Ao Adeoye

Survey of blindness in rural communities of south-western Nigeria

A population based survey of rural communities in the Akinlalu‐Ashipa ward of Ife North Local Government in Osun State, Nigeria, was conducted to determine the prevalence and causes of blindness. 2921 inhabitants were screened by a random cluster sample technique, out of whom 27 were blind in both eyes. The overall prevalence rate of blindness (best corrected visual acuity less than 3/60 in the better eye) was found to be 0.9% (95% confidence interval 0.84–0.96%).

Prevalence and causes of blindness and visual impairment among school children in south-western Nigeria

The aim of the study was to assess the prevalence and identify the causes of blindness and visual impairment in school children of Ilesa-East Local Government Area of Osun State, Nigeria. A total of 1144 school children in primary and secondary schools were selected using a 2-stage random sampling method and examined to determine the prevalence and causes of blindness and visual impairment. A total of 17 (1.48%) children were blind or visually impaired. These comprised of 11 (0.96%) children who were visually impaired and 4 (0.3%) who were severely visually impaired. Only 2 (0.15%) school children were blind. The causes of visual impairment were refractive error 10 (0.87%) and immature cataract 1 (0.08%), causes of severe visual impairment included corneal opacities 2 (0.2%), amblyopia leading to squint 1 (0.08%) and 1 cataract 1 (0.08%). The causes of blindness in school children were corneal scars presumed to be due to vitamin A deficiency 1 (0.08%) and keratoconus 1 (0.08%). Causes of blindness and visual impairment in children attending regular schools in Nigeria were treatable. Prevention, early recognition and prompt treatment of these diseases by regular screening of school children would definitely reduce unnecessary visual handicap in Nigerian school children so that they can attain their full potential in the course of their education. Also, information from this study is relevant for the purpose of planning eye care programmes for the prevention of blindness in Nigerian school children. This will go a long way in the prevention of unnecessary blindness and visual impairment in school children.

Characteristics of Patients who Dropout From a Glaucoma Clinic

PurposeTo find the dropout rate and identify the clinical characteristics of patients who drop out in the first year of follow-up from a glaucoma clinic. DesignDescriptive hospital-based study at a tertiary hospital eye department. MethodsClinical characteristics of consecutive patients newly diagnosed with glaucoma who dropped out (n=452) were compared with patients who did not drop out (n=295) within 12 months. ResultsThe rate of dropout from follow-up was 60.5% within 1 year; 43.1% of the study group dropped out after their first follow-up visit. The dropout rate was high in all age groups, but higher in the age groups 21 to 30 years, 41 to 50 years, and over 70 years. Males had a higher dropout rate than females (78.6% vs. 34.5%). Dropout rate was higher among those with mild/moderate glaucoma than those with severe disease (88.2% vs. 37.2%); those who lived further away from the hospital than those who lived nearer to the hospital (72.5% vs. 40.8%), those who were referred from screening clinics for nonblinding eye disease compared with those referred because of a blinding eye disease (72.2% vs. 58.9%). More patients (63.8%) unsure of their family eye disease history dropped out, compared with 34.3% of those with positive family history of glaucoma and other potentially blinding diseases. More patients who had no systemic disease dropped out, than those with systemic disease (54.6% vs. 39.6%); whereas patients on 2 medications or more had a higher dropout rate than those on less than 2 medications (68.1% vs. 52.1%). Of the study factors, those that were statistically significantly associated with dropping out of follow-up from the glaucoma clinic were age, sex, place of domicile, diagnosis at referral, severity of disease, family history, and polydrug use. ConclusionsThe dropout rate from this glaucoma clinic in the first year was high (60.5%). Patients who were more likely to dropout were younger patients, male, those who travelled far distances to the clinic, those with mild to moderate glaucoma, those with no family history of blinding eye diseases, and patients taking 2 or more eyedrops. Patients who seem to perceive their problems as not serious dropped out of follow-up. These findings have great implications in planning future studies and intervention to improve the follow-up of glaucoma patients in the study area.

Visual functions of commercial drivers in relation to road accidents in Nigeria

Objective: To determine the effects of the visual functions on the occurrence of road traffic accidents (RTA) amongst commercial drivers in Ife central local government area (LGA) of Osun state of Nigeria. Design: A cross-sectional study. Settings: Four major motor parks located at Ife Central LGA. Materials and Methods: Of the estimated 270 commercial drivers in the four major parks of the LGA, 215 consecutive drivers were interviewed and had their eyes examined. Structured questionnaires were administered by an ophthalmologist. Results: The prevalence of visual impairment (visual acuity < 6/18) in the better eye without correction was 3.3% ± 2.4 and there was a significant association between uncorrected visual acuity impairment in the better eye and RTA (P = 0.0152). Refractive error was seen in 8.4% of the drivers, but none of these wear corrective glasses. Visual field defect, abnormal stereopsis and color vision impairment did not have any significant association with RTA. Conclusion: Poor visual acuity is strongly associated with RTA amongst Nigerian commercial drivers as opposed to visual field defect, abnormal color vision and stereopsis. A significant proportion of visual impairment was due to uncorrected refractive errors.

