Abdulkabir Ayansiji Ayanniyi

Human resource development for Vision 2020 in developing countries: a change from absolute numbers.

Purpose. To critically review the numbers, distribution, staff mix, and productivity of eye care workers (ECW) in Kwara State, north central Nigeria. Methods. A cross-sectional descriptive survey of all ECW identified from all eye care facilities in July 2008 was carried out using a structured questionnaire. Output data on cataract surgery of each institution were also collected and data analyzed using SPSS 16. Results. A total of 157 ECW comprising 8 ophthalmologists, 4 diplomates, 16 residents training ophthalmologists, 96 mid-level ophthalmic personnel (67 ophthalmic nurses, 3 optometrists, and 26 others), and 33 administrative and supporting staff were available to a population of 2.37 million. Ophthalmologist to population ratio was 1:300,000, optometrist 1:790,000, and ophthalmic nurses 1:35,000. Eighty percent of ECW and institutions are located in the state capital. There were no orthoptists, low vision specialists, counselors, or cataract finders, while optometrists, managers, and primary ECW were inadequate. The staff mix was 1 surgeon to 12 other ECW and an average of 182 cataract surgeries per surgeon per year. Conclusions. Emphasis should shift to team building and ensuring available workers perform optimally rather than meeting the absolute numbers of some cadre, which does not guarantee improved output. Issues of equitable distribution, appropriate staff mix, filling identified gaps in human resources, and addressing poor service uptake should be the focus to reach the goals of Vision 2020: The Right to Sight.

A 37-year-old woman presenting with impaired visual function during antituberculosis drug therapy: a case report.

IntroductionCombination antituberculosis drug therapy remains the mainstay of treating tuberculosis. Unfortunately, antituberculosis drugs produce side effects including (toxic) impaired visual function, which may be irreversible. We report a case of antituberculosis-drug-induced impaired visual function that was reversed following early detection and attention.Case presentationA 37-year-old Yoruba woman, weighing 48 kg, presented to our facility with impaired visual functions and mild sensory polyneuropathy in about the fourth month of antituberculosis treatment. Her therapy comprised ethambutol 825 mg, isoniazid 225 mg, rifampicin 450 mg, and pyrazinamide 1200 mg. Her visual acuity was 6/60 in her right eye and 1/60 in her left eye. She had sluggish pupils, red-green dyschromatopsia, hyperemic optic discs and central visual field defects. Her intraocular pressure was 14 mmHg. Her liver and kidney functions were essentially normal. Screening for human immunodeficiency virus was not reactive. Her impaired visual function improved following prompt diagnosis and attention, including the discontinuation of medication.ConclusionsThe ethambutol and isoniazid in antituberculosis medication are notorious for causing impaired visual function. The diagnosis of ocular toxicity from antituberculosis drugs should never be delayed, and should be possible with the patients history and simple but basic eye examinations and tests. Tight weight-based antituberculosis therapy, routine peri-therapy visual function monitoring towards early detection of impaired function, and prompt attention will reduce avoidable ocular morbidity.

Clinical findings among nigerian paediatric glaucoma suspects during a school eye health survey.

Objective: To report clinical findings suspicious of glaucoma among primary school children in Ilorin, Nigeria. Methods: A cross sectional survey of ocular health among 1,393 school children carried out between July 2005 and Janu- ary 2006. Criteria for suspecting glaucoma included a cup disc ratio (CD) of > 0.5, a CD asymmetry between the fellow eyes of > 0.2, and/or intraocular pressure (IOP) > 21mmHg by applanation tonometry. Results: Eleven (6 boys and 5 girls) of 1,393 pupils (0.8%), aged between 7 and 13 years, had ocular findings suspicious of glaucoma. Twenty two eyes of 11 pupils had a CD ratio > 0.6, and among these 5 eyes had IOP > 21. Three of the pu- pils had a CD asymmetry of > 0.2. Conclusion: A significant proportion of these Nigerian school pupils had clinical signs suggestive of glaucoma. A func- tional school health programme with eye health component coupled with efficient referral system is advocated.Objective: To report clinical findings suspicious of glaucoma among primary school children in Ilorin, Nigeria. Methods: A cross sectional survey of ocular health among 1,393 school children carried out between July 2005 and January 2006. Criteria for suspecting glaucoma included a cup disc ratio (CD) of > 0.5, a CD asymmetry between the fellow eyes of > 0.2, and/or intraocular pressure (IOP) > 21mmHg by applanation tonometry. Results: Eleven (6 boys and 5 girls) of 1,393 pupils (0.8%), aged between 7 and 13 years, had ocular findings suspicious of glaucoma. Twenty two eyes of 11 pupils had a CD ratio ≥ 0.6, and among these 5 eyes had IOP > 21. Three of the pupils had a CD asymmetry of > 0.2. Conclusion: A significant proportion of these Nigerian school pupils had clinical signs suggestive of glaucoma. A functional school health programme with eye health component coupled with efficient referral system is advocated.

