Co Bekibele

Profile of patients presenting at a low vision clinic in a developing country.

BackgroundLow vision is an important public health problem; however, very few low vision clinics are available to address the needs of low vision patients in most developing countries. The purpose of this study was to describe the characteristics of patients attending the low vision clinic of a Nigerian tertiary hospital.MethodsThis was a prospective cross sectional study of all new patients seen at the low vision clinic over a 36 month period. Patients were administered with a structured questionnaire, and were examined and tested with low vision devices by the attending low vision specialist. Information on the demographic and clinical characteristics of the patients was recorded.ResultsA total of 193 new patients seen during the period were studied. The mean age was 41.4 years, and their ages ranged between 6 and 90 years with a male to female ratio of 1.9:1. Majority (58%) were aged below 50 years, 23.3% were children (≤15 years), while 21.8% were elderly patients (≥65 years). The commonest cause of low vision was retinitis pigmentosa (16.6%); 14.5% had age related macular degeneration (ARMD); 9.8% had albinism; while only 1% had diabetic retinopathy. ARMD (45.2%) was the commonest cause in the elderly patients, while albinism (24.4%) and optic atrophy (24.4%) were the commonest in children.ConclusionThe demographic and clinical characteristics of low vision patients seen in this clinic are similar to that of patients in other developing countries, but different from those in developed countries. Elderly patients and females may be under-utilising low vision services. There is a need for further research into the determinants of low vision service utilisation in developing countries. This would further aid the planning and delivery of services to low vision patients in these countries.

Awareness and knowledge of glaucoma among workers in a Nigerian tertiary health care institution.

Purpose: The aim of this study reports the level of awareness and knowledge of glaucoma among selected health care personnel at a health institution in southwestern Nigeria. Materials and Methods: Health personnel at the Federal Medical Centre, Owo, Nigeria, a tertiary health care institution were stratified into a clinical and an administrative directorate. One-hundred twenty participants were selected from each directorate by a random sampling technique. A structured questionnaire was used to collect sociodemographic data and data on the level of knowledge and awareness of glaucoma. Statistical analyses included the independent t-test and Pearsons chi-square test for categorical variables. Statistical significance was indicated by P < 0.05. Results: From the target population of 240 participants, 216 (98 males; 118 females) completed the questionnaire. The mean age of the participants was 35.07 ± 07 years. A total of 148 (68.6%) participants had heard of glaucoma comprising all participants from the clinical directorate and 28 participants from the administrative directorate. There was no statistically significant difference between the clinical and administrative directorates about the knowledge of the aspect of vision that is first affected by glaucoma, the painless nature of glaucoma among most Africans and the irreversible nature of glaucoma-related blindness (P > 0.05, all comparisons). Conclusion: There is the need to update the knowledge base of these workers if they are to be useful in propagating information of the irreversible blindness that could arise from delay in glaucoma diagnosis and treatment.

Survey of low vision among students attending schools for the blind in Nigeria: a descriptive and interventional study.

Purpose: The aim of this study is to determine the prevalence of low vision among students attending all the schools for the blind in Oyo State, Nigeria. The study set out to determine the proportion of students with low vision/severe visual impairment after best correction, to determine the causes of the low vision, to document the associated pathologies, to determine the types of treatment and visual aid devices required, and to provide the visual aids needed to the students in the schools. Materials and Methods: All schools students for the blind in Oyo State were evaluated between August 2007 and January 2008. All the students underwent a thorough ophthalmic examination that included measurement of visual acuity, retinoscopy and subjective refraction, tests for visual aids where indicated, and a structured questionnaire was administered. Results: A total of 86 students were included in the study and the mean age was 19.4 ± 8.19 years. Twenty six (30%) were under 16 years of age. The most common cause of blindness was bilateral measles keratopathy/vitamin A deficiency (VAD) in 25 students (29.1%). The most common site affected was the cornea in 25 students (29.1%), the lens in 23 (26.7%), and the retina/optic nerve in 16 (18.6%). Preventable blindness was mainly from measles keratopathy/VAD (29.1%). Eleven students benefited from refraction and correction with visual aids; two having severe visual impairment (SVI), and nine having visual impairment (VI) after correction. Conclusion: The prevalence of low vision in the schools for the blind in Oyo State is 2.3%, while the prevalence of visual impairment is 10.5%. These results suggest that preventable and treatable ocular conditions are the source of significant childhood blindness in Oyo State.

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.