Determinants of previous dilated eye examination among type II diabetics in Southwestern Nigeria

PURPOSE To assess the prevalence and factors influencing previous dilated eye examination in screening for retinopathy among type II diabetics. METHODOLOGY Cross-sectional study of type II diabetic patients receiving treatment at a tertiary hospital in southwestern Nigeria was conducted with information on gender, age, duration of diabetes, current medication and previous dilated eye examination recorded. Eye examination included visual acuity, pen torch examination, applanation tonometry and direct ophthalmoscopy of the dilated eye in a dark room. Visual acuity was presented as classified by WHO while data was analyzed using SPSS version 11 and statistical significance inferred at P<0.05. RESULTS Eighty three type II diabetics with mean age 57.5+/-10.8 years and mean duration of diabetes of 6.6 years were studied. Visual impairment (<6/18 in the better eye) and blindness (<3/60 in the better eye) were recorded in 3.6% and 12% of the patients respectively while diabetic retinopathy was present in 21.6%. Only 24 [28.9%] diabetics had previous dilated eye examination; absence of eye symptoms [50.8%] and lack of referral [45.8%] were the main barriers to having previous dilated eye examination. Previous dilated eye examination was significantly influenced by the presence of visual impairment/blindness [P=0.002], longer duration diabetes mellitus [P=0.006], current insulin treatment [P=0.040] and presence of non-diabetic vision threatening eye diseases [P=0.016]. CONCLUSION Dilated eye examination rate is low; inadequate knowledge about diabetic retinopathy as well as low referral rates is contributory. Massive health education on diabetic retinopathy as well as development of sustainable retinopathy screening protocol would be helpful.

Childhood eye diseases in southwestern Nigeria: a tertiary hospital study

BACKGROUND Eye diseases are important cause of medical consultation in children, with the spectrum varying in different localities. This study aimed to determine the spectrum of childhood eye diseases in a tertiary hospital serving rural and semi-rural communities. METHODS We conducted a retrospective review of all patients less than 15 years old who presented to the eye clinic of Wesley Guild Hospital Ilesa, Nigeria between January 2001 and December 2006. Data on age at presentation, age at onset of disease, sex and diagnosis were collected and analyzed using SPSS. A p value less than 0.05 was considered statistically significant. RESULTS We evaluated the reports of 286 children, with a male:female ratio of 1:1.1. Children aged 11–15 years made up the largest group (p=0.013). Ocular trauma (21.7%), allergic conjunctivitis (17.8%), infections of the eye and its adnexa (15.4%) and refractive errors (14.3%) were the most common conditions. Ocular injury was more common in males (p=0.002) and children aged 6–10 years, and 87.1% of these cases were a closed globe injury. Infections were seen more commonly among females and children aged 0–5 years, with keratitis representing 40.9% of these cases. Congenital eye disease represented 13.3% of childhood eye diseases. CONCLUSION The prevalent childhood eye diseases recorded here can lead to absenteeism from school and are potentially blinding. Health education aimed at the prevention of ocular trauma and prompt presentation for the management of other eye diseases should be encouraged.

Epidemiology of ocular trauma among the elderly in a developing country

Purpose: To study the epidemiology of ocular trauma among the elderly in a developing country. Method: This is a multi-center retrospective clinical study of patients aged 65 years and above managed for ocular trauma between 2001 and 2007 at 4 hospitals in southwestern Nigeria. Age, sex, occupation, residential address, location at time of injury, activity preceding injury, agent of injury, treatment modalities offered and presenting visual acuity were recorded in a predesigned form. Type of injury was classified according to Birmingham Eye Trauma Terminology. Data were recorded and analyzed with descriptive statistics and Chi square using SPSS 11 (SPSS Inc., Chicago, IL) and statistical significance accepted at P < 0.05. Results: 78 patients with overall mean age of 70.1 ± 5.5 years and male to female ratio of 1.9: 1 (P = 0.007) were studied. Mean age for males was 70.0 ± 5.4 years and 70.1 ± 5.7 years for females. Eye injury occurred most commonly on the farm (37.2%), during farm related activities (35.9%) with sticks/twigs (41.1%) being commonest agent of ocular trauma among the elderly. However, injury occurred most frequently at home (51.9%) and during a fight/dispute (25.9%) with inciting agents being most frequently (33.3%) home related in elderly females. Eye injury was mainly of closed globe variety (85.9%); open globe injury was associated with higher incidence of hospitalization (P < 0.0001) and visual impairment (P = 0.004) at presentation. Conclusion: Although eye injury in elderly occurred more commonly on the farm during farm related activities, gender related differences are present with injury occurring more commonly in the home and during assaults/disputes.