Ophthalmic research priorities and practices in Nigeria: An assessment of the views of Nigerian ophthalmologists

Purpose: To study the views of ophthalmologists on research priorities and outcomes in Nigeria. Materials and Methods: A structured questionnaire was distributed to 120 ophthalmologists and ophthalmic residents who were attending an annual congress in Nigeria. The participants’ background information, relative research priorities, frequency of publications, research types, publication media, challenges faced in publishing and impact on health practice or policy were collected. Results: Eighty-nine (74.2%) of the 120 questionnaires were returned. Childhood blindness was given the highest priority for ophthalmic research by 42.9% of the respondents, and genetic studies had the least priority (19.8%). About two-thirds of the respondents had either never been involved or only involved occasionally in any type of ophthalmic research. Clinical trials (13.1%) and basic science studies (12%) were the least-performed types of research. About 51% of the respondents indicated that they had never published in journals nor did so “occasionally”; only 9% quarterly and 43% published less than once a year. They also indicated that their research very rarely resulted in change of clinical practice or health policy (20%). Conclusions: Research works conducted by respondents were largely simple low-budget ones that rarely had significant impacts and outcomes, including publication. There is a need to retrain and emphasize the importance of research during undergraduate and postgraduate medical education. Adequate resources and research infrastructure should be provided for ophthalmic research in Nigeria.

Challenges, Attitudes and Practices of the Spectacle Wearers in a Resource-Limited Economy

Purpose: To evaluate challenges, attitudes and practices among spectacle wearers to effect positive change when necessary, and determine positive change in a resource-limited economy. Materials and Methods: A multi-hospital descriptive, cross sectional survey of spectacle wearers was conducted between May 2007 and December 2008 in Nigeria. Results: A total of 214 wearers comprising 43.5% males and 56.5% females aged 18-84 years were surveyed. The majority of subjects (92.6%) had at least secondary education. The wearers’ challenges included expensive spectacles (43.0%), falling/scratched/broken lenses (29.4%) and fear that spectacles would damage the eyes (23.8%). The wearers’ attitudes were comprised of consultations with ‘road side dispensers’ (7%) and permitting other individuals to select spectacle frames for them (26%). Care and maintaince practices included use of handkerchief, tissue paper, fingers and water to clean spectacles (49.5%) and placing spectacles inside spectacle cases (30.4%). There were no associations (P > 0.05) between gender or literacy levels and who selected the frames for the subjects, caregivers consulted for spectacles, and cleaning materials for spectacles. The placement of spectacles when not in use was significantly associated (P < 0.05) with the wearers’ gender and literacy levels but not with the length of spectacle wear. Conclusion: Attitudes and practices requiring positive change crossed gender and educational levels among spectacle wearers. The cost of spectacles should be regulated and availability of standard eye care practices would reduce challenges including lens-related defects and quackery. During consultation with a recognized eye care professional, counseling of wearers on positive attitudes/practices as well as allaying fear of spectacle wear is required.