Effect of face washing with soap and water and cleaning with antiseptics on upper-lid bacteria of surgical eye patients

OBJECTIVE To determine the effect of face washing with soap and water and cleaning with povidone iodine and cetrimide/chlorhexidine gluconate (Savlon) on upper-lid bacteria. DESIGN Prospective, nonrandomized clinical trial. PARTICIPANTS Eighty patients attending the Eye Clinic, University College Hospital, Ibadan, Nigeria. METHODS Eighty patients assigned to 4 groups had swabs of the upper eyelid skin taken before and after face wash with soap and water, and cleansing with Savlon and 5% povidone iodine. Specimens were cultured and Gram stained. Bacterial counts were carried out using standard techniques. RESULTS Face washing with soap and water increased the proportion of patients with bacterial isolates from 80.0% to 87.5%. The average colony count increased from 187.1 to 318.5 colony units per mL (p = 0.02). Application of 5% povidone iodine without face washing with soap and water reduced the proportion of patients with bacterial isolates from 82.6% (mean count 196.5) to 28.6% (mean count 34.1)(p = 0.001); in comparison, the application of 5% povidone iodine after face washing with soap and water reduced the proportion from 71.4% (mean count 133.9) to 40.0% (mean count 69.0)(p = 0.01). Application of Savlon without face washing with soap and water reduced the proportion of patients with bacterial isolates from 100% (mean count 310.9) to 41.2% (mean count 19.8)(p = 0.004) compared with the application after face washing, which reduced the proportion from 89.5% (mean count 240.3) to 41.2% (mean count 82.9)(p = 0.02). CONCLUSIONS Both povidone and Savlon are effective in reducing periocular bacteria in an African setting. Prior face washing with soap and water had no added benefit in reducing bacterial colony count.

Distribution Pattern of Lens Opacity Among A Rural Population in South Western Nigeria

PURPOSE To determine prevalence of the morphological types of age-related lens opacity in Southwestern Nigeria as part of need assessment survey towards planning an eye health care service. METHOD Multistage cluster sampling was used in selecting a representative cross-sectional sample of persons 50 years of age or older among the residents of the rural wards in Akinyele Local Government Area in southwestern Nigeria. Lens opacity was graded using the World Health Organization cataract grading system. RESULTS One thousand two-hundred persons were recruited for the survey and 1031 (85.9%) had grading of lens opacity. The mean age of the participants was 64.9 years and 51.1% were male. Five hundred and ninety persons had definite lens opacity (crude prevalence rate 57.2%; 95% Confidence interval [CI] 54.1-60.3) (standardized prevalence 47.0%; 95% confidence interval 46.7-47.3). The prevalence for participants aged 70 years and above (82.5%; 95% CI 78.2-86.3) was three times more than for participants aged 50-59 years (29.2%; 95% CI 24.2-34.6). Nuclear opacity was the most prevalent type of lens opacity (20.9%; 95% CI 18.4-23.5). Sixty percent of the grade 3 lens opacity was found among participants aged 70 years and above. CONCLUSION This is the first population-based survey on prevalence of lens opacity subtype in this West Africa subregion. The prevalence of lens opacity in the rural Akinyele local government is high. Nuclear sclerosis was the most prevalent form among this rural population.

Comparison of peribulbar with posterior sub-tenon's anesthesia in cataract surgery among Nigerians

Purpose: To compare the akinetic and the analgesic effects of peribulbar and posterior sub-Tenon′s anesthesia in patients undergoing cataract surgery. Methods: In a hospital-based randomized comparative interventional study, patients aged 50 years and above who underwent elective surgery for uncomplicated cataract were randomized to receive either peribulbar block or posterior sub-Tenon block. Pain during injection, surgery, and after surgery was assessed using numerical reporting scale (NRS). Limbal excursion was measured with a transparent meter rule. Result: A total of 152 eyes of 152 patients were studied. Peribulbar and sub-Tenon regional blocks provided comparable adequate akinesia (P = 0.06) and similar levels of analgesia (P = 0.10) during cataract surgery. Both techniques also provided similar levels of analgesia to the patient during injection and in the immediate postoperative period. Ninety-two percent of patients who had peribulbar and 97% of those who had sub-Tenon blocks reported either mild pain or no pain at all during surgery (P = 0.49). There was no report of severe pain in all patients during the stages of the surgery. Occurrence of chemosis and subconjunctival hemorrhage was more common in sub-Tenon than peribulbar anesthesia. Conclusions: This study shows that peribulbar and posterior sub-Tenon routes of administering anesthetic substances is comparable in providing adequate akinesia and analgesia for cataract surgery with minimal complications. Therefore, both techniques are effective and safe for cataract surgery among Nigerians.