Perception and attitude of people toward onchocerciasis (river blindness) in south western Nigeria

Background: Onchocerciasis (river blindness) is a major cause of bilateral blindness with devastating socioeconomic consequences. Since Nigeria is the most heavily onchocerciasis endemic country in the world, the information on people’s knowledge about this disease is significant. This could influence their response to current preventive measures of the African Programme for Onchocerciasis Control. Aim: This study was designed to estimate the level of knowledge and attitudes of rural/semi-urban communities in Ife North Local Government Area of Osun State toward onchocerciasis. Materials and Methods: Cluster random sampling was used to select 500 adults for the study. Semi-structured questionnaires were administered to subjects. Data on knowledge of the local name, cause, mode of transmission, manifestation, severity, treatment, and prevention of onchocerciasis were collected and analysed. Statistical analysis included frequency distribution of the responses and a Chi-square test for comparison of variables with the P value for statistical significance set at 0.05. Results: Onchocerciasis was well known by its local name among 458 (91.6%) of the respondents. Only seven (1.4%) knew that it affects both the eyes and skin. The cause was commonly attributed to impure blood by 114 (22.8%), whereas transmission was thought to be through fomites by 161 (32.2%). Only 12 (2.4%) respondents attributed the disease to blackfly bites. The level of education and the association of onchocerciasis with a river were significantly associated (P = 0.001). Subcutaneous nodules were felt to contain water (85.4%), baby worms (3.2%), and fat (0.6%). There was a negative attitude toward sufferers of the disease. Conclusion: Adequate information transfer in simple local dialect by trained personnel to the communities at risk of onchocerciasis is essential for better uptake of all aspects of the onchocerciasis control programme.

Awareness and utilization of protective eye device among welders in a southwestern Nigeria community

OBJECTIVE To determine the level of awareness and practice of use of protective eye devices among welders in Ile-Ife. METHODS This is a cross-sectional descriptive study of 405 consenting welders. A pretested proforma was utilized to obtain information on sociodemographic characteristics, as well as awareness and use of protective eye device. RESULTS The age of the respondents ranged from 16 to 80 years. The mean age was 39 ± 13 years. A large proportion (315, 78%) of the welders was aged between 21 and 50 years. The youngest group aged ≤ 20 years accounted for 15 (4%) of all welders, while the oldest group aged > 60 years accounted for 21 (5.2%). 402 were males (99.3%) and three were females (0.7%). Three hundred thirty-six (83%) of the welders had practiced for 6 years and above. There was a high level of awareness of protective eye devices among the welders (367, 90.6%), being higher among arc welders compared with gas welders (P < 0.001). Less than half (186, 45.9%) of the welders possessed protective eye devices. Of these, only 39 (9.6%) made use of the devices always. Some of the reasons for not using the protective eye devices include discomfort and poor visibility (56, 13.6%) and inadequate appreciation of the necessity to wear it (49, 12.1%). CONCLUSION The findings of this study suggest that a significant proportion of welders in Ile-Ife were not utilizing protective eye device. Health education and awareness campaigns about the importance and benefits of utilizing protective eye devices are recommended.

Cost-Related Antibiotic Dosage Omissions—Challenge for Orbital Cellulitis Management in Resource Poor Communities

Background: Orbital cellulitis is a medical emergency with potential vision and life threatening complications. Aim: To highlight clinical presentation and challenges in the management of orbital cellulitis in resource poor communities of southwestern Nigeria. Method: Retrospective review of patients managed for orbital cellulitis at the Wesley Guild Hospital, Ilesa, Nigeria for biodata, socioeconomic status, clinical presentation, compliance to prescribed medications and treatment outcome. Data was analyzed using SPSS version 11. Result: Seventeen patients with mean age and standard deviation of 10 ± 9.9 years were managed for orbital cellulitis. Thirteen (76.5%) females and 4(23.5%) males giving a male to female ratio of 1:3.3 (p = 0.03). Most patients (94.1%) belonged to low socioeconomic status and sinusitis was the most common predisposing factor. 10 (58.8%) had intravenous antibiotics only while 7(41.2%) had surgical drainage of abscess in addition. Delayed and irregular administration of antibiotics was observed in 9 (52.9%) patients due to lack of funds thus necessitating change of choice in antibiotics. Complication include ptosis 3(17.6%), corneal opacity 2 (11.8%), optic atrophy 1(5.9%) and 1(5.9%) meningitis and death 1(5.9%). Conclusion: Cost and affordability should be major determinants of choice of empirical antibiotics in resource poor communities to ensure timely and regular treatment and improve prognosis in management of orbital cellulitis.