The Sokoto Blind Beggars: Causes of Blindness and Barriers to Rehabilitation Services

Purpose: To determine the causes of blindness and the barriers to accessing rehabilitation services (RS) among blind street beggars (bsb) in Sokoto, Nigeria. Materials and Methods: A cross-sectional survey of 202 bsb (VA < 3/60) using interviewer administered questionnaire. The causes of blindness were diagnosed by clinical ophthalmic examination. Results: There were 107 (53%) males and 95 (47%) females with a mean age of 49 years (SD 12.2). Most bsb 191 (94.6%) had non-formal education. Of 190 (94.1%) irreversibly bsb, 180/190 (94.7%) had no light perception (NPL) bilaterally. The major causes of blindness were non-trachomatous corneal opacity (60.8%) and trachoma corneal opacity (12.8%). There were 166 (82%) blind from avoidable causes and 190 (94.1%) were irreversibly blind with 76.1% due to avoidable causes. The available sub-standard RS were educational, vocational and financial support. The barriers to RS in the past included non-availability 151 (87.8%), inability to afford 2 (1.2%), unfelt need 4 (2.3%), family refusal 1 (0.6), ignorance 6 (3.5%) and being not linked 8 (4.7%). The barriers to RS during the study period included inability of 72 subjects (35.6%) to access RS and 59 (81.9%) were due to lack of linkage to the existing services. Conclusion: Corneal opacification was the major cause of blindness among bsb. The main challenges to RS include the inadequate services available, societal and users factors. Renewed efforts are warranted toward the prevention of avoidable causes of blindness especially corneal opacities. The quality of life of the blind street beggar should be improved through available, accessible and affordable well-maintained and sustained rehabilitation services.

Indications for destructive ocular surgeries in Nigeria.

INTRODUCTION Destructive ocular surgery (DOS) means eye loss. An audit of its indications would be useful in reducing its incidence. OBJECTIVE To determine indications for destructive ocular surgeries. MATERIALS AND METHODS The case records (files) of all the patients who had DOS in a tertiary health facility in Nigeria from January 2004 to December 2011 were reviewed retrospectively. The information extracted include the bio data, indication for DOS, type of surgery performed and history of the use of traditional eye medications (TEM) and willingness to use an artificial eye (AE). RESULTS Thirty-seven patients had DOS. The mean age of the patients was 35.51years (SD 21.6) and the male to female ratio was 2.1:1. Evisceration was the commonest DOS performed , in 30 eyes (81.1 %). The most common indication for DOS was intraocular infection, in 15 eyes (40.5 %), followed, among others, by trauma in 13 (35.1 %) and malignant ocular tumours in 4 (10.8 %). There was association between age and indication for DOS (P = 0.032). Many patients, 15 (40.5%), used TEM and most, 34 (91.9%), refused an artificial eye (AE) after surgery. CONCLUSIONS The most common indication for DOS in this study was intraocular infection. Evisceration was the commonest destructive eye surgery offered.

Uniocular blindness in a six-year-old boy following penetrating eye injury from a domestic hen peck

Domestic hen pecking eye trauma causes avoidable blindness and the public should guard against it, especially among children.

Survey of the attitudes of nigerian ophthalmologists to and resources for ophthalmic research.

Aim: To study the views of ophthalmologists on their attitude to and the resources for ophthalmic health research in Nigeria and draw appropriate policy implications. Materials and Methods: Structured questionnaires were distributed to 120 ophthalmologists and ophthalmic residents who were attending an annual congress in Nigeria. Data were collected on background information, importance attributed to research, motivation for conducting research, funding, ethical oversight, literature search, and statistical support. The coded responses were statistically analyzed. P < 0.05 was statistically significant. Results: Eighty-nine of the 120 questionnaires were returned giving a response rate of 74.2%. Research function was rated a distant last by 49.5% of the respondents after clinical service (93.2%), teaching (63.1%), and community service (62.8%). Advancement of knowledge was the strongest motivating factor for conducting research (78.2 %). Securing funding (91.8%) and finding time (78.8%) were the major constraints. The ethical review committees were considered suboptimal by the respondents. Literature searches for research were conducted on the internet (79.3%) and was independent of age (P = 0.465). Research data were stored and analyzed on commonly available statistical software. Conclusions: Although study respondents regarded research highly, they were severely constrained in conducting research due to lack of access to funds and finding time away from the clinical workload. We recommend periodic (re)training on conducting good research including preparation of successful applications for research grants and allotting protected research time for ophthalmologists in Nigeria.

Survey of Medical Officers Attitudes and Knowledge of Eye Conditions in Older Patients

Aim: To assess medical officers’ attitude and knowledge of eye conditions in the elderly. Study design: Convenient sampling technique.