevalence of conjunctivitis (2.3%) was reported in a previous study[17] in public schools.

Furthermore, this study recorded no trauma associated ocular morbidity in private schools. However, in the public schools a case each of cataract and optic atrophy secondary to trauma was noted. Besides, two cases of sub-conjunctival hemorrhage following corporal punishment one at home and the other in the school were observed .Two cases of sub-conjunctival hemorrhage following corporal punishment one each at home and in the school, had also been documented.[7],[18] The supervision in private schools is likely to be better than in public schools partly because there is a lower pupils to teacher ratio in private schools. Also, corporal punishments are not allowed in most private schools.

Out of the total number of six pupils with microbial/infective conjunctivitis five (83.3%) were from the public schools. Abah et al.[1] did not record any case of infective conjunctivitis in their work which was attributed to the good personal hygiene of the pupils.[19],[20],[21] Five cases of blepharitis (1.9%) were also noted amongst the public-school pupils. Ayanniyi et al. reported a prevalence of 0.7 % for infective conjunctivitis and 0.2% for eyelid infection in Ilorin.[8]

Strabismus is the most common amblyogenic factor and approximately 40% of children with manifest strabismus have amblyopia.[37] In Nigeria, it is generally believed that strabismus is not common. In Zaria, a prevalence of 0.3 % was recorded.[1] A prevalence of 0.89% was reported in Benin City with the number of girls greater than boys.[22] This study also recorded all girls (3) with a prevalence of 0.55% having strabismus. In contrast to this, amongst seven-year-old Iranian school children, boys were noted to have a higher prevalence of strabismus than girls. The prevalence of strabismus was 2.2% in boys and 1.3% in girls.[23] The fact that only a selected age (seven-year-old pupils) was studied and not a range of ages as it was for this study, may probably account for the variation noticed.

A case of corneal opacity was seen in one boy. A similar study done in Zaria [1] did not record any case of corneal opacity/scar. The low prevalence of corneal scars/opacities seen in this study may probably be because it is an enlightened population that has complied with the Expanded Program on Immunization (EPI) program and vitamin A distribution

Limitations of the study

  1. The inability to sub-classify ametropia to the various components as myopia, hypermetropia, astigmatism due to the inability to procure a portable auto refractor for the screening exercise.
  2. The intraocular pressure of those diagnosed as glaucoma suspects were not measured because of inaccessibility to a portable tonometer for the field work.



  Conclusion Top


From the study, it can be concluded that majority of the pupils with ocular disorders in the public primary schools had vernal conjunctivitis while refractive error was the commonest ocular disorder seen in the pupils from the private schools. There was no statistically significant difference in the ocular morbidities between the pupils in public schools and those in private primary schools in the study area.

Avoidable and preventable (treatable) eye diseases constituted the bulk of the cases seen in pupils of public and private primary schools in Sabon-Gari, Zaria, Kaduna State, Nigeria.


  Recommendations Top


  1. School eye health program (targeted at teachers, health workers and policy makers) should be implemented locally, state wide and nationally by the ministries of education/boards for private schools and the ministries of health.
  2. There is a need for strong advocacy by eye care practitioners for children eye care.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Jose R, Sachdeva S. School eye screening and the National Program for Control of Blindness. Indian Pediatr 2009;46:205-8.  Back to cited text no. 2
    
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Frick KD, Foster A. The magnitude and cost of global blindness: an increasing problem that can be alleviated. Am J Ophthalmol 2003;135:471-6.  Back to cited text no. 4
    
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Serge R, Donatella P, Daniel E, Ivo K, Ramachandra P, Gopal P et al. Global data on visual impairment in the year 2002. Bulletin of the World Health Organization 2004;82:844-51.  Back to cited text no. 5
    
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Grover AK, Surbhi A. Eye screening in children: its relevance and implications. Journal International Medical Sciences Academy 2012;25:221-2.  Back to cited text no. 6
    
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Ayanniyi AA, Mahmoud AO, Olatunj FO. Causes and prevalence of ocular morbidity among primary school children in Ilorin, Nigeria. Niger J Clini Pract 2010;13:248-53.  Back to cited text no. 8
    
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Strong K, Wald N, Miller A, Alwan A. Current concepts in screening for non-communicable disease: World Health Organization consultation group report on methodology of non-communicable disease screening. Journal of Medical Screening 2005;12:12-9.  Back to cited text no. 9
    
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Ferebee A. Childhood vision: public challenges and opportunities. New-York; 2004 School of Public health and health services, George Washington Medical Centre, 1-24.  Back to cited text no. 10
    
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Saad A, El-Bayoumy BM. Environmental risk factors for refractive error among school children in Assiut District, Egypt. East Mediterr Health J 2007;3:819-28.  Back to cited text no. 11
    
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Ben DK, Anne E, Mohammed A, Abdul-Sadik A, Nana YK et al. Refractive error and visual impairment in private school children in Ghana. Optom and Vis Sci 2013;90:1456-61.  Back to cited text no. 12
    
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Ovenseri-Ogbomo GO, Assien R. Refractive error in school children in Agona Swedru, Ghana. S Afr Optom 2010;69:86-92.  Back to cited text no. 13
    
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Fahd AA, Tarek TA, Ayub A, Ataur RK. Prevalence and pattern of refractive errors among primary school children in Al Hassa, Saudi Arabia. Global Journal of Health Science 2013;5:125-34.  Back to cited text no. 14
    
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Ayanniyi AA, Olatunji FO, Mahmoud AO, Ayanniyi OR. Clinical findings among Nigerian paediatric glaucoma suspects during a school eye health survey. The Open Ophthalmology Journal 2008;2:137-40.  Back to cited text no. 15
    
16.
Bowling B. Conjunctiva: In Kanski’s Clinical Ophthalmology—A Systematic Approach, 8th ed. China, Elsevier, 2016.  Back to cited text no. 16
    
17.
Amol B, Kanthamani K, Narendra PD, Guruprasad BS, Joyita G. Ocular morbidity in school going children of Kolar district, South India. J Clin Biomed Sci 2012;2:175-84.  Back to cited text no. 17
    
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Ayanniyi AA, Mahmoud OA, Olatunji FO, Ayanniyi RO. Pattern of ocular trauma among primary school pupils in Ilorin, Nigeria. African Journal of Medicine and Medical Sciences 2009;38:193-6.  Back to cited text no. 18
    
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Morakinyo OM, Gree A, Oloruntoba EO. Prevalence of skin infections and hygiene practices among pupils in selected public primary schools in Ibadan, Nigeria. African Journal of Sustainable Development 2014;4:49-62.  Back to cited text no. 19
    
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Sarkar M. Personal hygiene among primary school children living in a slum of Kolkata, India. J Prev Med Hyg 2013;54:153-8.  Back to cited text no. 20
    
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22.
Akpe BA, Dawodu OA, Abadom EG. Prevalence and pattern of strabismus in primary school pupils in Benin city, Nigeria. Niger J Ophthalmol 2014;22:38-43.  Back to cited text no. 22
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23.
Hassan H, Abbas AY, Ebrahim J, Hadi O, Babak E, Saman M et al. The prevalence of strabismus in 7-year-old schoolchildren in Iran. Strabismus 2015;23:1-7.  Back to cited text no. 23
    




 

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