Ao Mahmoud

Cataract blindness in Osun state, Nigeria: results of a survey.

Purpose: To estimate the burden of blindness and visual impairment due to cataract in Egbedore Local Government Area of Osun State, Nigeria. Materials and Methods: Twenty clusters of 60 individuals who were 50 years or older were selected by systematic random sampling from the entire community. A total of 1,183 persons were examined. Results: The age- and sex-adjusted prevalence of bilateral cataract-related blindness (visual acuity (VA) < 3/60) in people of 50 years and older was 2.0% (95% confidence interval (CI): 1.6–2.4%). The Cataract Surgical Coverage (CSC) (persons) was 12.1% and Couching Coverage (persons) was 11.8%. The age- and sex-adjusted prevalence of bilateral operable cataract (VA < 6/60) in people of 50 years and older was 2.7% (95% CI: 2.3–3.1%). In this last group, the cataract intervention (surgery + couching) coverage was 22.2%. The proportion of patients who could not attain 6/60 vision after surgery were 12.5, 87.5, and 92.9%, respectively, for patients who underwent intraocular lens (IOL) implantation, cataract surgery without IOL implantation and those who underwent couching. “Lack of awareness” (30.4%), “no need for surgery” (17.6%), cost (14.6%), fear (10.2%), “waiting for cataract to mature” (8.8%), AND “surgical services not available” (5.8%) were reasons why individuals with operable cataract did not undergo cataract surgery. Conclusions: Over 600 operable cataracts exist in this region of Nigeria. There is an urgent need for an effective, affordable, and accessible cataract outreach program. Sustained efforts have to be made to increase the number of IOL surgeries, by making IOL surgery available locally at an affordable cost, if not completely free.

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.

Views of West African surgeons on how well their educational and professional backgrounds may have prepared them for health leadership roles

Background: Because of the appalling health indices in West Africa, Physicians there need to be at the forefront of the organizational challenge in managing and improving health systems. Aim: To collate the views of West African surgeons on how well their educational and professional backgrounds may have prepared them for leadership and managerial roles in health care, and draw appropriate policy implications. Material and Methods: Filled structured questionnaires from 110 surgeons that were attending an annual conference were analyzed. The respondents’ bio data, professional, educational, health administrative backgrounds were probed. Their views on justifications for physicians’ involvement in health managerial roles, probable influence of some physicians’ characteristic traits and professional attributes on health leadership roles, and suggestions for improvement were also collated. Results: 71.8% of the respondents had held or were then holding health-related administrative posts; 90% had attended different varieties of management courses; 95.4% identified physicians as the inherent leaders of the health care team; but only 28.4% adjudged their health management role “strongly important” (28.4%) among their multi-faceted roles; and they largely agreed that some stated professional and characteristic traits of physicians tend to make them poor leaders and managers. Conclusions: Our findings suggest that the preparations that the respondents got from their formal and professional education for leadership and managerial roles in health care were not optimal. We recommend for a paradigm shift for physicians on health leadership issue which is to be facilitated by a well-focused short time duration health management course for all physicians, particularly specialists.

Ocular Morbidity and Health Seeking Behaviour in Kwara State, Nigeria: Implications for Delivery of Eye Care Services.

Background There is currently limited information as to which conditions are most prevalent in communities in developing countries. This makes effective planning of eye services difficult. Methods 3,899 eligible individuals were recruited and examined in a cross-sectional survey in Asa Local Government Area, Nigeria. Those who self-reported an ocular morbidity were also asked about their health-seeking behaviour. Health records of local facilities were reviewed to collect information on those presenting with ocular morbidities. Results 25.2% (95% CI: 22.0–28.6) had an ocular morbidity in at least one eye. Leading causes were presbyopia and conditions affecting the lens and conjunctiva. The odds of having an ocular morbidity increased with age and lower educational attainment. 10.1% (7.7–13.0) self-reported ocular morbidity; 48.6% (40.4–56.8) of them reported seeking treatment. At the facility level, 344 patients presented with an ocular morbidity over one month, the most common conditions were red (26.3%) or itchy (20.8%) eyes. Conclusion Ocular morbidities, including many non vision impairing conditions, were prevalent with a quarter of the population affected. The delivery of eye care services needs to be tailored in order to address this need and ensure delivery in a cost-effective and sustainable manner.

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.

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.

Exploring the options for alternative means of livelihood for blind street beggars in Sokoto, Nigeria

AIM To explore the readiness of and the options for alternative means of livelihood for Blind Street beggars in Sokoto, Nigeria, with a view to achieving the millennium development goals. MATERIALS AND METHODS A cross-sectional study was conducted in a Local Government Area (LGA), in Sokoto State over a 6 weeks period (May/June, 2009). Ethical clearance was obtained from the Ethical Committee of University of Ilorin Teaching Hospital. A list of blind persons in these areas was obtained from the local traditional head of the blind (Sarkin Makafi) who gave the general consent for the study and also assisted in mobilizing the subjects. Blind subjects who consented were examined and included in the study. Data were collected with a semistructured questionnaire. The desire for occupational change and the preferred alternative means of sustenance were explored. Data obtained were coded, analyzed, and summarized in form of frequency tables. RESULTS A total of 216 (94.7%) subjects were examined out of the 228 subjects that were enumerated. However, only 202 of the registered persons that were actually found to be blind on ophthalmic examination were included in the analysis. Majority of the subjects, 201 (99.5%), wanted alternative means of livelihood. About half of the subjects, 100 (49.8%), wanted to be established in farming or trading. CONCLUSION Most respondents expressed readiness for alternative means of livelihood.

The Educational Travails of a Visually-Impaired 25 Year-Old Nigerian University Student with Stargardt's Disease

Stargardt’s disease is probably under-diagnosed in sub-Saharan Africa as its subtle macular changes in the earlier stages of the disease are often out of proportion to the bilateral gradual impairment of central vision. In addition, the paucity of well-equipped eye clinics manned by trained retinal sub-specialists makes the detection of the disease a rare event. We present a patient in whom we made a diagnosis of Stargardt’s disease on clinical grounds in Nigeria and who subsequently had corroboratory fundus angiographic and electro diagnostic tests in the United Kingdom. The patient, who was already severely visually incapacitated in his mid-twenties, had to abandon medical studies for a perceived less visually demanding one. His hope for a restoration of his eyesight now rests on the promising advances being made in gene and stem cell therapy.

Coats disease in a Nigerian man with a favorable structural outcome following retinal laser photocoagulation

Sir, George Coats in 1908 identified this very rare idiopathic retinal telangiectasia with intraretinal or subretinal exudation without appreciable signs of retinal or vitreal traction that typically affects one eye of male children.[1] We wish to share our experience with the first documented case of Coats disease in Nigeria which suggests that the limited nature of retino‐vascular abnormalities of the disease in adults make it amenable to retinal laser photocoagulation.

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.