Exophthalmometric value and palpebral fissure dimension in an African population

Background: Normative data for exophthalmometric values and palpebral fissure dimensions are important for earlier diagnosis of orbital and palpebral fissure pathologies. Objective: To describe the normal exophthalmometric values and palpebral fissure dimensions among healthy adults of Black race. Design: A cross-sectional descriptive study. Setting: Population based (general community). Method: Population-based multistage random sampling was used to recruit 1020 subjects who had no orbital or eye lid diseases and were free from systemic disease like thyroid eye disease that may affect orbital volume. These healthy adult subjects had their exophthalmometric values and palpebral fissure dimensions (horizontal and vertical palpebral fissure, lateral and medial canthal distances, inter-outer canthal distance, inter-inner canthal distance, margin reflex distance, and lid crease) measured with a Hertel′s exophthalmometer and a plain non-stretchable plastic ruler, respectively. Results: A total of 1020 subjects (515 females and 505 males) of age range 16-85 years were studied. The mean ± SD exophthalmometric values were 15.27 ± 2.5 and 15.31 ± 2.4 mm for the right and left eyes, respectively. In the right eye, the mean palpebral fissure height was 8.3 mm, mean palpebral fissure width was 32.1 mm, mean upper eyelid crease was 7.1 mm, mean margin reflex height was 3.2 mm, mean lateral canthal distance was 12.9 mm, and the mean medial canthal distance was 10 mm at primary position of gaze. Conclusions: Exophthalmometric values and palpebral fissure dimensions were obtained among healthy adult Nigerians. Knowledge of these normal parameters is valuable in the management of eyelids and orbital diseases, as well as in manufacturing spectacles.

Association between gender, age and palpebral dimensions/exophthalmometric values among Nigerians of Ido local government area of Oyo State, Nigeria

Background: Knowledge of factors that could affect exophthalmometric and palpebral′s measurement are important in clinical for the correct interpretation of these parameters. Among these factors are age and sex. Aims and Objectives: The objective of this study is to describe the relationship between gender, age and palpebral dimensions/exophthalmometric values (EV) among Nigerian. Materials and Methods: In a descriptive cross -sectional survey, EV and palpebral dimensions were measured in 1020 eligible and consented adults Nigerians using Hertel′s exophthalmometer and non -stretchable plain plastic ruler respectively. Results: The studied population comprised of 1020 subjects including 515 females and 505 males. In the male subjects, the mean (mm) palpebral fissure width, palpebral fissure height, upper eyelid crease, margin reflex distance, lateral canthal distance, medial canthal distance, inter inner canthal distance and inter outer canthal distance were; 32.6 ± 2.8, 8.3 ± 1.4, 6.9 ± 1.6, 3.2 ± 1.2, 12.8 ± 2.0, 10.1 ± 0.9, 39.9 ± 3.2, 99.5 ± 5.6 respectively. Males had a significantly higher EV compared with females (15.5 ± 2.5 mm vs. 15.1 ± 2.4 mm, P = 0.0005). Conclusion: In this study, we described the relationship between gender, age and EV/palpebral dimension in African population. The knowledge of this relationship is valuable in the early diagnosis of the eyelid and orbital diseases, manufacturing of spectacles as well as achieving a satisfactory cosmetic eyelid surgery.

Socio -demographic predictors of patients' satisfaction

Background: Health care market is widely becoming competive as a result of various alternative orthodox therapies in circulation. Therefore, to ensure continuous patronage of orthodox medical care market, there is need to improve patient,s satisfaction with orthodox medical services. Objective: To find out the relationship between patients′ socio -demographic characteristics and satisfaction with the hope that this knowledge may facilitate better understanding of patient′s expectation. Materials and Methods: In a descriptive cross -sectional survey using a random sampling technique (wherein all eligible and consenting participants were enrolled), a self -administered questionnaire was used to obtain information from the eligible and consented respondents on their self -rated level of satisfaction with the hospital personnel, the quality of care received, the comfort at the facility, and the prescribed medications in a subsidized eye clinic wherein patients pay half of the regular fees. Results: The study population consisted of 320 participants (178 males and 142 females) with a mean age ± SD of 53 ± 14.9 years. There was a significant association between the overall satisfaction and all the variables except marital status and monthly income. Age and place of domicile were found to be independent predictors of satisfaction. Respondents living outside Ibadan were 2.5 times more likely to be satisfied with care than those living in Ibadan while patients who were younger than 40 years of age were 16 times less likely to be satisfied with care compared to patients aged 70 years and above. Conclusion: Health care practitioner should be aware that socio -demographic characters may significantly influence how patients rate their health care experiences and as such should put these into consideration when attending to their patients.